Policy context

Australia’s healthcare system provides services by both public and private providers, and funded by multiple levels of government, third parties, such as private health insurers, and individuals. 

Australian Government initiatives to address healthcare costs     

Safety nets, co-payments and concessions for medicines and medical services

In Australia, healthcare providers can set their fees and enter arrangements with private health insurers. This can result in fees being set above the rebate paid to patients under the Medicare Benefits Schedule (MBS), or what is covered by private health insurance, leaving individuals with out-of-pocket costs for health services. Prescription medicines listed on the Pharmaceutical Benefits Scheme (PBS) are subsidised by the Australian Government, however, there is a set co-payment that the individual has to pay. 

The MBS and PBS have Safety Net Schemes in place to reduce the financial burden as medical and pharmaceutical costs accumulate for an individual and their family. These schemes reduce subsequent out-of-pocket costs once a threshold is reached for that calendar year (the threshold is lower for concession card holders). Once thresholds are reached, individuals (or families) can access subsidised medicines and medical services by only paying a co-payment. MBS thresholds can be tracked by individuals through an online portal. Tracking PBS thresholds is the responsibility of the individual with support from their pharmacist using a prescription record form, placing the burden on the individual to lodge a claim to qualify for the Safety Net Scheme.

Income support and concessions for people unable to work due to illness

Eligible Australians on low or no income can access income support and concessional rates for services (such as utilities and public transport) through Services Australia. Eligibility is means tested and considers personal circumstances (e.g., co-habitation and dependent children). Services Australia’s role is to support individuals who require financial or practical assistance by providing income support payments and services. People unable to work due to illnesses, such as cancer, may qualify for income support payments, such as the Disability Support Pension (DSP) or JobSeeker. Further information about Australia’s social security system is available here.

The Strengthening Medicare Taskforce

Based on the recommendations of the MBS Review Taskforce, the Federal Minister for Health and Aged Care established the Strengthening Medicare Taskforce in 2022 to provide recommendations on priorities to improve primary care, including making care more affordable and reducing the pressure on other areas of the health system. Information on the Australian Government’s Strengthening Medicare Taskforce is available here.

The MBS Continuous Review

Building on the work of the MBS Review Taskforce, the MBS Continuous Review implements a range of recommendations including around transparency and out-of-pocket costs. Information on the MBS Continuous Review is available here.

The Medical Costs Finder website

In response to the Ministerial Advisory Committee on Out-of-Pocket Costs recommendation to increase healthcare cost transparency in the private sector, the Australian Government developed Medical Costs Finder. This is an online tool to help Australians understand the cost of specialist medical services. The tool relies on voluntary sharing of information by medical specialists on their fees for services, a high level of health literacy and an understanding of the components of medical services to adequately compare costs.

Financial support for people needing to travel to care

Patient-assisted travel schemes provide subsidies for people living in regional and remote areas to cover the costs of attending specialist medical appointments. These schemes are funded by the Federal Government under the National Healthcare Agreement, however jurisdictional differences in eligibility criteria mean some Australians may miss out or receive very low subsidies. This can create financial hardship or affect decision-making about accessing medical services. Further information about the schemes in each State and Territory is available here.