Freedom Of Information

Who Introduced a Two Tier Medicare Rebate System?

Documents Obtained via Freedom of Information

It wasn’t easy obtaining these documents, RAPS met very strong resistance from the APS to the FOI process.  The eventual documents revealed why that resistance was so enduring.

Note: Links to download the FOI documents are at the bottom of this article.

The APS managed to stall RAPS efforts to obtain these documents for almost 12 months, eventually forcing the decision to the Administrative Appeals Tribunal.  Here the APS ran out of options.  Why such determined resistance?  Because the FOI documents presented a truth which directly contradicted major facts the APS had been presenting to their members regarding the introduction of the two tier Medicare rebate system.

In short, the APS only ever advocated for clinical psychologists to be admitted to the Medicare Register.

The FOI documents include every official policy recommendation from the APS with respect to the development of the Better Access initiative across 2005 and 2006.

The main submission to DoHA by the APS was in May 2006, here are some excerpts:

“All applicants will have to complete a range of requirements equivalent to those for eligibility to the APS College of Clinical Psychologists in order to be admitted to the Register.”

“Process of Selection for Admission to the Register

The application forms will be processed initally by clerical staff according to the criteria for admission to the Register and will be sorted into three categories:

Catergory 1.  Clear eligibility on the basis of qualifications, experience and professional development

E.g. Current membership of the APS College of Clinical Psychologists or clear evidence of having completed postgraduate degree in clinical psychology and experience in a mental health setting

Catergory 2.  Eligibility requires clarification of qualifications, experience and professional development

E.g. Postgraduate psychology degrees other than clinical psychology; experience in a mental health setting

Catergory 3.  Eligibility requires clarification of experience and professional development

E.g. Registered psychologists (four-year degree) with extraordinary experience in mental health who meet criteria on the basis of professional development activities and experience

The latter two categories of applicants would have their applications assessed by an experienced clinical psychologist (preferably with high familiarity with APS College of Clinical College Psychologists requirements) appointed by the APS.  This clinical psychologist would also advise applicants in Category 3 on what is necessary to complete training or experience in order to gain future admission to the Register.”

Note:  The above selection process and 3 categories were tightened considerably in the APS submission to DoHA in August.  These additional restrictions, for all practical purposes, shut the door on highly experienced expert practitioners, but allowed new and therefore inexperienced graduates directly into the Medicare Registry.

There is no mention of any other category of psychologists to be admitted to the Register.  The APS advocated for:

  • a tier that was entirely occupied by clinical psychologists, and
  • that the APS would control this gateway for entry.

In the June Edition of the APS publication ‘InPsych’ the Executive Director Lyn Littlefield states:

“It is worth noting here that the original APS position in the negotiations before the introduction of the Better Access initiative was for a broader definition of a ‘clinical and mental health specialist psychologist’ that was not restricted to those eligible for Clinical College membership.”

There is no evidence of such advocacy in the FOI documents.

So how did a two tier Medicare rebate system come into existence for psychology services?

It appears, from colleagues reports, that Tony Abbott, as indeed do all politicians, takes advice from peak bodies.  In this instance the APS.  The advice was to admit clinical psychologists only to the Medicare Register.  The advice was problematic, the mental health needs of Australians could not be serviced by the smaller number of clinical psychologists.  We surmise that Tony Abbott decided to admit all psychologists registered to practice to the Medicare register.  The skill base of these registered, highly trained, expert psychologists was needed to meet the demand.  An unfortunate decision was then made to include all of these ‘other psychologists’ on a lower rebated second tier.  We do not know how this decision was made, we do know that the APS only advocated for clinical psychologists to be admitted.  APS advocacy for clinical psychologists as the only mental health experts was a likely factor influencing Tony Abbott’s decision for a two tier system.  Since the introduction of this system in November 2006 the APS has never advocated for the two tiers to be changed.

All in all, was the decision for a two tier system a wise one?  You decide … here is some relevant information to help you.

Freedom of Information Documents:



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