Ten years of reform in 10 days: Australia’s telehealth revolution

When the World Health Organization declared COVID-19 to be a pandemic in March 2020, it had already become clear that COVID would require swift countermeasures to curb its worst effects and preserve access to health services. 

Over the course of a long weekend, Australia’s Commonwealth Health Department was able to put together core elements of a health system plan to expand access to telehealth services, i.e., consultations via phone or video call. 

A new case in ANZSOG’s John L. Alford Case Library Ten years of reform in 10 days: Australia’s telehealth revolution looks at how the Health Department was able to work with the medical profession to rapidly implement telehealth, which is now a permanent part of the Medicare system. 

The case uses interviews with public servants and members of the health industry to go behind the scenes and look at how bureaucratic obstacles were overcome at the start of the pandemic and the tweaks to implementation required to minimise unintended negative consequences. 

Health Minister Greg Hunt gave departmental officials wide scope and flexibility to implement telehealth, and the experience became a prime example of how COVID allowed public services the licence to do things differently. 

On February 24, just weeks before COVID-19 hit Australia, Caroline Edwards had been recalled to the Health Department to step in as Acting Secretary. She and her colleagues were at the heart of putting together core elements of a health system plan that recognised that about half of Australian GP visits are for chronic conditions, making many people vulnerable to any disruption of care. 

‘It arose out of two things,’ she said, ‘How can we provide care to people who were potentially very contagious? Also, how can we protect health practitioners from being infected?’ 

Although telehealth was already part of the Medicare system, with an established legal framework, scaling up at speed still presented a mammoth challenge.  

The dangers of COVID quickly cured any qualms about telehealth amongst the medical profession. The public was also very anxious to maintain access to healthcare. Doctors’ associations and other peak bodies now backed rapid and widespread telehealth adoption and the technology went from niche to mainstream. 

Health officials created more than 270 new Medicare items within weeks, something that would normally take over a year. Looking back, Minister Hunt remarked: ‘There was a 10-year plan to roll telehealth out. We put that together in 10 days.’ 

The case looks at the follow-up to the initial rollout, and the implementation of changes designed to encourage doctors to use telehealth, and stop corporate clinics from poaching patients to create telehealth-only practices.  

At the beginning of October 2020, the federal government announced that telehealth would be funded to the end of March 2021, later extended to the end of the year. In December 2021, the government decided to make telehealth services a permanent part of the MBS. The move was broadly welcomed, especially since COVID was far from over. By late 2022, there had been approximately 111 million telehealth consultations since the beginning of the pandemic. 

Department officials interviewed for the case say that it took the impetus of COVID for people to question the status quo and work to give telehealth its rightful place in the health system. They note that having well-established systems like Medicare meant the government had the tools in place to make telehealth work. 

Caroline Edwards reflected that she wasn’t sure telehealth would have happened without a triggering event like COVID: ‘If you hold things up till you’ve got all your ducks in a row, chances are you will miss the moment. And this is a good example of that,’ she said.  

The consequences of going too slowly on reform or missing the window for change were often underestimated, Edwards observed, ‘Perhaps the way we look at the risk matrix has to be adjusted.’