Key Australian healthcare reform statistics
How could Australia build a more accessible and sustainable health system? Bupa answers key health reform questions.
Bupa’s Building a More Accessible, Modern and Sustainable Health System discussion paper sets out Bupa’s perspective on health reform in Australia. It addresses key questions about preventive and primary care, Hospital in the Home, mental health, specialist affordability, health workforce pressures and how Australia can build a more accessible and sustainable health system.
Key Australian healthcare reform statistics
- In 2023-24, there were approximately 788,000 potentially preventable hospitalisations, costing an estimated $7.7 billion or 8.5 per cent of total admitted patient expenditure.
- Demand continues to grow, with 15 million Australians (61 per cent) living with at least one chronic condition and almost 10 million (38 per cent) experiencing multimorbidity.
- Australia spends 3.1 per cent annually on preventive healthcare despite more than one-third of Australia’s disease burden being attributable to modifiable risk factors.
- In 2022–23, Australia recorded 158,900 Hospital in the Home (HITH) separations, but only 6,400 (4 per cent) occurred in private hospitals.
- Among Australians who needed specialist care in 2024–25, 18.3 per cent delayed or did not see a specialist, while 8.6 per cent identified cost as a reason for delaying or foregoing care.
- By 2033, Australia will have an estimated undersupply of 6,981 fulltime-equivalent specialists, increasing to 12,812 by 2048.
How could Australia fund preventive care and chronic disease management instead of only paying for GP visits?
General practice has shifted from episodic treatment towards more prevention and longer-term management of patients since Medicare began in 1984, yet funding remains heavily reliant on fee-for
service Medicare Benefits Schedule (MBS) payments – a model suited to discrete consultations rather than the proactive, team-based, longitudinal care now required.
Blended funding should complement fee-for-service payments rather than replacing them, with comparable international systems using combinations of activity-based payments, capitation and practice-level funding to preserve access incentives while funding coordination and proactive management more predictably.
Build on MyMedicare by enabling practices to voluntarily participate in a blended funding model that combines fee-for-service payments for direct clinical care with flexible, patient-linked funding for chronic and complex care.
What would make it easier for Australians with chronic conditions to get coordinated care from GPs, nurses, pharmacists and allied health professionals?
Expanding multidisciplinary teams would increase capacity by enabling GPs to focus on diagnosis, complex decision-making and continuity of care, while other professionals provide preventive care, education and follow-up in their scope of practice.
Strengthen the capacity of existing programs such as the WIP – PS for eligible practices to support a broader mix of nurses, midwives, allied health professionals and Aboriginal and Torres Strait Islander health workers and practitioners working to their full scope.
Why are potentially preventable hospitalisations still high in Australia, and which primary care reforms might reduce them?
In 2023-24, there were approximately 788,000 potentially preventable hospitalisations, costing an estimated $7.7 billion or 8.5 per cent of total admitted patient expenditure. When people cannot access timely primary care, chronic conditions can worsen, leading to poorer health outcomes and avoidable hospital use. Strengthening investment in preventive primary care is therefore both a health and economic imperative.
Despite broad support for prevention, Australia's funding system remains focused on treatment with Medicare’s fee-for-service model rewarding episodic care rather than continuity, multidisciplinary management, prevention and long-term health outcomes.
Which patients in Australia can safely receive hospital level treatment through Hospital in the Home, and what evidence supports it?
HITH enables admitted patients to receive hospital-level care at home instead of in a hospital bed, avoiding admission or supporting earlier discharge while maintaining inpatient-equivalent clinical governance, oversight and escalation pathways. As chronic and complex conditions grow alongside an ageing population, HITH offers a clinically proven way to meet rising acute care demand without expanding hospital capacity. HITH is associated with lower mortality, fewer readmissions, lower costs and higher patient and carer satisfaction than inpatient care for appropriately selected patients.
Introduce minimum benefits for an initial group of established HITH services with clear substitution potential, including IV antibiotics and infusion therapy, infection management, complex wound care, post-operative/post-acute care, and palliative care.
Australian modelling shows savings of 39 per cent per episode versus inpatient care, consistent with a 2023 UK review finding savings in 13 of 15 economic evaluations.
What stops Hospital in the Home from scaling across Australia, including in private care?
In 2022–23, only 4 per cent of HITH separations (6,400 of 158,900) were delivered in the private sector. Public hospitals can invest directly in HITH capacity and referral pathways, while private access instead depends on whether an individual hospital has invested in a program and negotiated funding with insurers.
There is no nationally prescribed minimum hospital benefit for HITH, so access and payment depend on individual hospital-insurer contracts. This creates a circular problem where hospitals hesitate to invest in HITH teams and systems without predictable demand, while insurers and clinicians hesitate to refer without assured service availability.
MBS rules generally prevent telehealth items being claimed for admitted HITH patients, apart from limited psychiatry items, discouraging specialists from referring patients where ongoing review would otherwise require in-person attendance. Dedicated telehealth items for admitted HITH patients would support clinical continuity, autonomy and timely escalation.
How could Australia fund earlier community based mental health support instead of waiting until people need hospital care?
Policy has shifted towards prevention and community-based care, but funding has not kept pace. Responsibilities remain dispersed across Commonwealth and state programs with separate mechanisms for primary care, specialist services, hospitals and psychosocial supports.
PHI regulation reflects a similarly hospital-centric model, where insurers can fund hospital-based mental health care but have limited legislative authority to fund preventive, community-based and digitally enabled care outside hospital settings and limited ability to co-fund services from a broader range of medical specialists.
Amend the Private Health Insurance Act 2007 and associated rules to enable private health insurers to fund a broader range of evidence-based early intervention, prevention, treatment and recovery services delivered outside hospital settings.
How can Australians check a specialist’s fees and likely out of pocket costs before booking?
The Government’s proposal to mandate specialist fee transparency through the Medical Costs Finder tool represents an important step in helping patients make more informed decisions about the specialist care they receive. By improving visibility of likely OOP costs before treatment, the Medical Costs Finder tool supports greater patient transparency and choice.
Expand the Medical Costs Finder to include typical fees, Medicare benefits, gap-scheme participation requiring specialists to publish indicative fees and an ability to correct information between updates.
Which reforms could shorten specialist waits and reduce out of pocket costs in Australia?
Restoring accessible and affordable specialist care therefore requires a coordinated response across affordability, workforce supply and service delivery. This chapter sets out reforms focused on reducing unexpected OOP costs, strengthening the specialist workforce pipeline and embedding shared care and secondary consultation within routine healthcare, to support a specialist care system that remains accessible, affordable and sustainable as community needs grow.
These reforms aim to reduce unexpected medical costs, support informed choice and encourage effective competition, while preserving clinical autonomy and specialists' ability to set their own fees.
Could timely specialist advice to GPs prevent unnecessary referrals without compromising care?
A nationally available system delivering an estimated 140,500 secondary consultations a year could avoid around 68,000 specialist referrals and reduce patient OOP costs by about $4 million annually.
Queensland's Mater eConsultant service illustrates the model in practice: since October 2025 it has supported more than 250 regional and rural GPs, with over 1,000 patients receiving earlier advice and almost 92 per cent avoiding a face-to-face specialist appointment, with responses averaging 2.1 business days.
Create a national service through which GPs can seek patient-specific advice from participating public and private specialists without first converting the request into a formal referral, covering diagnostic clarification, interpretation of investigations, treatment and medicines management and whether direct referral is required.
Which Australian health reforms could improve access and outcomes while limiting avoidable hospital spending?
We know that earlier intervention, improved access to community-based care and more effective management of chronic and complex conditions, can reduce avoidable hospital admissions, improve workforce participation and reduce pressure on both the private and public hospital systems.
Reorienting our healthcare system towards prevention and integrated, person-centred care, delivered by a flexible, multidisciplinary workforce and enabled by technology is a large part of the solution to tackling chronic disease.
How should Australia respond to GP and specialist workforce shortages without compromising care quality?
Workforce shortages are placing increasing pressure on Australia's health system. The Department of Health, Disability and Ageing (the Department) projected a General Practitioner (GP) shortfall of more than 800 in 2024, rising to more than 2,600 by 2028 and 8,600 by 2048. At the same time, four in ten GPs are aged over 55, increasing retirement-related workforce pressures.
Specialist shortages are also expected to grow, reaching 6,981 full-time-equivalent specialists by 2033 and 12,812 by 2048. Australia is increasingly reliant on internationally trained doctors, with annual overseas entrants now exceeding domestic medical graduates.
Given that specialist supply is shaped by decisions across university funding, hospital employment, vocational training, accreditation, migration and healthcare financing, reform should establish a nationally coordinated framework that aligns the levers held by governments, health services, training organisations and regulators.
What evidence shows prevention and care closer to home can make the health system more sustainable?
Prevention delivers a median return on investment of $14.30 for every $1 spent, though outcomes vary by intervention and population. Modelling suggests non-communicable disease elimination could lower health expenditure by around 40 per cent and lift GDP by nearly 4 per cent. More realistically, closing the gap to best-performing countries on major risk factors could lower expenditure by 6.2 per cent and lift GDP by 1.3 per cent over 2026-2050.
Victoria's SunSmart program illustrates the long-term value of sustained prevention, estimated to have prevented more than 43,000 skin cancers between 1988 and 2011.
HITH is associated with lower mortality, fewer readmissions, lower costs and higher patient and carer satisfaction than inpatient care for appropriately selected patients.
A South Australian evaluation of community-based psychosocial support found reductions in mental health hospitalisations of around 39 per cent and bed days of around 16 per cent.
