Australia
A high-income universal system with subsidized palliative medicines, a recognized specialty and a national outcomes benchmarking program, alongside tightening opioid controls.
9 domains reviewed · 9 high-confidence · 0 dated estimates · 9 material gaps
WHO region: Western Pacific. World Bank income group: Income group not yet retrieved.
- Domains reviewed
- 9 of 9
- Hospice: 3 of 4
- Backed by a primary document
- 0 of 9
- Open questions
- 13
- Sources behind this dossier
- 24
- Newest source 2026
Lessons from Australia
- Tighter opioid controls cut subsidized dispensing, but a quarter of the fall moved to privately paid use and monitoring did not reduce high-dose prescribing. Judging the effect on patients needs data from every channel: public, private and hospital.159,162,163
- A national outcomes benchmarking program improved care only when paired with education, implementation support and feedback. Collecting data alone did not.165,166
- A dedicated palliative section in the national medicines subsidy did not solve access at home. Subsidy listing needs matching pharmacy stock and community nursing.160,161
- Nurse practitioners who could prescribe made a rural home model work, but fee-for-service rebates did not cover travel. Widening prescribing needs payment rules that fit home care.164
- Aboriginal health workers and local care that lets people die on country are central to acceptable end-of-life care for Aboriginal families.499,500,501
- Mandatory real-time prescription monitoring did not reduce high-dose opioid prescribing and was followed by more use of unmonitored drugs, so monitoring alone should not be expected to improve safety.163
- A three-tier public health model can match bereavement support to need, with most people needing only informal support and a small high-risk group needing specialist care.689
Palliative care
Is morphine available in Australia?
Opioid supply. Is a therapeutic opioid physically available in the wards that need it? Every country on this question
Prescribed opioid use fell from 2015 to 2022 as subsidized dispensing dropped, with part of the fall shifting to privately paid and hospital use. Palliative physicians report essential medicines readily available in hospitals but several hard to obtain at home, and a national core list of community palliative medicines followed.159,160,161
How much of community access difficulty comes from pharmacy stocking, shortages or the 2020 subsidy restrictions?
Help answer it:Search PubMedHow does Australia regulate opioids for pain?
Narcotics regulation. What licensing regime governs stocking and dispensing, and when did it last change? Every country on this question
All codeine became prescription-only in 2018. States introduced real-time prescription monitoring, mandatory in Victoria from 2020, and national subsidy rules for opioids tightened the same year. In general practice, monitoring did not reduce high-dose prescribing.162,163
Did monitoring and the 2020 subsidy changes alter opioid access for palliative patients?
Help answer it:Search PubMedWho can prescribe morphine in Australia?
Prescriber authority. Who is legally allowed to prescribe, and can that group be widened? Every country on this question
General practitioners, working with community pharmacists, prescribe and coordinate end-of-life medicines at home. Endorsed nurse practitioners may prescribe, and a rural pilot judged prescribing authority essential to a nurse practitioner-led palliative model.161,164
What controlled-drug prescribing rights do nurse practitioners hold for palliative care in each state?
Help answer it:Search PubMedHow does palliative care reach patients in Australia?
Service delivery. Through what structure does care actually reach a patient at home? Every country on this question
Care is delivered in hospital, home, outpatient, aged care, correctional and disability settings. A government-funded national outcomes and benchmarking program has run since 2005, voluntary for services, and a parallel program for aged care homes began in 2021 with partial uptake. Its evaluators found benchmarking improves care only with education and implementation support.165,166
Do participating services achieve better patient outcomes than non-participating ones?
Help answer it:Search PubMedWho pays for palliative care in Australia?
Financing. Who pays for the drug, the visit and the workforce? Every country on this question
Palliative care is funded mainly through Medicare, the universal insurance scheme. Most opioid analgesics are subsidized through the national medicines scheme, which has a dedicated palliative care section; prescriptions outside its rules are paid privately. A rural nurse practitioner-led model cost more than fee-for-service income covered.165,159,160,164
How is specialist palliative care funded between the Commonwealth and the states?
Help answer it:Search PubMedHow are palliative care clinicians trained in Australia?
Training and recognition. What credential exists, who awards it, and does anyone recognize it? Every country on this question
Palliative medicine has been a recognized specialty since 2005. The Australasian Chapter of Palliative Medicine, within the Royal Australasian College of Physicians, runs accreditation and advanced training, which general practitioners can also enter. Specialist clinicians report training gaps for chronic non-cancer disease.167,168
How many palliative medicine specialists are there relative to need?
Help answer it:Search PubMedHow does Australia prevent opioid misuse without blocking pain relief?
Opioid safeguards. How are misuse and diversion controlled, and are treatment and naloxone available, without blocking pain relief? Every country on this question
After Victoria made real-time prescription monitoring mandatory, high-dose opioid prescribing did not fall, while starts of unmonitored pain medicines such as pregabalin rose. Opioid agonist treatment starts did not change, and people on high doses had lower odds of starting it. Among people who inject drugs, 92% of those trained had acquired take-home naloxone, and 63% of recent opioid users with a kit usually carried it.163,686,687,688
Has mandatory real-time prescription monitoring changed opioid access for people receiving palliative care, and what share of community pharmacies nationally now stock core end-of-life medicines?
Help answer it:Search PubMedHow do children get palliative care in Australia?
Children's palliative care. How do children with life-limiting conditions get palliative care and the medicines they need? Every country on this question
In Queensland, hospital admissions of young people with life-limiting conditions rose 29.6% from 2011 to 2016, including rises of 36.2% for non-cancer conditions and 70.2% for Indigenous young people. A national collaborative trains regional professionals so children can be cared for at home. Parents of children with non-cancer conditions reported greater support needs.691,692,693
How many children with life-limiting conditions across Australia are reached by specialist pediatric palliative care each year, and does access differ for Indigenous and rural children?
Help answer it:Search PubMedHospice care in Australia
How the hospice model works here, who can use it, who pays and who it reaches. Covered 3 of 4.
What does hospice care look like in Australia?
Hospice model. What does hospice mean here, who runs it, and in what settings? Every country on this question
Australian peer-reviewed reports describe "hospice" mainly as small local services within wider palliative care, such as a four-bed end-of-life unit inside a residential aged care facility in one rural NSW town and a community-based specialist palliative care service in Gympie, Queensland. The terms hospice and palliative care overlap in this literature, and these are single-site examples.356,357
How many inpatient hospices or palliative care units operate nationally, and who owns them (state, faith-based, charity)?
Help answer it:Search PubMedWho can get hospice care in Australia?
Hospice eligibility. Who can enter hospice, on what criteria, and how late do patients arrive? Every country on this question
What admission criteria (prognosis, diagnosis, referral route) do Australian inpatient hospices and palliative care units apply, and how late do patients arrive? No hospice-specific PubMed evidence was found.
Help answer it:Search PubMedWho pays for hospice care in Australia?
Hospice funding. Who pays for hospice care: a public benefit, insurance, charity or families? Every country on this question
In the two evaluated services, care was free to patients: the NSW unit was funded by the Local Health District, and the Queensland service combined government funding with local fundraising. These are single-site findings.356,357
How are hospice and inpatient palliative care beds funded nationally across state health budgets, Medicare and charity?
Help answer it:Search PubMedHow many people reach hospice in Australia?
Hospice reach. How many dying people use hospice, and who is left out? Every country on this question
A systematic review pooling studies from the UK, Australia, New Zealand and Canada found non-cancer patients, the oldest old, ethnic minorities and people in rural or deprived areas under-represented in hospice populations. Australia-specific figures were not reported separately in the abstract.343
What share of Australian deaths involve hospice or inpatient palliative care, and how does access differ for rural and Indigenous people?
Help answer it:Search PubMedWhat fills the gap in Australia
How people get care outside formal services: families, faith communities, volunteers, health workers, healers, other medicines and charity. Described, not scored.
- Family caregiving
Rural and remote Aboriginal people in the Northern Territory expressed a strong wish to die at home connected to land and family. Reasons included belief in 'death country', passing sacred knowledge to the right family member, and having the 'right person' in the family provide care.499
Subnational evidence- Community health workers and home-based care
In 6 rural Noongar communities in Western Australia, an Aboriginal health worker and a researcher shared advance care planning information at community events and home visits. Western Australian palliative providers said cultural safety training did not replace the need for an Aboriginal worker on the team.500,501
Subnational evidence
Sources cited here
- 159Chidwick K, Bharat C, Gisev N, et al.
Trends in prescription opioid analgesic use in Australia from 2015 to 2022. International Journal on Drug Policy 2024;135:104666. National IQVIA sales and PBS claims: total use fell, a quarter of the PBS fall offset by private and hospital use; most opioids PBS-subsidized for severe pain. Abstract and full text read.
- 160Power J, Luckett T, McNeill R, et al.
Essential medications in palliative care: an updated survey of Australian and New Zealand medical practitioners practising palliative care. Internal Medicine Journal 2026;56(8):1361-1368. Essential medicines readily available in hospitals, several hard to access in the community; the earlier survey contributed to the PBS palliative care section. Abstract and full text read.
- 161Tait P, Aylmer K, Christie L, et al.
A National Core Community Palliative Care Medicines List for managing end-of-life symptoms. Australian Journal of General Practice 2025;54(9):643-646. Development of the national core list; GPs coordinate with pharmacists. Abstract read.
- 162Xia T, Picco L, Lalic S, et al.
Determining the Impact of Opioid Policy on Substance Use and Mental Health-Related Harms: Protocol for a Data Linkage Study. JMIR Research Protocols 2023;12:e51825. Describes the 2018 codeine rescheduling, state real-time prescription monitoring (mandatory in Victoria from April 2020) and 2020 PBS opioid restrictions. Full text read.
- 163Nielsen S, Picco L, Russell G, et al.
Changes in opioid and other analgesic prescribing following voluntary and mandatory prescription drug monitoring program implementation: A time series analysis of early outcomes. International Journal on Drug Policy 2023;117:104053. Monitoring did not reduce high-dose prescribing in general practice. Abstract read.
- 164Mitchell GK, Senior HE, Bibo MP, et al.
Evaluation of a pilot of nurse practitioner led, GP supported rural palliative care provision. BMC Palliative Care 2016;15(1):93. Nurse practitioner prescribing in a rural pilot; service cost exceeded national insurance income. Abstract and full text read.
- 165Clapham S, Clark K, Draper K, et al.
A National Quality Initiative to Improve Palliative Care Outcomes: Identifying Enabling Factors that Drive Quality Improvement. Palliative Medicine Reports 2025;6(1):241-250. PCOC, established 2005 and government funded, voluntary; care funded mainly through Medicare across settings. Abstract and full text read.
- 166Johnson CE, Dai Y, Bryce L, et al.
The Palliative Aged Care Outcomes Program (PACOP): establishing a national framework to improve palliative care in long-term care facilities for older people. BMC Geriatrics 2026;26(1). Program established 2021 with government funding; partial uptake by 2025. Abstract and full text read.
- 167Oh SN, Kim SH, Lee MA, et al.
The Hospice and Palliative Medicine Physicians Certification Programs across Countries/Regions. Journal of Hospice and Palliative Care 2025;28(2):31-39. Review of certification in the United States, United Kingdom, Australia, Japan, Taiwan, Hong Kong and South Korea. Abstract and full text read.
- 168Disler R, Madhuvu A, Ly L, et al.
Palliative Care Training Gaps Remain in Chronic Disease Management Post-COVID-19. Journal of Pain and Symptom Management 2025;69(6):569-580. Specialist clinicians report lack of training for chronic non-cancer conditions. Abstract read.
- 686Picco L, Xia T, Bell JS, et al.
Changes in opioid agonist treatment initiation among people prescribed opioids for pain following voluntary and mandatory prescription drug monitoring program implementation: A time series analysis. Drug Alcohol Rev 2023;42(7):1639-1646. Same Victorian general-practice dataset examining opioid agonist treatment starts after monitoring began. Abstract read.
- 687Akhurst J, Price O, Sutherland R, et al.
Naloxone cascade of care among people who regularly inject drugs in Australia, 2020-2022. Int J Drug Policy 2024;133:104572. National interview survey of 2,149 people who inject drugs on take-home naloxone awareness, acquisition and carriage. Abstract read.
- 688Tait P, Horwood C, Hakendorf P, et al.
Improving community access to terminal phase medicines through the implementation of a 'Core Medicines List' in South Australian community pharmacies. BMJ Support Palliat Care 2017;10(1):e4. Repeat pharmacy survey in one state (South Australia), 2012 versus 2015. Abstract read.
- 689Aoun SM, Breen LJ, Howting DA, et al.
Who needs bereavement support? A population based survey of bereavement risk and support need. PLoS One 2015;10(3):e0121101. Postal survey of 678 bereaved clients of four funeral providers testing the three-tier public health model of bereavement support. Abstract read.
- 690Aoun SM, Keegan O, Roberts A, et al.
The impact of bereavement support on wellbeing: a comparative study between Australia and Ireland. Palliat Care Soc Pract 2020;14:2632352420935132. Comparison of two population-based bereavement surveys in Australia and Ireland. Abstract read.
- 691Bowers AP, Bradford N, Chan RJ, et al.
Analysis of health administration data to inform health service planning for paediatric palliative care. BMJ Support Palliat Care 2020;12(e5):e671-e679. Queensland hospital admissions data for people aged 0-21 with a life-limiting condition, 2011 and 2016; one state. Abstract read.
- 692Donovan LA, Slater PJ, Delaney AM, et al.
Building capability in paediatric palliative care and enhancing education through the voice of parents: the Quality of Care Collaborative Australia. Palliat Care Soc Pract 2022;16:26323524221128835. Interviews with 11 parents from one specialist service; authors are involved in the program they describe. Abstract read.
- 693Aoun SM, Gill FJ, Phillips MB, et al.
The profile and support needs of parents in paediatric palliative care: comparing cancer and non-cancer groups. Palliat Care Soc Pract 2020;14:2632352420958000. Non-randomised pilot with 28 parents in Western Australia using a carer needs tool developed by the authors' group. Abstract read.
- 356Handley T, Jorm C, Symington C, et al.
'It sort of has the feel of being at home': Mixed-methods evaluation of a pilot community-based palliative end-of-life service in a regional setting. Aust J Rural Health 2022;30(5):582-592. Evaluation of a four-bed end-of-life hospice unit in a residential aged care facility in one rural NSW town, funded by the Local Health District; single site, 58 admissions. Full text read.
- 357Rosenberg J, Flynn T, Merollini K, et al.
Exploring the 'citizen organization': an evaluation of a regional Australian community-based palliative care service model. Palliat Care Soc Pract 2024;18:26323524241260427. Co-designed mixed-methods evaluation of one community-based specialist palliative care service (Little Haven, Gympie, Queensland) funded by government and local fundraising; single service, co-designed with the service (self-evaluation elements). Full text read.
- 343Tobin J, Rogers A, Winterburn I, et al.
Hospice care access inequalities: a systematic review and narrative synthesis. BMJ Support Palliat Care 2021;12(2):142-151. Systematic review of 130 studies of adult hospice care in the UK, Australia, New Zealand and Canada (1987-2019) finding under-representation of non-cancer patients, the oldest old, ethnic minorities and rural or deprived residents; findings pooled across four countries. Abstract read.
- 499McGrath P.
'I don't want to be in that big city; this is my country here': research findings on Aboriginal peoples' preference to die at home. Aust J Rural Health 2007;15(4):264-8. 72 qualitative interviews with Indigenous patients, caregivers, health workers and interpreters in the Northern Territory. Abstract read.
- 500Sinclair C, Williams G, Knight A, et al.
A public health approach to promoting advance care planning to Aboriginal people in regional communities. Aust J Rural Health 2014;22(1):23-8. Qualitative study with 18 Noongar community members in 6 rural communities of the Great Southern region, Western Australia. Abstract read.
- 501Shahid S, Bessarab D, van Schaik KD, et al.
Improving palliative care outcomes for Aboriginal Australians: service providers' perspectives. BMC Palliat Care 2013;12(1):26. Interviews with 15 palliative care providers in Western Australia; provider views only. Abstract read.