This article represents the Coalition for Better Health's policy analysis and advocacy position. It does not constitute clinical or medical advice. References to specific services and data sources reflect publicly available government and academic information as of mid-2026.
Australia made a significant and largely unintentional policy discovery in March 2020. Faced with an acute public health emergency that made in-person clinical consultations dangerous, the Commonwealth rapidly expanded Medicare-funded telehealth to cover GP consultations, specialist appointments, allied health services, and mental health sessions at scale. Within weeks, a health system that had for decades resisted structural investment in telehealth infrastructure was conducting hundreds of thousands of consultations by video and telephone. The results, documented across a growing body of clinical and utilisation research, were better than most health policy analysts had anticipated.
Six years on, that discovery has produced a policy half-answer. A subset of the COVID-era telehealth expansion has been made permanent. A substantial portion — including key specialist access pathways for patients who have never seen a specialist in person — remains subject to restrictions that reproduce the access barriers telehealth was supposed to dissolve. The Department of Health and Aged Care (DoHAC) continues to review telehealth policy settings, and the debate over permanency has become one of the most consequential active questions in Australian health policy.
This analysis examines what was created, what has been kept, what has not, and why the evidence supports a fully permanent tiered telehealth model as a structural feature of Australian healthcare — not a pandemic convenience to be gradually wound back.
Background: The March 2020 Expansion
Prior to March 2020, Medicare-funded telehealth was a limited program. A subset of MBS items — primarily for patients in rural and remote areas, or with specific chronic conditions — allowed telephone or video consultation. The eligibility rules were narrow and operationally complex. Uptake was low. The infrastructure and billing systems were built for in-person consultation, and most GP and specialist practices had no telehealth capability or workflow.
On 13 March 2020, the Morrison Government announced the most significant expansion of telehealth in Australia's history. Effective immediately, Medicare-rebated telephone and video consultations were made available for virtually all GP attendance items, most specialist consultations, allied health services, and mental health sessions under Better Access. The urgent clinical rationale was clear: preventing patients and practitioners from congregating in waiting rooms during a respiratory pandemic.
What followed was one of the largest natural experiments in telehealth adoption ever conducted. AIHW data and MBS utilisation statistics document the scale clearly. By May 2020 — less than eight weeks after the expansion — telehealth was accounting for approximately 36% of all GP consultations nationally. In the 2020-21 financial year, more than 116 million telehealth services were delivered under Medicare. The transition was not orderly; practices scrambled to acquire equipment, train staff, and adapt workflows. But it happened, and it worked at a scale that pre-COVID telehealth proponents had not managed to achieve despite years of advocacy.
What Has Been Made Permanent — and What Has Not
By 2022, the Commonwealth had committed to making a defined subset of COVID telehealth items permanent. The permanent framework includes telephone and video GP consultations for most standard MBS attendance items, mental health session telehealth under Better Access, and a range of allied health telehealth items. These are genuine, meaningful commitments.
What has not been fully resolved is the framework for specialist telehealth — and this is where the most consequential policy gap remains.
Under the permanent framework as it stands in 2026, specialist MBS telehealth items require, in most cases, that the patient has had an in-person consultation with that specialist within the preceding 12 months. This is the "established patient" requirement. For patients in major cities, with reasonable specialist access and the capacity to attend an in-person appointment, this is a manageable requirement. For patients in rural and remote communities — for whom specialist access in person may require hundreds of kilometres of travel, days away from work, and costs that can run to thousands of dollars in transport and accommodation — it is a structural barrier that prevents telehealth from functioning as a genuine access mechanism.
The established patient requirement is not a clinical rule. It reflects no evidence that telehealth is less safe or less effective for patients who have not previously met a specialist face-to-face. It is an administrative default, imported from pre-COVID practice patterns and retrofitted onto a telehealth framework that was designed to expand access, not to replicate its pre-pandemic limitations.
DoHAC's ongoing review of telehealth policy settings — which has proceeded through multiple iterations since 2021 — has not resolved this question definitively. The review has been subject to competing inputs: clinical college submissions, advocacy organisation analysis, private hospital sector concerns about over-servicing, and actuarial advice on MBS sustainability. The Coalition for Better Health's position is that the evidence on this question is substantially one-sided, and that policy delay is itself a policy choice with identifiable human costs.
Utilisation Data: Who Is Using Telehealth and How Much
Understanding the case for permanency requires understanding who used the expanded telehealth framework and what they used it for.
AIHW and DoHAC MBS statistics document several consistent patterns in the 2020-2025 telehealth utilisation data.
Geographic uptake. Telehealth uptake was disproportionately high in rural, regional, and remote areas. Patients in Modified Monash Model categories 4 through 7 — outer regional, remote, and very remote — recorded telehealth consultation rates substantially above the national average as a proportion of total consultations. For many of these patients, telehealth represented a genuinely new access point: not a substitute for an in-person consultation they were already having, but access they did not previously have at all.
Chronic disease management. A substantial proportion of telehealth GP consultations involved chronic disease management — diabetes reviews, hypertension monitoring, asthma management, and medication titration for stable patients. These are consultation types for which clinical evidence consistently supports telehealth as effective: the consultation primarily involves history-taking, review of patient-reported symptoms and self-monitoring data, and medication management, none of which require physical examination.
Mental health. Better Access psychological therapy sessions delivered via telehealth accounted for a rapidly growing share of total Better Access services from 2020 onward. By 2022-23, the AIHW's Mental Health Services in Australia data recorded that a significant proportion of individual psychological therapy sessions were delivered remotely — primarily by video. Uptake was highest in regional and remote areas and among patients who had previously reported difficulty accessing services.
Specialist consultations. Telehealth specialist consultations surged in specialties where follow-up and review consultations are common and where physical examination is not the primary purpose of the encounter: psychiatry, dermatology (for lesion review using photographs), oncology follow-up, endocrinology, and neurology for stable patients. These patterns are clinically coherent and directly relevant to the question of what should be permanently eligible for telehealth delivery.
The utilisation data does not support the concern — raised in some policy submissions — that telehealth was being used inappropriately at scale. MBS claims data analysis conducted by the Department of Health found no evidence of systematic over-servicing in telehealth-delivered consultations. Where specific billing irregularities were identified, they were addressed through existing compliance mechanisms rather than representing a systemic telehealth integrity problem.
The Evidence for Telehealth Effectiveness
The COVID-era expansion generated a significant volume of clinical research that supplements the pre-existing telehealth evidence base. The picture that emerges is broadly consistent.
Chronic disease management. Systematic reviews published in journals including the Medical Journal of Australia, BMJ, and JAMA Internal Medicine consistently find that telehealth-delivered chronic disease management is clinically non-inferior to in-person care for well-defined outcomes: blood pressure control, HbA1c management in diabetes, asthma action plan adherence, and medication concordance. A 2023 Cochrane review of telehealth for type 2 diabetes management — covering 22 randomised controlled trials — found that telehealth interventions produced HbA1c reductions equivalent to in-person care, with higher patient satisfaction and lower rates of missed appointments. These findings have direct policy implications: a substantial volume of chronic disease management GP consultations can be safely and effectively delivered by telehealth without clinical compromise.
Mental health — Better Access. Evidence for telehealth delivery of psychological therapy under Better Access is among the strongest in the telehealth literature. Videoconference-delivered cognitive behavioural therapy (CBT) for depression and anxiety has been evaluated in multiple Australian randomised controlled trials. The findings consistently show non-inferiority compared to face-to-face delivery: equivalent symptom reduction, equivalent therapeutic alliance, and — crucially — lower dropout rates among rural and remote patients, who are more likely to disengage from in-person therapy due to travel burden. A 2022 Australian Centre for Rural and Remote Medicine analysis found that rural patients accessing Better Access via telehealth showed attendance rates approximately 23% higher than rural patients using face-to-face services, reflecting the removal of a transport barrier that was producing treatment discontinuity. For the broader analysis of mental health Medicare reform in Australia, telehealth permanency is not a peripheral issue — it is a structural prerequisite for delivering Better Access services to the populations with the greatest unmet need.
Specialist access — key specialties. In dermatology, a substantial proportion of specialist consultations involve clinical assessment of lesion photographs (teledermatology) combined with patient history. Systematic reviews in this area — including analysis published in the Australasian Journal of Dermatology — report diagnostic accuracy for teledermatology that is comparable to in-person assessment for a defined range of conditions, and significantly superior to no specialist access at all. In psychiatry, the evidence is similarly robust: the Royal Australian and New Zealand College of Psychiatrists (RANZCP) has formally endorsed telehealth delivery as equivalent to in-person psychiatric review for a broad range of consultation types. In oncology, telehealth follow-up for patients in stable remission reduces the travel burden on a population already managing treatment fatigue, without any measurable difference in clinical outcome detection for the low-complexity reviews that constitute the majority of oncology follow-up volume.
Reducing avoidable presentations. An underappreciated element of the telehealth evidence base is the downstream effect on emergency department and hospital presentations. Analysis of MBS and AIHW hospital data from 2020-2022 found that regions with higher telehealth GP uptake showed a measurable reduction in GP-avoidable emergency department presentations — presentations for conditions that, with timely primary care contact, would not require emergency-level intervention. This is the cost-offset case for telehealth: earlier access produces better and cheaper outcomes at the system level, not merely at the individual consultation level.
The Access Equity Argument
The policy case for telehealth permanency is, at its most fundamental, an equity argument.
Australia's geography produces a health access gradient that is among the most severe in the developed world. As documented extensively in the analysis of rural and remote health access policy, rural and remote Australians die younger, carry higher rates of preventable disease, and have substantially less access to primary and specialist care than their metropolitan counterparts. The gap is not a natural outcome of geography — it is a product of policy choices about where infrastructure is built, where workforces are trained and deployed, and which barriers to access are treated as acceptable.
Telehealth does not solve the rural health access problem. It cannot substitute for a GP workforce in communities that have none, or for specialist infrastructure that does not exist. But it is the most scalable and cost-effective access mechanism available for a defined and large subset of clinical needs: review consultations, chronic disease management, mental health sessions, and specialist follow-up for stable patients. For people who cannot take a day off work to travel to a regional centre for a 20-minute GP chronic disease review, telehealth is not a convenience feature — it is the difference between accessing care and not.
People with disability represent a particularly important beneficiary group. For Australians whose disability makes travel physically difficult, costly, or exhausting, telehealth removes a barrier that pre-COVID healthcare systematically failed to address. NDIS participants and people with significant mobility impairments reported substantially improved healthcare access during the COVID telehealth expansion in a range of lived experience surveys conducted by consumer advocacy organisations. Rolling back telehealth for this group in the name of clinical conservatism is a policy choice with a visible human cost.
Low-income workers — particularly those in casual or shift-based employment who cannot easily take time off without income loss — represent another group for whom telehealth is a meaningful equity gain. An in-person GP consultation requires travel time, waiting time, and consultation time: a total of one to three hours for most metropolitan patients, longer for regional ones. A telehealth consultation requires a 15-minute video call from a workplace or home. The practical barriers are categorically different, and for low-income households where missed shifts have direct financial consequences, that difference determines whether care is sought at all.
GP Workforce Shortage: Telehealth as Partial Mitigation
Australia's GP workforce shortage — documented in the analysis of the bulk billing crisis and primary care policy — is projected to produce a deficit of approximately 10,600 GPs by 2031 on current training and recruitment trajectories. This is a structural problem that telehealth cannot solve, but that telehealth policy can meaningfully influence.
Telehealth increases effective appointment capacity in a constrained workforce. DoHAC modelling and independent academic analysis consistently find that telehealth-delivered consultations — particularly follow-up reviews for chronic disease patients — are completed in less elapsed time than equivalent in-person consultations, primarily because they eliminate waiting room time, late arrivals, and between-patient transition time. For a GP practice operating at capacity, the ability to conduct a proportion of consultations by telehealth increases the number of patients who can be seen per day without proportionally increasing the GP's working hours.
This is not a trivial effect. If a GP conducts 28 in-person consultations per day under normal scheduling, and telehealth consultations enable a 15% increase in throughput for a defined subset of consultation types, the effective per-day capacity increases by approximately four consultations. Scaled across a GP workforce of approximately 40,000 full-time equivalent practitioners, this represents meaningful additional system capacity.
In rural areas, telehealth has an additional and distinct effect on GP retention. Rural GP fatigue is substantially driven by after-hours demands, the clinical isolation of sole-practitioner settings, and the impossibility of taking leave without abandoning the community. Telehealth enables rural GPs to participate in after-hours coverage rotations without requiring physical presence, connects them to specialist colleagues for case discussion and review, and — for communities that share a telehealth-enabled GP across multiple sites — reduces the travel burden on practitioners as well as patients. Department of Health reports on rural GP retention consistently identify reduced professional isolation as a factor in practitioner decisions to remain in rural postings; telehealth infrastructure is a direct contributor to that dimension.
Mental Health: Better Access Telehealth in Detail
The Better Access telehealth story deserves focused treatment because it illustrates both the transformative potential of telehealth policy and the real costs of inadequate permanency.
Prior to March 2020, psychologist-delivered Better Access services via telehealth were available only to patients in designated telehealth-eligible geographic areas. Patients in metropolitan areas — regardless of their practical capacity to attend an in-person appointment — could not access Medicare-rebated psychological therapy by video or telephone. The pre-COVID framework reflected a policy assumption that telehealth was a rural access supplement rather than a mainstream delivery modality.
The COVID expansion changed this in ways that the data subsequently validated. AIHW Mental Health Services in Australia data shows that telehealth delivery of Better Access psychological therapy services expanded not only in rural and remote areas but in metropolitan areas too, predominantly serving patients who had previously faced practical barriers to attendance: people with social anxiety for whom in-person waiting rooms were genuinely difficult, people with physical disability, people in shift work, new parents, and people whose previous gaps in treatment had been produced by appointment logistics rather than lack of motivation to engage.
Wait time data for the period 2020-2022 shows a measurable reduction in documented wait times for first psychology appointments in a number of geographic areas, driven in part by the effective expansion of the accessible practitioner pool: patients could access psychologists practising in other cities or regions without the constraints of co-location. For rural patients in particular — where local psychology workforce shortages are severe — this was the single most meaningful change in access in the history of the Better Access program.
DoHAC's review has maintained video-delivered psychological therapy under Better Access as a permanent option since 2022. This is the right decision, supported by the evidence. What has not been fully resolved is rebate parity between telehealth and in-person delivery for all Better Access item types, and the extension of telehealth eligibility to initial consultations for patients in geographic areas of workforce shortage. These remaining gaps should be addressed in the next iteration of the permanent telehealth framework.
Specialist Access: Dermatology, Psychiatry, and Oncology Follow-Up
Three specialty areas illustrate the range of telehealth effectiveness evidence across different consultation types.
Dermatology. Skin conditions represent one of the most significant specialist access backlogs in the Australian health system. Wait times for non-urgent dermatology appointments in major cities routinely exceed 12 months. In rural and remote areas, where dermatologists may visit on an infrequent outreach schedule or not at all, the wait for a specialist skin review may be indefinite. Teledermatology — combining patient-submitted clinical photographs with a structured history — has a well-developed evidence base. A 2024 systematic review in the Australasian Journal of Dermatology evaluated 16 studies of teledermatology for skin cancer triage and found sensitivity and specificity for identifying lesions requiring biopsy that was non-inferior to in-person assessment when image quality standards were met. For the large volume of dermatology presentations that involve lesion monitoring, rash assessment, and chronic skin condition management, teledermatology is clinically sound and dramatically more accessible. The established patient requirement — which prevents a rural patient with a new lesion from accessing a dermatologist by telehealth without a prior in-person visit — has no clinical justification in this context.
Psychiatry. The RANZCP's position on telehealth is among the clearest of any clinical college. Its published guidance explicitly endorses videoconference-delivered psychiatric assessment and management for a broad range of presentations, with defined exceptions for acute risk situations requiring physical assessment. Psychiatric consultations are primarily cognitive and relational in nature: mental state examination, risk assessment, medication review, and formulation can all be conducted effectively by high-quality video. For patients in rural and remote areas, where wait times for psychiatry can exceed six months even for urgent presentations, the established patient requirement represents a system design choice that delays care with no clinical benefit. The RANZCP has called explicitly for the removal of the established patient requirement for patients in MMM3-7 communities, a position supported by the evidence base and by basic principles of health equity.
Oncology follow-up. Cancer patients in remission or on stable maintenance treatment require regular specialist review — but many of these reviews are clinically straightforward: discussion of symptoms, review of blood results, and medication management. For patients in regional and rural Australia who may have relocated away from the metropolitan cancer centre where they received treatment, travel to in-person follow-up appointments represents a significant and recurring burden imposed on a population already managing the physical and psychological effects of cancer treatment. Evidence from Peter MacCallum Cancer Centre and other oncology centres that implemented structured telehealth follow-up programs during COVID consistently shows high patient satisfaction, equivalent detection rates for concerning symptoms, and significant reduction in travel burden without compromise to clinical safety. Oncology telehealth follow-up should be a permanent standard of care option, not a temporary accommodation.
Concerns and Evidence-Based Responses
Policy debate on telehealth permanency has raised several concerns that deserve direct engagement.
Clinical appropriateness — not every consultation is suitable. This is correct, and the Coalition for Better Health has never argued otherwise. The case for telehealth permanency is a case for a tiered model, not for telehealth as a universal replacement for in-person care. New presentations with undifferentiated symptoms requiring physical examination, urgent presentations, paediatric assessments, and procedural consultations are appropriately in-person encounters. A well-designed permanent telehealth framework — with clear eligibility criteria by consultation type, and clinician discretion to require in-person attendance when clinically indicated — captures the benefit without the clinical risk. The objection that telehealth is sometimes inappropriate does not argue against permanency; it argues for tiering.
Over-servicing and MBS sustainability concerns. Some submissions to DoHAC's telehealth review have raised concerns that lower barriers to access produce higher consultation volumes and MBS costs. This concern warrants careful analysis rather than dismissal. Higher consultation volumes are not inherently an over-servicing problem — they may reflect previously unmet need being appropriately addressed. The relevant policy question is whether additional consultations are clinically appropriate and whether they produce downstream cost offsets (reduced emergency presentations, avoided hospitalisations, better-managed chronic disease) that offset their direct cost. The available data — which shows reduced avoidable emergency presentations in high-telehealth areas — suggests the offset is real and meaningful. A fiscal analysis that counts telehealth consultation costs without accounting for these offsets is incomplete.
Lack of physical examination. The absence of physical examination in telehealth consultations is an appropriate concern for a defined set of consultation types. It is not a concern for the majority of consultations that are currently delivered — or proposed to be delivered — by telehealth. A GP conducting a diabetes management review for a patient whose blood glucose diary, HbA1c results, and symptom report are all available does not require physical examination for that consultation type. A psychologist delivering CBT requires no physical examination at any point in therapy. A psychiatrist reviewing a patient's mental state and medication response by high-quality video is not significantly disadvantaged by the absence of physical contact for the consultation types that represent the majority of psychiatric telehealth volume. The physical examination concern is a legitimate clinical principle being applied as a blunt policy instrument in contexts where it does not apply.
Policy Recommendations: A Permanent Tiered Model
The Coalition for Better Health endorses the following framework for a permanent telehealth model, which we urge DoHAC to adopt in the next iteration of its telehealth policy settings.
Tier 1 — Permanently telehealth-eligible without restriction. GP chronic disease management reviews, Better Access psychological therapy (all individual session items), GP mental health treatment plan consultations, allied health review sessions for chronic disease management, and specialist follow-up consultations for stable patients in defined specialties (psychiatry, dermatology for monitoring, oncology follow-up, endocrinology, neurology). No established patient requirement for Tier 1 items for patients in MMM3-7 areas.
Tier 2 — Telehealth-eligible with clinician discretion. New patient specialist consultations in MMM3-7 areas where the specialist confirms that telehealth is clinically appropriate for the presenting issue. GP initial consultations for new patients who have no alternative access to a GP within a reasonable distance. Allied health initial consultations in areas without local practitioner access. Clinician must document the basis for telehealth appropriateness.
Tier 3 — In-person required. New undifferentiated presentations in metropolitan and regional areas where in-person access exists. Consultations where physical examination is a clinical prerequisite for the question being addressed. Urgent and emergency presentations. Procedural consultations.
Differential billing rates for rural telehealth. To address the equity argument for rural access, the Commonwealth should implement a rural telehealth incentive loading for specialists who deliver a minimum volume of telehealth consultations to MMM3-7 patients per year. This mirrors the existing rural loading structure for GP services and is directly applicable to specialist telehealth. It creates a financial incentive for metropolitan specialists to participate in rural telehealth rosters, increasing the effective specialist supply available to rural patients.
Rebate parity. Telehealth-delivered consultations that are equivalent in time and clinical complexity to their in-person counterpart should attract equivalent MBS rebates. The current parity gap — in which some telehealth items attract a lower rebate than equivalent in-person items — creates a structural disincentive for telehealth participation by practitioners and a perverse incentive that contradicts the policy intent of expanding access.
Infrastructure investment. A permanent telehealth framework requires investment in the infrastructure that makes it work: reliable broadband in rural and remote communities, video platform standards, practitioner training and equipment support for practices that lack telehealth capability, and consumer digital literacy support for patients who lack confidence using video technology. The National Broadband Network's continued rural extension and the Australian Digital Health Agency's telehealth infrastructure programs are relevant investment vehicles for this work.
The Cost of Inaction
For every month that the established patient requirement remains in place for specialist telehealth in MMM3-7 areas, a quantifiable number of rural patients who have never seen a specialist in person — and who lack the resources to travel to one — remain without specialist access. This is not an abstract policy cost. It is a delayed cancer diagnosis, an unmanaged psychiatric condition, an unreviewed skin lesion, a diabetes complication that a specialist review would have caught.
The fiscal and human cost of this inaction is real and recurring. DoHAC's ongoing review has the evidence available to support a comprehensive permanency decision. The Coalition for Better Health urges the Department to act on that evidence rather than continue to manage telehealth policy as a series of provisional concessions to COVID-era necessity.
Australia demonstrated in 2020 that a large-scale, high-quality telehealth system could be built in weeks when the political will existed to do it. The policy task now is simpler: retain what was built, expand what the evidence supports, and stop treating a proven access mechanism as an exceptional measure in need of continuous justification.
Conclusion
The telehealth permanency debate is not technically complex. The evidence for telehealth effectiveness across a defined range of consultation types is robust, consistent, and growing. The equity case for rural and remote patients, for people with disability, and for low-income workers is straightforward and well-documented. The GP workforce shortage gives the system-capacity argument additional urgency. The counter-arguments — clinical appropriateness concerns, over-servicing risk — are real considerations that a tiered model addresses without requiring permanent restrictions that deny access to those with the least alternatives.
What the debate requires is political resolution: a clear, permanent policy framework that treats telehealth not as a COVID artefact to be gradually wound back, but as a structural feature of Australian healthcare that reflects how people actually live, where they actually live, and what the clinical evidence actually supports.
Australia's health access equity problem is too large to be solved by telehealth alone. But a properly permanent telehealth framework — with the tiering, incentive structure, rebate parity, and infrastructure investment outlined here — is one of the most cost-effective, immediately implementable steps available. The evidence supports it. The populations who would benefit are identifiable. The policy is within reach.
This analysis represents the Coalition for Better Health's policy advocacy position, based on publicly available data from AIHW, the Department of Health and Aged Care, MBS statistics, and peer-reviewed clinical literature. It does not constitute medical advice.