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Background
Health practitioner regulation in Australia began in 1837 when a Medical Council was established in the colony of Van Diemen’s Land (now Tasmania) (Thomson, 2006). This set the pattern of co-regulatory arrangements between the state and the professions. The Commonwealth (national) Government was established in 1901, and the responsibility for health practitioner regulation was maintained by the states and later additionally, two territories. Between 1901 and 2010, a patchwork arrangement for the registration of health practitioners developed across the country. By 2010, 15 health profession groups were regulated by legislation in one or more jurisdictions. In many cases, each jurisdiction had separate legislation for each practitioner group. Only the state of Victoria had multi-professional legislation, having introduced its Health Professions Registration Act in 2005. Some health practitioner groups (e.g. Chinese Medical Practitioners in Victoria (Zhou et al., 2012) and Aboriginal and Torres Strait Islander Health Practitioners in the Northern Territory), were only registered in a single jurisdiction prior to the introduction of the Scheme (Australian Health Ministers’ Advisory Council, 2009).
Governments in Australia have traditionally been funders, providers and regulators of components of the health care system. Almost 70 per cent of expenditure on health care is undertaken by the federal and jurisdictional governments, which includes universal access to public hospital services as well as taxation support for private health insurance, with approximately 43 per cent of total expenditure contributed by the Commonwealth and 27 per cent by states and territories (Australian Institute of Health and Welfare, 2014). Health policy, including that concerning the health workforce, is understandably then a central and omnipresent concern to Australian governments. Its constitutional arrangements also provide for a complex reform environment (Healy and Walton, 2016; Sgrò, 2014; Spigelman and Rendalls, 2015).
Moves towards this significant change in workforce governance began when reform of the health workforce began to be seen as a part of broader economic reform agenda. Governments can influence the labour market of health practitioners through influencing education and training opportunities, and through wider health system reform and direct regulation. This paper focusses on the direct regulation lever. In 2002 the Commonwealth Government, through its Treasury Department, issued the nation’s first Intergenerational Report as part of the 2002-2003 budget (Australian Government, 2002). Its aim was...