Funding

Pathology services are largely publicly subsidised through Australia’s Medicare system.

Free access to public hospital care, including pathology testing, is a fundamental component of Medicare.  Public hospital services to public patients (admitted and non admitted patients) are funded jointly by the Australian, State and Territory governments through the National Healthcare Agreements - formerly the Australian Health Care Agreements (AHCAs).  

The Australian Government subsidises the costs of general practice and medical specialist services (including to pathology) to private patients in the community and in hospitals (private and public) through the Medicare Benefits Scheme (MBS).  Medicare rebates are based on the schedule of fees.  Doctors can accept the Medicare rebate as full payment for their service – this is known as bulk billing - or they can charge their own fee.  The patient then claims back from Medicare some of the money they paid to the doctor.

Some pathology testing is funded by private health insurers, workers’ compensation and motor accident schemes as well as by individuals on a fee for service basis.

Public pathology services are funded primarily through the National Healthcare Agreements and, to a lesser extent, through the MBS.  In contrast, the private pathology sector is largely funded through the MBS.   Most testing requested by GPs, specialists in private practice and by doctors working in private hospitals is undertaken by private pathology companies.  In some jurisdictions, the public pathology sector is a significant provider of testing services to GPs, specialists in private practice and communities.