Contemporary rural health workforce policy in Australia: Evidence-based or ease-based?

Arthur Cheung

Tuesday, March 29th, 2011

Arthur T L Cheung
Fifth Year Science/Medicine
Graduate Certificate in Governance and Public Policy
University of Queensland

Arthur has a passion for health policy, public and global health. During his medical studies he has been President of Towards International Medical Equality (TIME), President of the Manali Medical Aid Project, and Queensland State Representative on the National Students Committee for Doctors for the Environment Australia. He currently sits on the Board of the Australian Youth Affairs Coalition amongst other pursuits.


Australia has a history of a rural health workforce shortage. This shortage was originally perceived to be within the context of an overall oversupply of health practitioners throughout Australia, an assumption that is now believed to be erroneous. Likewise, interest group support for Government policy responses to the maldistribution has waned over time. Regardless, Australia has consistently experienced a shortage of health workers in rural areas.

This article critiques the development of contemporary rural health workforce policy in Australia against theories of policy development, highlighting the introduction of section 19AB (the “ten year moratorium”) in 1996 to the Health Insurance Act 1973 as a turningpoint for the selection of policy instruments.

The Australian Healthcare System

Medicare is Australia’s universal healthcare system. The provision of medical care by medical practitioners in Australia is regulated through Medicare Provider Numbers (MPNs). A doctor must obtain a MPN in order to charge fees for professional services rendered outside of salaried hospital positions. [1]

In 1996, the Australian Federal Government introduced an amendment to the Health Insurance Act 1973 (the Act), restricting access to MPNs by foreign graduates of an accredited medical school (FGAMS; a term which includes international students studying at Australian medical schools) and overseas trained doctors (OTDs). For simplicity, this article will hereafter use the term OTD to refer to both OTDs and FGAMS. Under the amendment, OTDs must wait a minimum period of ten years from the date of their first Australian medical registration before being eligible for a MPN. This requirement, introduced under section 19AB of the Act, has subsequently been referred to as the “ten year moratorium.”

By 1999, Government policy began to utilise section 19AB exemptions as a means to address rural health workforce shortage. OTDs willing to work in Districts of Workforce Shortage (DWS) were given access to MPNs. [2] These DWS are determined by the Federal Government’s Department of Health and Ageing (DoHA), and consistently have primarily been rural and remote areas.

Policy introduction: The Ten Year Moratorium

Issue identification

The introduction of section 19AB was undertaken within the context of a perceived oversupply of urban doctors and ballooning costs to the Government through Medicare’s fee-for-service system. [4-6] These costs were a result of the introduction of Medicare in 1984, which caused private health insurance rates to plummet, shifting responsibility for healthcare costs from individuals to the…