Medicare is Australia’s national health insurance scheme. Medicare rebates are payable for health services that are specified as items on the Medicare Benefits Schedule (MBS). In response to the COVID-19 pandemic, between March 2020 and May 2020 the Australian Government introduced 281 new telehealth items on the MBS to enable the entire Medicare-eligible population to access a broad range of health services via videoconferencing and phone rather than face-to-face with a provider. Although the temporary telehealth items introduced in response to COVID-19 were initially scheduled to expire on 30 September 2020, the Australian Government postponed their expiry on three occasions in 2020 and 2021.

The COVID-19 pandemic and the pace and scale of the Australian Government’s response impacts on the risk environment faced by the Australian public sector. This performance audit was conducted under phase two of the ANAO’s multi-year strategy that focuses on the effective, efficient, economical and ethical delivery of the Australian Government’s response to the COVID-19 pandemic.

The expansion of telehealth services in 2020 to provide whole of population access to health services during the COVID-19 pandemic has been described by the Department of Health and Aged Care (Health) as ‘10 years of reform in only 10 days’. Rapid implementation of policy changes can increase risks to effective and efficient delivery of public services. The audit was conducted to provide assurance to Parliament over the rapid implementation of health policy changes during a pandemic and the transition from emergency to permanent arrangements.

Key findings:

• The temporary and permanent expansion of MBS telehealth items was informed by largely robust policy advice and planning. Policy advice to government on temporary telehealth services introduced in response to COVID-19 considered stakeholder views, although it did not present a structured assessment of risks or options for decision. Policy advice on permanent telehealth maintained focus on objectives, largely considered stakeholder opinions, and assessed the costs and benefits of different options. The implementation of temporary and permanent telehealth was based on business as usual processes for changes to MBS items, and there was no implementation plan for temporary telehealth. There was a high-level implementation plan for the permanent expansion of telehealth, although this did not adequately address evaluation.
• The department did not plan for performance monitoring or evaluation of temporary or permanent telehealth. Performance monitoring of the temporary telehealth expansion was limited and lacked measures and targets that could inform judgements about performance, and there was no evaluation that could assist with the design and implementation of potential expansions to telehealth during future emergency conditions. Evaluation of permanent telehealth is developing.