Review of Section 19AA, Distribution Priority Area and Modified Monash Model

As part of the Working Better for Medicare Review being led by independent reviewers Professor Sabina Knight and Adjunct Professor Mick Reid (which stemmed from the Supporting Health, Care and Support Services in Thin Markets 2023–24 Budget measure), the Australian Government Department of Health and Aged Care (the Department) engaged Healthcare Management Advisors (HMA) to review the Fellowship requirements under Section 19AA and the Distribution Priority Area (DPA) and the Modified Monash Model (MMM) as appropriate and effective workforce distribution levers. This project was undertaken in collaboration with KBC Australia, and the Centre for Australian Research into Access (CARA) based at Deakin University.

Section 19AA, DPA and MMM are distribution levers used to encourage or require health professionals to work in areas of workforce shortages. Section 19AA requires doctors who are permanent residents or citizens of Australia to have completed or be undertaking vocational training with a recognised speciality college (registered under Section 3 of the Health Insurance Act 1973) to access Medicare benefits. The DPA classification facilitates the placement of medical practitioners in communities of greatest need across Australia. It is used to direct where international medical graduates can work in general practice, access Medicare benefits, and where bonded Australian-trained GPs can meet their return of service obligation. The MMM measures remoteness and population size on a Modified Monash (MM) categories MM1 to MM7 scale. The MMM is used broadly across various health, aged care, and disability programs to measure rurality.

The overarching Working Better for Medicare Review also included review of Section 19AB (which outlines where international medical graduates are able to work in Australia and access Medicare benefits) and the District of Workforce Shortage (DWS, which specifies areas with a shortage of non-GP specialties).

The goals of the review were to evaluate how appropriate and robust the assumptions underpinning the levers were, alignment with workforce policies and priorities and to identify opportunities to improve the way the levers achieve their aims. HMA applied a staged approach to the review, including a literature scan to inform the development of a Review Framework, stakeholder engagement, and data analysis of the changes to the GP workforce across Australia as well as impacts of the DPA and MMM classification systems on workforce distribution.

The review found that Section 19AA should be retained to ensure training and practice standards, currency of knowledge and skills are maintained across all medical professions; a lever to aid in the distribution of the GP workforce is required, but it should focus on distribution to areas of comparatively higher need and not blanket inclusion based on MMM categories.

The overarching Working Better for Medicare Review is available here.

A technical paper produced by CARA focused on the application of the MMM in Australian rural health policy to incentivise the distribution of the GP workforce to more rural and remote settings is available here.

The project commenced in January 2024 and was completed in June 2024.