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Medicare policy changes to primary health care funding for Australia’s indigenous Peoples 1996–2023: a scoping review

International Journal for Equity in Health volume 23, Article number: 245 (2024) Cite this article

Abstract

Background

The Australian Government began implementing Medicare policies in the late 1990s aiming to improve Indigenous Peoples’ access to the primary care. No aggregate central list of what policies have been implemented exists. The aim of this review was twofold: first to perform a scoping review to identify any literature mentioning a policy implemented between 1996 and 2023 regarding Indigenous Peoples’ access to Medicare or the Pharmaceutical Benefits Scheme for primary care, and secondly to synthesise and describe any policies to enable learning from past successes and failures.

Methods

Scoping review following the PRISMA-ScR process. Seven electronic databases were searched for any papers identifying any policy implemented between 1996–2023 to improve Indigenous Peoples’ access to primary care. This was supplemented with searches in Google, key government databases, hand searching and expert input.

Results

Sixteen policies were implemented and organised into six categories according to the primary care barrier they targeted: Medicare Benefits Schedule (MBS) funding structure; lack of Indignenous-appropriate MBS items; Pharmaceutical Benefits Scheme (PBS) access barriers; inappropriate care from mainstream general practitioners; bureaucratic impediments to MBS and PBS access; and data gaps.

Discussion/conclusion

This is the first synthesis of Medicare and PBS policy history to improve Indigenous Peoples’ access to primary health care, and provides a platform for future analysis. Identifying the names of relevant policies in any area is key to accountability and reliance on individual expertise is no substitute for transparent and durable policy record-keeping. A searchable long-term policy repository should be established to ensure that related policies can be identified, and that key policy documentation is publicly available in perpetuity.

Introduction

Aboriginal and Torres Strait Islander peoples (hereafter, respectfully, Indigenous Peoples) experience a disproportionate burden of disease (estimated at 2.3 times greater than non-Indigenous Australians), and lower life expectancies than non-Indigenous Australians (8.6 years for less for males and 7.8 years less for females) [1]. Chronic diseases account for 80% of the difference in the burden of disease observed between Indigenous Peoples and other Australians [2]. Chronic conditions occur at much earlier ages in Indigenous Peoples, and in the 35–74 years age group, chronic disease accounts for 75% of the mortality gap for males and 79% for females [2, 3]. These health inequities have manifested as a direct result of the ongoing impact of colonization: loss of land, language, culture and identity; and ongoing racism and discrimination [4, 5].

In response to experiences of racism in mainstream health services, and an unmet need for culturally safe and accessible primary health care, the first Aboriginal Community Controlled Health Service (ACCHS) was established in 1971 [6]. There are now over 140 ACCHS’ across Australia. Unlike mainstream primary health services which tend to operate on a biomedical model of healthcare, ACCHS’ offer comprehensive primary health care services which take an holistic approach to healthcare [7]. However, ACCHS’ should be viewed as being in addition to mainstream healthcare services, and therefore provide Indigenous Peoples with greater choice for their health care needs [8].

Medicare is Australia’s universal health insurance scheme. It is available to Australian and New Zealand citizens, permanent residents, some temporary residents, and citizens of nations that offer reciprocal benefits, once they register with Medicare. Medicare covers various medical and hospital services including consultations, procedures and tests that are listed on the Medicare Benefits Schedule (MBS), and all services in a public hospital. Each service listed on the MBS is allocated an MBS Item Number. Each MBS Item Number has a Scheduled Fee that is determined for by the Australian Government. Once patients are registered with Medicare, they can claim a rebate from Medicare for services: 100% of the Scheduled Fee for general practice (GP) services; 85% of non-GP services that are provided out of hospital; and 75% of services provided in a private hospital. A service provider can charge patients more than the Scheduled Fee, resulting in patients having to pay a gap fee. Some GPs do not charge more than the Scheduled Fee for their services and bill Medicare directly (a process known as bulk-billing), meaning that patients have no upfront out-of-pocket expenses.

The Pharmaceutical Benefits Scheme (PBS) is the system that subsidies prescription medications. Through this system, patients make a co-contribution payment to medicines on the PBS, which are provided at a greatly reduced cost to patients. The co-payment is further reduced for Commonwealth Health Care Concession Card Holders (for example, people on an old age or disability pension).

Three to six times the average national health expenditure on Medicare through the MBS and PBS is required to address Indigenous Peoples health disparities [9]. Up until the late 1990s it was widely believed that health expenditure for Indigenous Peoples was excessive [10], and much higher than for non-Indigenous people [11]. Two landmark reports reversed that belief. The first estimated that per-capita MBS expenditure for GP presentations for Indigenous Peoples was 35% of non-Indigenous expenditure in 1995–96, and PBS medicines expenditure was 22% of non-Indigenous expenditure [11]. The other report found nation-wide, systemic barriers to Indigenous Peoples’ access to the MBS and PBS, and concluded radical changes were required to provide needs-based funding for Indigenous Peoples [12]. Whilst considerable increases have been made since, data for expenditure twenty years later in 2015–16 remained low, with MBS being less than 75% of non-Indigenous expenditure, and PBS at 37% [13].

There are many features of the MBS and PBS which impede access, particularly for Indigenous Peoples, including: the need for a Medicare Card (registration with Medicare requires a fixed address and some Indigenous Peoples have a mistrust of Government services due to past Government policies) [5]; cost (patient co-payment requirements for GP and PBS services); the fee for service basis for GP services (payment made for each item provided encourages volume-driven and fragmented care, rather than quality of outcomes and integrated care) [14]; the GP-centric nature of the MBS (the MBS mainly funds care provided by GPs, rather than other workforce types such as allied health professionals, Aboriginal Health Workers and nurses) [15, 16]; a lack of understanding of Indigenous Peoples’ holistic health needs and inappropriate care from mainstream GPs (racism, lack of Indigenous status identification, lack of choice of male/female practitioners, fee for service resulting in episodic care that does not recognise holistic health needs) [5, 17,18,19,20,21,22]; and geographical access issues (a higher proportions of Indigenous Peoples live in rural and remote areas where there are fewer GPs and pharmacists) [5, 23]. Insufficient and inappropriate access to primary health care is reflected in higher potentially preventable hospitalisations for Indigenous Peoples (three times the rate of other Australians) [24].

To improve health outcomes and address some of the above-mentioned barriers, considerable policy efforts to improve GP-related MBS and PBS access for Indigenous Peoples have been made [26]; however, there is currently no central list of what policies have been implemented and no repository that stores these. The aim of this review was therefore twofold: first to perform a scoping review to identify any literature mentioning a policy implemented between 1996 and 2023 regarding Indigenous Peoples access to Medicare or the Pharmaceutical Benefits Scheme for primary care so we could identify what policies existed, and secondly to synthesise and describe these policies to enable learning from past successes and failures.

Methods

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) [27] checklist: i) development of inclusion/exclusion criteria; ii) extraction and coding of study characteristics and findings; and iii) data analysis and synthesis of findings.

Eligibility criteria

Literature were eligible if they: (a) mentioned a policy focussing on Australia’s Indigenous Peoples access to GP-related MBS or PBS funding; (b) were implemented between 1996 and 2023; and (c) were published in English. All literature (for example, journal articles, reviews, editorials, book chapters, conference proceedings, fact sheets and so on) were included.

Exclusion criteria

Not focused on Indigenous Peoples’ access to GP-related MBS or PBS funded, implemented after 2023, or published in a language other than English.

Information sources and search strategy

An initial search was conducted in January 2024 in seven electronic academic databases: MEDLINE, Science Citation Index, Academic Search Complete, CINAHL, APA Psycinfo, Health Source: Nursing/Academic Edition, and Psychology and Behavioural Sciences Collection. In addition, the first 50 results in Google were searched. A modified search was conducted in Australian Indigenous Health InfoNet. The reference lists of full text papers were scanned to identify any papers not captured in the initial search, and expert input was also sought from an expert in Indigenous Peoples policy regarding MBS and PBS in primary care. Searches in three other key government sites (Analysis and Policy Observatory, the National Department of Health, and Services Australia (the department responsible for Medicare)), were not possible as there were no functions to combine search terms.

To ensure relevant results were obtained, search terms were developed using a modified version of the PICO (Population, Interest, Comparator and Outcome) Framework without the comparator component [28]. Alternative keywords for each search term were combined using the Boolean operator 'OR' to ensure all possible variations were captured; the search was then refined by combining the searches with 'AND'. The wildcard '*' was used to allow for word truncations. The keywords and search strategy are shown in Table 1. The search terms were constructed and agreed upon by two authors (HK and HS) and a university librarian. HK is an expert on the review topic, and HS is a skilled academic who teaches literature searching and research methods at the postgraduate level and has experience conducting systematic reviews.

Table 1 Search terms and search string (except Australian Indigenous Health InfoNet)*
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Study selection

Papers were exported into Excel, and duplicates were removed. A stepwise procedure to identify relevant papers was used. Authors HK and HS performed the initial search. Authors HK, HS and GS screened the titles and abstracts against the inclusion/exclusion criteria; the remaining texts were retrieved in full and screened against the inclusion/exclusion criteria. HK supplemented the search by screening the reference lists of included papers, and through expert input. The authors met with the final list of included/excluded papers and resolved any disagreement by discussion and consensus. Reasons for exclusion were recorded.

Data collection and policy synthesis

Where available, the following data were extracted into a Microsoft Excel spreadsheet: first author, year, country, study type, aim, sample, methods, results and conclusion. As the primary purpose of this search was to identify all relevant policies, study quality was not appraised.

Policy synthesis was conducted by author HK and comprised summarising the purpose of the policy and categorising them according to the barrier they were intended to address. Disagreements were resolved by discussion and consensus. The policies are presented in a narrative format.

Results

The initial search yielded 439 papers after duplicates were removed. After reviewing the abstracts against the inclusion criteria, 273 were removed as they did not meet the inclusion criteria. The full text of the remaining 166 papers were examined, and a further 69 were removed. In the 97 papers remaining (Table 2), 12 policies could be identified. An additional 4 policies were identified through hand searching and expert input, bringing the final total to 16 (see Fig. 1).

Fig. 1
figure 1

PRISMA Flowchart showing papers searched and no. of policies identified

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Table 2 Summary of literature that led to policies being identified to improve Indigenous Peoples access to primary care through the Medicare Benefits Schedule (MBS) or the Pharmaceutical Benefits Scheme (PBS)
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Study characteristics

Sixteen policies were implemented between 1996 and 2023 (Table 3.). These were organised into six categories according to the barrier they targeted: MBS funding structure (n = 3); lack of Indignenous-appropriate MBS items (1); PBS access barriers (6); inappropriate care from mainstream GPs (3); bureaucratic impediments to MBS and PBS access (1); and data gaps (2). The policies are described further below. Table 3. provides the timeline of when the policies were implemented.

Table 3. Timeline and purpose of policies to improve primary care access to the MBS and PBS for Indigenous Peoples (1999-2023), by barrier
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Policies aimed at improving the MBS funding structure

Sect. 19(2) exemptions (1996-ongoing)

Section 19(2) of the Health Insurance Act 1973 prohibits services from receiving national Government health care financing from grant and Medicare sources, commonly referred to as ‘double dipping’. Exemptions from this prohibition allowed ACCHSs to both access MBS funds and continue to receive grant funding for health care delivery, thereby providing improved financial viability [10] and establishing a new uncapped and flexible funding stream not subject to grant conditions [117]. However, some ACCHSs were concerned grant funding would be reduced if MBS funding was increased, and there was little support for ACCHSs to make organisational changes needed to increase MBS funding [12]. Furthermore, funds generated under the exemption varied considerably across ACCHSs [12, 118].

Aboriginal Coordinated Care Trials (ACCTs) (1997–2005)

As an alternative to the standard fee for service MBS structure, the (Aboriginal Coordinated Care Trials) ACCTs policy tested a form of capitation—a payment system where health-care providers are paid a fixed amount per person to provide all the care needed for a given period [119]. In the seven trial sites (which ranged from area health networks to individual ACCHS), funds were pooled between national and state governments, with a third-party community organisation as the ‘funds holder’ [120] [121]. Under this approach, the national Government replaced MBS and PBS to a set amount per person to a flexible funding pool.

Primary Health Care Access Program (PHCAP) (1999-?2006)

This policy, another capitation alternative to the standard fee for service MBS structure, was conducted in the seven ACCTs sites as well as 12 new regions [122]. Lessons from the previous ACCTs were acknowledged [121], and in a shift, the formula for capitation funding was increased by using ‘multipliers’ – factors used to augment average national MBS expenditure to address funding inequity. The first multiplier set minimum expenditure at double the average national MBS expenditure (to account for higher morbidity rates among Indigenous Peoples), and the second multiplier set maximum expenditure at four times the national average in remote locations (to account for higher costs of service delivery in remote areas due to increased costs associated with geographic access to geographic access). Another lesson learnt was that unlike the ACCTs, ACCHSs were allowed to continue to claim MBS funding as well as receiving capitated funding, an approach known as ‘mixed mode’ funding [97].

Policies aimed at addressing the lack of Indigenous-appropriate MBS items

MBS item numbers addressing health needs specific to Indigenous Peoples have gradually been added to the MBS since 1999. These can be divided into Indigenous-only items (which are available only to Indigenous Peoples) and Indigenous-focussed items (which are designed to address health issues and structures primarily serving the needs of Indigenous Peoples, but do not specifically exclude non-Indigenous people) (Table 4).

Table 4 Medicare Benefits Schedule (MBS) item numbers addressing health needs specific to Indigenous Peoples
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Indigenous-only MBS items (1999-ongoing)

The introduction of the first Indigenous-only MBS item, a health check for Indigenous Peoples aged 55 and over [123], was an acknowledgment from Government that the health needs of Indigenous Peoples were sufficiently different from non-Indigenous people to justify specific MBS-funded care (Table 4). The health check was expanded in 2004 to include Indigenous Peoples aged 15–54, and again in 2006 to include those under 15 years of age (Table 4), and these three MBS items were combined into a single item number in 2010. Further Indigenous-only MBS items have been added over time (Table 4), including an item to support retinal screening for Indigenous Peoples with diabetes added in 2016.

Indigenous-focussed MBS items (2000-ongoing)

Indigenous-focussed MBS items were first added to support point of care testing for diabetes management in eligible Indigenous services in 2000, with additional items added in 2006 and 2015. Medicare items to support the work done by health workers other than GPs in ACCHSs (such as immunisations and wound care) were first added in 2006, with additional items added in 2008 and 2020. In 2018, an MBS item was added to support renal dialysis in very remote areas, a service required overwhelmingly by Indigenous patients [58]. Additional Indigenous-focussed MBS items have continued to be added over time (Table 4).

Policies aimed at overcoming PBS access barriers

Sect. 100 Remote area aboriginal health services program (1999-ongoing)

Arrangements made under Sect. 100 of the National Health Act 1953 enabled remote ACCHSs to provide PBS medicines for free directly from their clinics. This was fundamentally different from standard PBS access arrangements as it did not involve patient payments, prescriptions, or the involvement of pharmacists in individual dispensing. The policy only applied to PBS medicines, so did not cover the cost of over-the-counter medicines not subsidised by the PBS [124].

PBS listings (1999-ongoing)

PBS listings include Indigenous-only items (which are available exclusively to Indigenous Peoples) and Indigenous-focussed items (which are available to certain non-Indigenous people as well as Indigenous Peoples).

PBS listings aim to reduce the cost of medicines for Indigenous Peoples by including them on the PBS. This ensures they are either available at no cost to the patient (under Sect. 100 arrangements) or PBS-subsidised and therefore more affordable (under standard dispensing arrangements). The scope of medicines listed has been contested over time, with stakeholders arguing for the list to be expanded [125]. PBS listings began in 1999 and items have continued to be added over time (Table 5).

Table 5 Pharmaceutical Benefits Scheme (PBS) item numbers addressing health needs specific to Indigenous Peoples [126]
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Indigenous health services pharmacy support (2021-ongoing)

This policy supports services provided by ACCHSs and service providers that contribute to the improvement of Quality Use of Medicines (QUM) and health outcomes for Indigenous Peoples through: QUM pharmacist support, QUM devices, QUM education, and QUM patient transport (Indigenous Health Services only) [127].

QUMAX program (2008–2021)

This policy funded urban and regional ACCHSs to support access to, and quality use of, PBS medicines. It included support for dose administration aids, cultural awareness training for pharmacy staff, quality use of medicines patient education, and funding to cover the patient payment for PBS medicines [12]. QUMAX ceased as a standalone program in 2021 and was absorbed into the Indigenous Health Services Pharmacy Support program [127].

Closing the Gap (CtG) PBS co-payment policy (2010-ongoing)

This policy aimed to improve PBS medicines access for eligible Indigenous Peoples by removing all or substantially decreasing patient payments [128]. Notably, it used standard pharmacy dispensing arrangements and was implemented in both ACCHSs and mainstream general practices.

Pharmacy trial program (2017–2021)

This policy included two Indigenous-specific trials aiming to improve medication management through increased pharmacy support in select sites: the Indigenous medication review service feasibility (IMeRSe) study (2017–2021) [129, 130], and the Integrating Practice Pharmacists into ACCHS (IPAC) project (2017–2020) [131]. The relevant Government advisory body rejected IMeRSe’s recommendation to fund Indigenous-specific medication review services through the introduction of additional MBS items [132] and deferred a decision on IPAC’s recommendation for funding for ACCHSs to employ pharmacists in non-dispensing roles [133].

Policies aimed at improving care from mainstream GPs

Brokerage model (2006-?2008)

This policy aimed to improve access to health care for urban Indigenous Peoples [134, 135] through a trial conducted in five urban locations [136] Under this policy, a third party independent of service providers, such as a local Indigenous Land Council, could refer Indigenous Peoples to registered mainstream general practices involved in Indigenous Peoples health, help organise appointments, and subsidise out of pocket costs [136].

Practice Incentive Program (PIP) Indigenous Health Incentive (IHI) (2010-ongoing)

This policy aimed to encourage mainstream general practices to improve care for Indigenous Peoples, by introducing three incentive payments for general practices: a sign-on payment; an annual payment for each patient registered for chronic disease management; and outcomes payments for reaching target levels of care [137].

Closing the Gap workforce (2010–2022)

This policy established three new types of primary health care workers: Indigenous health project officers, Indigenous outreach workers and Care Coordinators [82]. Indigenous health project officers were based in both the ACCHS sector (in national and state based peak bodies) and support organisations for mainstream general practice (then known as Divisions of General Practice, now Primary Health Networks (2023)). These positions were to provide leadership in Indigenous health, including increasing awareness of Closing the Gap initiatives. Indigenous outreach workers were based in Divisions/Medicare Locals to support Indigenous Peoples to access primary health-care services and follow-up treatment. Care coordinators based in both ACCHS’ and mainstream sectors aimed to help coordinate care for patients with chronic disease.

Policies aimed at addressing bureaucratic impediments

Medicare administration policies (1999-ongoing)

This policy included the provision of alternatives for Indigenous Peoples without standard identification to enrol in Medicare (a key access barrier [9, 17]), streamlined billing arrangements to facilitate MBS claiming and established a network of Medicare Liaison Officers to support ACCHSs navigate the MBS, along with a free telephone hotline number [138, 139].

Policies aimed at addressing data gaps

Voluntary Indigenous Identifier (VII) (2002-ongoing)

The lack of identification of Indigenous Peoples is a barrier to GP-mediated service delivery [18, 20, 21] and GP-generated data collection [140]. This policy made provisions for Indigenous Peoples to voluntarily record their Indigenous descent with Medicare [141]. This included an Indigenous descent variable on the Medicare enrolment form. Indigenous Peoples are advised that recording their Indigenous descent will help to shape government plans and policies and see if the policies are making a difference [142].

PBS indicator, expenditure and policy reporting (2006-ongoing)

This policy included important PBS information in a new national reporting framework. The Aboriginal and Torres Strait Islander Health Performance Framework [143], introduced indicators grouped into three tiers (health status and outcomes, health determinants and health system performance), and two-yearly reports against those indicators are issued. The Framework includes indicators relevant to MBS and PBS access, although unlike MBS access, PBS access is specifically reported under the indicator ‘access to prescription medicines’ and Government policies aiming to increase PBS access are specified [144]. This information facilitates both the analysis of PBS access policies and the comparison of PBS expenditure over time.

Discussion

Our findings discuss policy efforts to address access barriers over a period of nearly 30 years. We identified 16 policies implemented between 1996 and 2023, compared them with access barriers and grouped them according to those barriers. PBS barriers had the highest number of policies (n = 6), of which all but the Pharmacy Trials Program and QUMAX were ongoing. Of the policies aiming to address the MBS funding structure (n = 3), two (which attempted fundamental changes) were time-limited, and one (which made minor changes) was ongoing. Of the policies aimed at improving care provided by mainstream GPs (n = 3), one was time limited. Of the policies aimed at improving data gaps (n = 2), both were ongoing. There was one policy each in the remaining two categories, lack of Indigenous appropriate MBS items and bureaucratic impediments to MBS and PBS access, and both were on-going. Policies which aimed to alter the fundamental MBS structure (CCT and PHCAP) were short-lived, but most other policies persisted over time.

Finding policies, particularly past policies, was very difficult without expert input. This difficulty supports concerns regarding policy amnesia, where past policies are forgotten or ignored [145, 146]. Institutional, governmental or organisational policy amnesia has been partially attributed to high rates of staff turnover [147]. More fundamentally, a lack of willingness, as well as ability, to apply knowledge gained from previous experience [148] is also a factor, where “the prevailing mentality militates strongly against any such recourse to the past” [148], p6. If policy decisions do not consider past policies or their effectiveness, policies remain in a state of perpetual infancy [149].

Identifying relevant policies, finding policy documentation and tracking changes over time is not straightforward, as it is difficult to identify related policies, to access historical policy documentation, and to ascertain changes to the structure or funding of policies over time [147]. Most material is stored on ephemeral webpages; policies are often revised, merged and/or renamed as governments change; and funding changes are difficult to trace. While some policies have clear beginning and end dates, many do not, and it is sometimes difficult to determine if a policy still exists.

There are some attempts to capture policy history in this space. The Analysis and Policy Observatory’s Public Policy Taxonomy was a step towards establishing a searchable policy repository, underpinned by an inferable classification and nomenclature system [150], but only limited search functions are available. The Australian Indigenous HealthInfoNet, which aims to support Indigenous health by making information readily accessible, also included limited search functions, but did include a lot of relevant grey literature.

Given this situation, a major methodological barrier to researching in this area is how to identify policies. We found some studies using document analysis of related policies in other fields: some were confined to point-in-time assessment rather than reviewing policies over time and these used online searches for key words to identify relevant documentation, mainly from government websites [151,152,153,154]. We found few examples of robust methods for undertaking historical reviews: some did not include methodology of how policies and relevant documentation were identified [155,156,157,158,159,160,161,162], and others had vague methodology [163, 164]. Others noted the same problem: that it was not possible to generate the names of relevant policies other than through expert knowledge [165, 166]. The need for researchers to know what to look for in advance undermines accountability and reflects the lack of a searchable policy repository. More fundamentally, reliance on individual expertise is no substitute for transparent and durable policy categorisation and record-keeping via a searchable policy repository. Our study had the advantage that some policies (those related to PBS access) have been identified by Government. However, we had to identify non-PBS policies and determine if they were in scope: other researchers may make different decisions.

Strengths and limitations

This review was undertaken using rigorous methods. It included a wide range of sources to comprehensively capture the scope of the available evidence. It is the first synthesis of Medicare and PBS policy history to improve Indigenous Peoples’ access to primary health care, and provides a platform for future analysis. This review has a number of limitations. Only papers written in English were included and papers written in other languages may have provided different or additional views. However, given this paper focused on Australian policy, it is unlikely that this had an impact on the findings. The selected databases searched were chosen as they contained the most relevant and up to date information on the topic and only the first 50 hits on Google were searched, and it is possible that some items could have been missed. This paper was a descriptive policy synthesis only; policy characteristics and the effectiveness of policies were not analysed. Policy attributes should be investigated through the application of a decolonising framework for Indigenous health policy analysis [167]. The scope was limited to improvement to MBS and PBS access in primary care, and not secondary or tertiary services, and the results for these could differ. Further, this policy synthesis did not consider the two political policy periods that are covered: the ‘practical reconciliation policy’ (1996–2006) and the ‘Closing the Gap policy’ (2008-current). Political party policy approaches can affect the approach to policy development and implementation, however during the period of this review, we argue that for the two policy periods of this examination the policy frame is congruent where the policy focus was on changing the relatively poorer circumstances in health, or inequality of health outcomes.

Conclusion

This is the first synthesis of policy history to improve Indigenous Peoples’ access to primary health care, and provides a platform for future analysis. Identifying the names of relevant policies in any area is key to accountability and reliance on individual expertise is no substitute for transparent and durable policy record-keeping. A searchable long-term policy repository should be established to ensure that related policies can be identified, and that key policy documentation is publicly available in perpetuity.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

ACCHS:

Aboriginal community controlled health service

ACCT:

Aboriginal Coordinated Care Trials

CtG:

Closing the Gap

GP:

General practitioner

IHI:

Indigenous Health Incentive

IMeRSe:

Indigenous medication review service feasibility

IPAC:

Integrating practice pharmacists into ACCHS

MBS:

Medicare Benefits Schedule

PBS:

Pharmaceutical Benefits Scheme

PIO:

Population, interest, and outcome

PIP:

Practice Incentive Program

VII:

Voluntary Indigenous Identifier

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Funding

HK was a recipient of an Australian Government Research Training Program scholarship.

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Authors and Affiliations

  1. Yardhura Walani Centre, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, 2601, Australia

    Helen Kehoe & Raymond Lovett

  2. Medicine and Health, University of NSW, Sydney, 2052, Australia

    Heike Schütze

  3. General Practice Clinical Unit, The University of Queensland, Brisbane, 4072, Australia

    Geoffrey Spurling

Authors
  1. Helen Kehoe
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  2. Heike Schütze
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  3. Geoffrey Spurling
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  4. Raymond Lovett
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Contributions

All authors conceived the study. HK and HS performed the literature search. HK, HS and GS performed the data screening. HK drafted the initial manuscript. HS substantially revised the manuscript. All authors reviewed subsequent drafts and approved the final manuscript.

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Correspondence to Heike Schütze.

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Kehoe, H., Schütze, H., Spurling, G. et al. Medicare policy changes to primary health care funding for Australia’s indigenous Peoples 1996–2023: a scoping review. Int J Equity Health 23, 245 (2024). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12939-024-02325-x

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Keywords

International Journal for Equity in Health

ISSN: 1475-9276

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