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6.4 Health payments and services

The department delivers many health payments and rebates on behalf of other government departments:

  • DVA health services payments
  • the External Breast Prostheses Reimbursement Program
  • the National Bowel Cancer Screening Program
  • the Continence Aids Payment Scheme
  • the Child Dental Benefits Schedule
  • the Stoma Appliance Scheme
  • the Hearing Services Program
  • the Practice Incentives Program
  • the Practice Nurse Incentive Program.

The department also administers three health registers:

  • the National Bowel Cancer Screening Register
  • AIR
  • the Australian Organ Donor Register.

Department of Veterans’ Affairs health services payments

The department is responsible for making payments to health professionals for health services on behalf of DVA. The department assesses claims and processes payments for the treatment of eligible DVA clients for medical, specialist, diagnostic imaging, pathology, allied health and dental services, and for private hospital admissions and prostheses.

On behalf of DVA, the department produces DVA’s Gold Cards (for all clinically necessary health care needs and all health conditions, whether they are related to war service or not), White Cards (for care and treatment of war‑caused or service‑related specific conditions) and Orange Cards (for pharmaceuticals only) for eligible veterans.

In 2018–19, the department continued to highlight the benefits of electronic claiming to providers by promoting the DVA Webclaim channel. The DVA Webclaim offers an alternative to manual claiming and delivers significantly faster payments and reconciliation for health professionals.

As a result of ongoing promotion of electronic claiming channels, DVA electronic claiming across all services increased to 93.9 per cent in 2018–19. Electronic claiming for allied health services increased to 87.5 per cent, electronic claiming for medical services increased to 96.9 per cent and electronic claiming for hospitals increased to 89.8 per cent.

Manual claiming for DVA decreased to 6.1 per cent in 2018–19.

Table 21: Department of Veterans’ Affairs processing




Cards produced




Services processed

17.8 million

17.3 million

16.8 million

Total benefits paid

$2.0 billion

$2.0 billion

$2.0 billion

Private Health Insurance Rebate

The Private Health Insurance Rebate reimburses or discounts the cost of private health insurance cover. It is available to all people who are eligible for Medicare and have a complying health insurance policy.

The rebate is income tested. The level of rebate that people are entitled to claim depends on their age and income. The rebate can be claimed in one of two ways:

  • as an upfront reduction in the cost of premiums—the Premiums Reduction Scheme (administered by the department)
  • as a tax offset in annual income tax returns (administered by the Australian Taxation Office).

Table 22: Private Health Insurance Rebate




Memberships registered

7.3 million

6.7 million

6.8 million

Total paid to private health funds

$6.0 billion

$6.0 billion

$6.1 billion

Working with industry—improving services to private health insurers

A doctor and a nurse sitting on chairs and using a tablet. They appear to be having a discussion.

In 2018–19, the department worked with private health insurers to identify opportunities to improve the customer experience of using the Private Health Insurance Premiums Reduction Scheme.

Our aim was to find ways to remove red tape and streamline our process. We listened carefully and, by collaborating with insurers, identified a way to improve customer service and still meet the rules of the premiums reduction scheme.

We removed the requirement for paper forms and can now collect information verbally and via mobile apps, Skype and instant messaging.

Within one month of agreeing on the new approach, the majority of health insurers had taken steps to stop using the paper forms.

The department also improved the way private health insurers transmit data for registrations, withdrawals and claims under the Private Health Insurance Premiums Reduction Scheme. As a result, insurers have been able to simplify data submission and no longer have to manage authentication certificates.

These changes will make it easier for private health insurance customers to receive the rebates to which they are entitled.

Hearing Services Program

The Hearing Services Program aims to reduce the incidence and consequences of avoidable hearing loss in the Australian community by providing high‑quality hearing services and devices to those who are eligible for assistance. The department processes and pays claims to accredited hearing service contractors via the HPOS eClaims facility.

Table 23: Hearing Services Program services and payments




% change since 2017–18

Services processed(a)





Total amount paid(b)

$419.0 million

$431.1 million

$432.9 million


(a) Services provided to individuals.

(b) Payments made to hearing service contractors.

Health Care Homes

The Health Care Homes program is designed to improve health care for patients with chronic and complex conditions by providing them with a medical practice ‘home base’ for the ongoing coordination, management and support of their treatment. The stage one trial of Health Care Homes began on 1 October 2017.

Health Care Homes medical practices receive a monthly bundled payment. There are three tiers of payments, which are linked to the level of patient complexity and need. The monthly payment is based on the tier levels of each of the practice’s registered patients. Payments are retrospective, allowing for regular patient review and, if necessary, adjustment of the patient’s Health Care Homes tier level.

External Breast Prostheses Reimbursement Program

The External Breast Prostheses Reimbursement Program reimburses up to $400 for each new or replacement external breast prosthesis for women who have had breast surgery as a result of breast cancer.

Claimants must be eligible for Medicare and must not have claimed under the program in the previous two years unless there is a medical reason.

In 2017–18, the department updated its website to advise customers that, if they receive an income support payment, they may be eligible for an advance payment under that program which they can use to pay for their prostheses before claiming a reimbursement. Any advance payment is subject to the income support advance payment rules.

Table 24: External Breast Prostheses Reimbursement Program




Number of claims processed




Amount paid

$6.1 million

$6.2 million

$6.3 million

Continence Aids Payment Scheme

The Continence Aids Payment Scheme gives eligible people with severe and permanent incontinence yearly or twice‑yearly payments to help buy continence aids products.

Table 25: Continence Aids Payment Scheme




Number of applications processed




Total amount paid

$84.5 million

$90.2 million

$89.4 million

Stoma Appliance Scheme

The Stoma Appliance Scheme provides support to people with a stoma by improving access to stoma‑related products.

The products are distributed through 21 regional stoma associations to their members across Australia.

The scheme operates under the National Health Act 1953.

Practice Incentives Program

The Practice Incentives Program (PIP) pays incentives to medical practices and individual providers to encourage improvements in general practice.

The PIP consists of 11 incentives, shown in Table 26 below.

In 2018–19, the department undertook a range of activities, including publication of articles in the quarterly Incentives News, to raise awareness of the PIP Indigenous Health Incentive (IHI), which helps to improve the health of Aboriginal and Torres Strait Islander people who are at risk of developing a chronic condition. As a result of these activities, the number of eligible practices participating in the PIP IHI and the number of outcome payments made increased.

Table 26: Practice Incentives Program payments

After hours

Incentive payments to practices encourage general practitioners (GPs) to provide their patients with access to after‑hours care.

Aged care access

Service Incentive Payments (SIPs) to GPs encourage increased and continuing services in Australian Government funded residential aged care facilities.


Sign‑on payments to practices encourage GPs to better manage the clinical care of people with moderate to severe asthma. SIPs are available to GPs for each asthma cycle of care completed for a patient with moderate to severe asthma.

Cervical screening(a)

Sign‑on and outcomes payments to practices encourage GPs to screen women aged between 24 years and nine months and 74 years inclusive who have not had a cervical smear in the past four years, increasing overall screening rates.


Sign‑on and outcomes payments to practices encourage GPs to provide earlier diagnosis and effective management of people with established diabetes mellitus. SIPs are available to GPs for completing an annual diabetes cycle of care.


Incentive payments encourage practices to adopt new digital health technology as it becomes available to improve administration processes and the quality of care provided to patients.

Indigenous health

Payments to practices encourage GPs to provide better health care for Aboriginal and Torres Strait Islander patients, including best‑practice management of chronic disease.

Procedural GP payment

Incentive payments to practices encourage rural GPs to provide procedural services.

Quality prescribing

Payments to practices encourage GPs to keep up to date with information on the quality use of medicines by taking part in activities recognised or provided by the National Prescribing Service.

Rural loading

A rural loading is applied to PIP payments to practices where the main location is outside a major metropolitan area.


Incentive payments to practices encourage GPs to provide teaching sessions to undergraduate medical students to ensure that the practitioners of tomorrow are trained and have actual experience of general practice.

(a) On 1 December 2017 the previous age cohort of 20 to 69 years was amended to 24 years and nine months to 74 years.

Table 27 below contains data on practice participation in the PIP.

Table 27: Practice participation in the Practice Incentives Program




Total number of practices participating




Practices registered per incentive(a)

After hours








Cervical screening












Indigenous health




Practices receiving outcomes payments(b)

Cervical screening(c) (d)








Procedural GP(e)




Indigenous health(f)





IHI patient registration payments




Teaching session payments




SIP(g) (asthma, cervical, diabetes, aged care access incentive)




Total amount paid at 30 June

$341.7 million

$342.9 million

$339.8 million

(a) Practices are automatically registered for the teaching, rural loading and quality prescribing incentives when they are approved for the program.

(b) Outcome payments are made to practices that have reached the target level required to receive the incentive under the program. This relates to the number of practices that received an outcome payment in the May quarter for the cervical screening and diabetes incentives.

(c) Cervical screening practices must screen at least 70 per cent of their eligible patients in a 30‑month reference period. For diabetes, the outcome payment is made to the practice when at least 2 per cent of practice patients are diagnosed with diabetes, and GPs have completed a diabetes cycle of care for at least 50 per cent of these patients.

(d) On 1 December 2017, cervical screening underwent a number of changes, including to MBS items and age eligibility, which impacted on the PIP cervical screening.

(e) The number of practices that received a Procedural GP payment.

(f) This relates to the number of outcome payments made to practices. This includes both Tier 1 and Tier 2 payments. Tier 1 is paid to practices for each registered Indigenous patient when the practice provides a target level of care in a calendar year. Tier 2 is paid to the practice for providing the majority of care for registered Indigenous patients in a calendar year.

(g) The total SIPs made for the asthma incentive, cervical screening incentive, diabetes incentive and GP aged care access incentive.

Practice Nurse Incentive Program

The Practice Nurse Incentive Program makes incentive payments to practices to support an expanded and enhanced role for nurses working in general practice.

General practices across Australia, including those in urban areas, as well as Aboriginal Medical Services and Aboriginal Community Controlled Health Services, may be eligible for an incentive to help with the costs of employing a practice nurse. To be eligible the practice must be accredited under the Royal Australian College of General Practitioners Standards for general practices.

In 2018–19, the number of practices participating in the program increased by 4.39 per cent, continuing the trend seen in previous years.

Table 28: Practice Nurse Incentive Program




Number of practices participating




Amount paid to practices(a)

$347.0 million

$364.3 million

$375.9 million

(a) Amount paid to practices includes the DVA loading paid to eligible practices

Child Dental Benefits Schedule

The Child Dental Benefits Schedule provides families, teenagers and approved care organisations with financial support for basic dental services for eligible children. Dental services include examinations, X‑rays, cleaning, fissure sealing, fillings, root canals and extractions.

Benefits for basic dental services are capped at $1,000 per child over two consecutive calendar years.

To be eligible, children must:

  • be aged between two and 17 years on any one day of the calendar year
  • receive (or their family, guardian or carer must receive) certain Australian Government benefits such as Family Tax Benefit Part A for at least one day of the calendar year
  • be eligible for Medicare.

In 2018–19, the department processed 5.4 million services and paid $324.9 million in benefits under the Child Dental Benefits Schedule.

National Bowel Cancer Screening Register

The Department of Health’s National Bowel Cancer Screening Program aims to reduce illness and death from bowel cancer through early detection or prevention of disease in Australia.

The department administers the National Bowel Cancer Screening Register. The department:

  • identifies and invites eligible people to participate in the program
  • makes payments to medical professionals for providing information on the register about consultations and medical procedures for people who have received positive test results
  • operates the information phone line for the general public and health professionals.

Under the National Bowel Cancer Screening Program, the department invited eligible people who turned 50, 52, 54, 56, 58, 60, 62, 64, 66, 68, 70, 72 and 74 years in 2018–19 to undertake screening.

Table 29: National Bowel Cancer Screening Program




Invitations distributed




Information line calls received




(a) The increase occurred due to a national awareness‑raising campaign through various media outlets.

Australian Immunisation Register

The AIR is a national register that records vaccinations given to people of all ages. It covers all vaccines, including:

  • all National Immunisation Program (NIP) vaccines on the childhood, adolescent and adult schedules
  • vaccines given in schools
  • travel vaccines
  • flu vaccines.

The AIR is administered under the Australian Immunisation Register Act 2015 on behalf of the Department of Health.

Individuals may require an up‑to‑date immunisation status on the AIR for their education, employment or overseas travel or to be eligible for some family assistance payments.

The AIR has over 26 million registrations.

In 2018–19, the AIR was expanded to record:

  • human papillomavirus (HPV) vaccines—previously held by the National HPV Register
  • vaccines given in state/territory school immunisation programs
  • historical vaccines held by each state/territory health department system.

Table 30: Australian Immunisation Register registrations




Vaccine episodes(a)

10.2 million(b)

14.8 million(b)

26.6 million

Amount paid to vaccination providers(c)

$10 million

$9.9 million

$9.5 million

(a) Vaccine episode: the number of vaccines administered by recognised vaccination providers and recorded on the AIR. A vaccine can consist of multiple antigens. For example, the measles, mumps, rubella (MMR) vaccine has three antigens.

(b) The AIR became a whole‑of‑life register on 30 September 2016. Previously the AIR only recorded vaccines for children aged zero to seven years.

(c) Payments are made to eligible vaccination providers on completion of the childhood NIP schedule for a child under seven years of age or for vaccinating a child under seven years of age who is more than two months overdue for their childhood NIP schedule vaccines.

Australian Organ Donor Register

The Australian Organ Donor Register is a national register that records people’s decisions about becoming organ and/or tissue donors for transplantation after death.

The register enables authorised medical personnel to verify a person’s decision about donating their organs and/or tissue for transplantation. People can register their donation decision online using their Medicare online account through myGov or the Express Plus Medicare mobile app on the department’s website. The website also has general information about organ and tissue donation for transplantation.

There are two types of registrations for organ donation:

  • consent registration
  • intent registration.

A legally valid consent registration occurs when a person aged 18 years or older provides a signed registration form or submits a registration using their Medicare online account through myGov or the Express Plus Medicare mobile app.

Intent registration occurs when a person registers their decision to donate through a channel that does not require a signature or electronic authentication—for example, by phone or email. Whether registration is by consent or intent, approval will always be sought from the person’s family before proceeding with the donation process.

The department promotes and raises national awareness of the Australian Organ Donor Register by supporting DonateLife week and the annual Gift of Life Walk.

The number of registrations on the Australian Organ Donor Register has seen steady annual growth. Table 31 shows the cumulative totals of the numbers of consent and intent registrations since the inception of the register.

Table 31: Australian Organ Donor Register registrations




Consent registrations




Intent registrations at 30 June




Total registrations




Enquiry line calls received