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In 2007 significant changes to PBS pricing arrangements were made, including creation of separate pricing formularies, price reductions, price disclosure and changes to the pharmacy mark-up structure. A review of these changes indicated that they have achieved a positive impact on patients and a modest reduction in PBS expenditure. Indications for significant savings from the reforms in the future are positive but, given the likely increase in demand, the cost of the PBS will continue to grow.
The Medicare Safety Net, introduced in 2004, supplements existing public insurance and offers additional coverage for families with high medical costs. A 2009 review found that the policy reduced out-of-pocket costs for some patients, but also led to significant increases in doctors' fees. Furthermore, the greatest beneficiaries of the Safety Net were families with high incomes. Here we will summarise key findings and examine government and stakeholder responses to the review.
There has been a growing recognition of the lack of community based mental health care in Australia. This recognition galvanised governments to develop a national action plan on mental health, released in mid-2006, and reported on in survey round 8. Since then, the Australian Government has expanded the national Medicare program to include many new mental health items. The high rate of uptake of these new items confirms the degree of unmet need in the mental health field.
Since the early 1990s, Australia has witnessed the de-institutionalising of mental health care. In recent years, there has been a growing recognition of the lack of community support programs, leaving many patients with inadequate levels of care and support. This failure received widespread publicity in late 2005 with the release of a scathing report of the system. This, along with other political factors, galvanised Australian governments to develop a national action plan on mental health.
Australia's Productivity Commission released a report in December 2005 recommending a large number of reforms to do with the training, demand, supply and distribution of Australia's Health Workforce. This survey reports on the problems and recommendations identified by the Productivity Commission, as well as the Government's actions in the area of workforce reform since the release of the report.
In June 2005, the Australian Senate Community Affairs Committee released a report, titled "the cancer journey: informing choices". The committee was made up of 2 Senators from the governing coalition parties, 3 from the opposition party and 1 independent. The report examines the key areas of multi-disciplinary and integrated service delivery and the use of complementary and alternative treatments. It made 33 recommendations aimed at improving treatment choices and outcomes for cancer patients.
Australia's Medicare program subsidises out-of-hospital services by reimbursing patients 85% of the schedule fee. Providers can set fees at their own discretion and all charges above the 85% rebate were borne through out-of-pocket payments. With the introduction of the Medicare Safety Net in March 2004, the government will pay 80% of out-of-pocket expenses for out-of-hospital charges once the family?s threshold has been reached. The remaining 20% is met by patients.
Bulk billing by GPs is a major issue in Australian health policy (see previous surveys). Bulk billing means that the GP bills the government directly, receives 85% of the scheduled fee, the patient pays nothing. If the GP does not bulk bill, the patient pays the bill and receives 85% of the scheduled fee. GPs are free to set their fees. Following the conservative win in the election on Oct 9, "Medicare Plus" will be implemented.
In March 2003, the Australian parliament approved changes to the structure of Medicare. The main changes introduced by the legislation are a reduction in the annual threshold level at which concession card holders or families become elegible for safety net benefits,$7.50 incentive for GPs to bulk-bill concession card holders and children under 16 in non-metropolitan areas and Tasmania and the introduction of a new MBSitem for the services of allied health professionals and dentists.
The Coordinated Care Trials are regional projects to test whether multi-disciplinary care planning and service coordination leads to improved health and well-being for people with chronic conditions or complex care needs. Some also involve ?funds pooling? between Commonwealth and State/Territory programs to provide funding flexibility for this coordinated approach to service delivery. Following a first round of 13 trials (1997-2000) there are now five second round trials.