Protecting Medicare's Integrity: Government's Commitment to Public Health

Strategic Insights -

The Australian government has showcased its dedication to ensuring the integrity and sustainability of Medicare, the country's world-class health system. In response to concerns about Medicare's operation, the government commissioned the independent Philip review in November 2022. The review led to significant amendments in the Health Insurance Amendment (Professional Services Review Scheme) Act 2023 and the Health Insurance Amendment (Professional Services Review Scheme No. 2) Act 2023. The Health Legislation Amendment (Improved Medicare Integrity and Other Measures) Bill 2025 aims to further strengthen Medicare by enhancing compliance activities, improving payment integrity, and addressing various issues related to pharmacy approvals and therapeutic goods.

Key Takeaways:

  • The government has committed to protecting Medicare's investment by strengthening its compliance framework to ensure integrity.
  • In 2023-24, payments for health benefits, including medical services, pharmaceutical services, and private health insurance rebates, totalled at least $65.1 billion in Australia.
  • The Health Legislation Amendment (Improved Medicare Integrity and Other Measures) Bill 2025 will improve payment integrity by reducing the timeframe for making bulk-billed claims.
  • The bill will enhance the Investigative powers to be used consistently and effectively across all health systems and schemes, including Medicare and the Pharmaceutical Benefits Scheme.
  • The bill will also improve the processes related to pharmacy approvals and make several sensible amendments to the Therapeutic Goods Act 1989 to alleviate therapeutic goods shortages.
  • The amendments are consistent with the government's commitment to public health and will mitigate public health risks associated with therapeutic goods and vaping goods.
  • The bill also amends the Public Health (Tobacco and Other Products) Act 2023, clarifying necessary aspects for smooth operation.

Statistics:

  • $65.1 billion: Total payments for health benefits, including medical services, pharmaceutical services, and private health insurance rebates, for 2023-24 in Australia.
  • November 2022: The date the government commissioned the independent review of Medicare integrity and compliance, the Philip review.
  • 2023-24: The financial year during which payments for health benefits totalled at least $65.1 billion in Australia.

Sources:

  • Ms WHITE (Lyons--Assistant Minister for Women, Assistant Minister for Health and Aged Care and Assistant Minister for Indigenous Health)
  • The Philip review
  • The Health Insurance Amendment (Professional Services Review Scheme) Act 2023
  • The Health Insurance Amendment (Professional Services Review Scheme No. 2) Act 2023
  • The Health Legislation Amendment (Improved Medicare Integrity and Other Measures) Bill 2025
  • The Therapeutic Goods Act 1989
  • The Public Health (Tobacco and Other Products) Act 2023