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Public-private mixed systems

Australia: Experiences in providing financial incentives for more coordinated,
multidisciplinary chronic disease management in primary healthcare

In Australia, prioritising the prevention and management of chronic diseases in PHC has
continually been on the national policy agenda over the past two decades (Cant & Foster,
2011). The country’s national health insurance, or Medicare, has allowed for population-wide
access to PHC, and policy reform over the years has created greater incentives to providers
for making PHC more coordinated and patient-centred.

Medicare provides universal health insurance and is financed through general tax revenue
and a government levy (Commonwealth Fund, 2020a). Both inpatient and outpatient care are
funded through the Medicare Benefits Scheme (MBS). The MBS includes a schedule of
subsidised Medicare services and over time has changed with respect to the country’s
changing health burden profile. In particular, the MBS has expanded over time to include
incentives for healthcare providers to deliver more coordinated, multidisciplinary PHC with
allied health professionals (Rural Health West & WAPHA, 2020).

Financial incentives to improve the quality of healthcare have been used both past and
present in Australia. In 1999, the Enhanced Primary Care (EPC) programme allowed for GPs
to receive incentives if providers conducted routine health assessments and developed
tailored chronic disease management care plans for people aged 65 and over, or for
Indigenous Australians aged 45 and over (Cant & Foster, 2011; Wilkinson et al., 2002). By
2004, the EPC expanded so that GPs could refer patients to private allied health
professionals with all costs continuing to be subsidised by MBS (Mason, 2013). In 2013,
these expanded services eventually became the Medicare-Plus Chronic Disease
Management services and are aimed in enhancing chronic disease management
among eligible recipients of services (Australian Government Department of Health, 2014).

Since 2019, the Australian Department of Health has provided financial incentives to GPs
through the Practice Incentive Program (PIP). PIP supports GPs in enhancing continuity and
capacity of care through eight types of incentives that each target a specific target
population (Australian Institute of Health and Welfare, 2020). These incentives for target
populations include after hours; eHealth; aged care access; Indigenous health; procedural
GP; quality improvement; rural loading; and teaching (Rural Health West & WAPHA, 2020).
Private practices that meet the PIP guidelines for providing team-based care are eligible to
receive subsidies for continuing those services. Certain services include prioritisation of
chronic disease management. For example, the PIP Indigenous Health Initiative
(IHI) supports GPs in delivering routine chronic disease management to Aboriginal and/or
Torres Strait Islander (ATSI) individuals aged 15 years and over (Rural Health West & WAPHA,
2020). Financial incentives are not standardised payments but are categorised based on the
specific service offered, including one-off sign-on payments, registration payments for each
new patient, and 2-tiered payments based on outcomes when health outcomes and quality
of care are met (Rural Health West & WAPHA, 2020). Practices are required to meet the
requirements of community sensitivity training for the specific PIP target population, including
cultural awareness training for those who apply for the IHI PIP.

Through PIP, not only are healthcare providers incentivised to deliver more tailored,
team-based care for chronic disease management, but target populations benefit from
receiving affordable quality of care.

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