australia are regulated by the private health insurance act 2007. complaints and reporting of the health industry is carried out by an independent government agency, the private health insurance ombudsman. the ombudsman publishes an annual report that outlines the number and nature of complaints per health fund compared to their market share. the private health system in australia operates on a "community rating" basis, whereby premiums do not vary solely because of a person's previous medical history, current state of health, or (generally speaking) their age (but see lifetime health cover loading below). balancing this are waiting periods, in particular for pre-existing conditions (usually referred to within the industry as pea, which stands for "pre-existing ailment"). funds are entitled to impose a waiting period of up to 12 months on benefits for any medical condition the signs and symptoms of which existed during the six months ending on the day the person first took out insurance. they are also entitled to impose a 12-month waiting period for benefits for treatment relating to an obstetric condition, and a 2-month waiting period for all other benefits when a person first takes out private insurance. funds have the discretion to reduce or remove such waiting periods in individual cases. they are also free not to impose them, to begin with, but this would place such a fund at risk of "adverse selection", attracting a disproportionate number of members from other funds, or from the pool of intending members who might otherwise have joined other funds. it would also attract people with existing medical conditions, who might not otherwise have taken out insurance at all because of the denial of benefits for 12 months due to the pea rule. the benefits paid out for these conditions would create pressure on premiums for all the fund's members, causing some to drop their membership, which would lead to further rises, and a vicious cycle would ensue. health funds are not permitted to discriminate between members in terms of premiums, benefits or membership on the basis of racial origin, religion, sex, sexual orientation, nature of employment, and leisure activities. premiums for a fund's product that is sold in more than one state can vary from state to state, but not within the same state. incentives a number of incentives encourage people to take out and maintain private hospital insurance, including: lifetime health cover loading: if a person has not taken out private hospital cover by 1 july after their 31st birthday, then when (and if) they do so after this time, their premiums must include a loading of 2% per annum. thus, a person taking out private cover for the first time at age 40 will pay a 20% loading. the loading continues for 10 years. the loading applies only to premiums for hospital cover, not to ancillary (extras) cover. medicare levy surcharge (mls): people whose income for mls purposes is greater than a specified amount and who do not have an 'appropriate level of cover' (being a complying health insurance policy that provides hospital cover with a payable excess not more than $750 for a policy covering a single insured, or $1500 for a policy covering more than one insured) pay the mls in addition to the standard medicare levy. private health insurance rebate: the government subsidises the premiums for all health insurance cover, including hospital and ancillary (extras), by a different percentage depending on income tier (with individuals on higher incomes entitled to a smaller rebate), and age (with those 70+ receiving the highest percentage rebate). medicare levy surcharge the government encourages individuals with income above a set level to privately insure. this is done by charging these (higher income) individuals a surcharge of 1% to 1.5% of income if they do not take out health insurance, and a means-tested rebate. this is to encourage individuals who are perceived as able to afford private insurance not to resort to the public health system, even though people with valid private health insurance may still elect to use the public system if they wish. the howard coalition government introduced a medicare levy surcharge (mls) with effect from 1 july 1997, as an incentive for people on higher incomes to take out and maintain an appropriate level of private health insurance, as part of an effort to reduce demand pressure on public hospitals by encouraging people to have insurance cover for them to use private hospitals. individuals can take out health insurance to cover out-of-pocket costs, with either a plan that covers just selected services, to a full coverage plan. in practice, a person with health insurance may still be left with out-of-pocket payments, as services in private hospitals often cost more than the insurance payment. initially, mls of 1% applied to individuals and families who did not have an “appropriate level of cover“ and whose taxable income was above a prescribed threshold. in 1997, the mls threshold was $90,000 for individuals or $180,000 for families. the threshold increased by $1,500 for each dependent child after the first in the family group. since 1 july 2012, the basis of the threshold has been "income for mls purposes", which includes the individual's or family group's taxable income, fringe benefits, superannuation contributions and net investment losses. in 2014, the surcharge rate was increased from 1% to 1.25% for those with mls income over $105,000, from $97,000, and 1.5% for those on incomes over $140,000, from $130,000; and the threshold amounts are doubled for families. the mls is calculated at the surcharge rate on the whole of an individual's mls income, and not just the amount above the mls threshold. the minimum mls amount is $900. the requirement that a higher-income earner have an “appropriate level of private hospital cover” is satisfied under the government's new four-tier hospital insurance structure introduced in 2019 by a basic hospital insurance cover. extras or add-on insurance alone does not qualify. private health insurance rebate in 1999, the howard government introduced the private health insurance rebate scheme, under which the government contributed up to 30% of the private health insurance premium of people covered by medicare. the program was estimated to cost $18.3 billion in 2007–08. in 2009, before means testing was introduced, the private health insurance rebate was estimated to cost $4 billion, around 20% of the total budget. the overall figure was projected to rise by almost 4% annually in real terms in 2007. since 2009, the rebate has been income- and age-tested. for a single person whose "income for mls purposes" is less than $90,000 a year, or $180,000 for a family, and under 65 years old, the rebate is 24.608% (1 april 2022 to 31 march 2023), covering both hospital and extras cover. the rebate phases down over those amounts and cuts out at $140,000 for a single person, and double for a family. the rebate can be claimed as a premium reduction or as a refundable tax offset. debates regarding medicare focus on the two-tier system and the role of private health insurance. controversial issues include: whether people with means should take up private health insurance whether rebates/incentives should be given in terms of private health insurance people with health insurance still accessing the tax-payer funded public system rather than relying on their insurance people with private health insurance are not required to pay the medicare levy surcharge. critics argue that the rebate is an unfair subsidy to those who can afford health insurance, claiming the money would be better spent on public hospitals where it would benefit everyone. supporters argue that people must be encouraged into the private health care system, claiming the public system is not universally sustainable for the future. similarly, even after the introduction of the rebate, some private health insurance companies have raised their premiums most years, to an extent negating the benefit of the rebate. in 2013/14 medicare expenditure was $19 billion and expected to reach $23.6 billion in 2016/17. during fy2014, approximately 47.2% of australians had private health insurance with some form of hospital cover. lifetime health cover loading to arrest the decline in the number of australians maintaining private health insurance, the government introduced the lifetime health cover loading, under which people who take out private hospital insurance later in life pay higher premiums, called a “loading”, compared to those who have held coverage since they were younger, and may also be subject to the medicare levy surcharge. four tier system from 1 april 2019, the federal government introduced a four tiered system of private hospital insurance, under which health funds will classify hospital policies into four tiers – basic, bronze, silver and gold. minimum coverage requirements will apply to each tier, and insurers can also offer add-ons (called "plus options") for the basic, bronze and silver tiers. the system will be rolled out by 1 april 2020. research conducted by consumer advocacy group choice found silver plus options offered by some health funds cost more than rival funds’ gold options, while providing less coverage. government agencies federal government agencies diphtheria immunization in brisbane, 1940 services australia, formerly the department of human services, is responsible for administering australia's universal health insurance scheme, such as making payments to health providers or patients. the department of health and aged care is responsible for national regulation of medicines and therapeutic devices, with the australian border force responsible for screening imports into australia to make sure that only approved medicines are allowed across the border. the australian institute of health and welfare (aihw) is australia's national agency for health and welfare statistics and information. its biennial publication australia's health is a key national information resource in the area of health care. the institute publishes over 140 reports each year on various aspects of australia's health and welfare. food standards australia new zealand and the australian radiation protection and nuclear safety agency also play a role in protecting and improving the health of australians. the australian health practitioner regulation agency (ahpra) are responsible for regulating the registration of most health practitioners. unless a person is registered on the national register as a certain health practitioner, it is illegal to call themselves as such or provide health care. national boards set the professional practice standards for each profession, and can apply to state and territory tribunals to suspend or remove health practitioner's registration. the national my health record is a digital health platform maintained by the australian digital health agency. the platform stores and allows access to medical records by registered health practitioners such as doctors and nurses. state and territory agencies the alfred hospital, melbourneeach state and territory is responsible for their own public hospitals, as well as the state or territory's health department (such as queensland health). for some internal territories (such as the jervis bay territory) and all external territories (such as norfolk island), health services are provided by another state or territory government. under the nhra, public health care services are provided by local health districts (such as metro north hospital and health service in queensland). ambulance services queensland and tasmanian state governments cover the cost of ambulance services for their citizens, both in the state and while interstate. outside of queensland and tasmania, the cost of ambulance services varies state-by-state, but is either a call out fee plus a per-kilometre charge, or a membership to that state's ambulance provider. each state and territory has their own ambulance service, such as nsw ambulance, ambulance victoria or the queensland ambulance service. non-government organisations australian red cross lifeblood collects blood, plasma and other essential tissue and organ donations and provides them to healthcare providers. the national health and medical research council (nhmrc) funds competitive health and medical research, and develops statements on policy issues. the royal flying doctor service provides both emergency and primary health care in rural and regional australia using aircraft. heart of australia provides specialist cardiac and respiratory investigation and treatment services in rural and regional queensland, particularly mining towns, using specially-equipped large trucks. challenges the royal adelaide hospital. workforce in a report published by healthworkforce australia in march 2012, a shortage of nearly 3,000 doctors, over 100,000 nurses and more than 80,000 registered nurses was predicted in the year 2025. in the conclusion of the report, the hwa explains: "for