The healthcare expenditure in Australia in the previous financial year was AUD 170.4 billion, with 10.3% of the gross domestic product (GDP), thereby allowing the country’s healthcare spending to pass the 10% mark for the first time. Healthcare expenditure continues to rise; however, the rate of increase has been curbed in the last few years. At AUD 6,846 per annum, Australia accounts for the highest per-capita expenditure in healthcare across Asia-Pacific (APAC). Due to one of the most super ageing population in APAC, Australia’s health spending is expected to continue rising, with a larger increase contributed from higher prices of health goods and services than from a higher service volume.

Healthcare services account for a significant proportion of the total spending. Australia’s health system is complex, especially the funding model, with multiple sources of funds, such as the commonwealth, state funds, private insurers, and out-of-pocket spending. As a result, the medical billing process is convoluted for both patients and providers, with scope for inefficient practice workflows and billing errors. Apart from medical billing, practice management is complex as it balances scheduling, emergency care, patient management, care coordination, and long-term treatment plans. Navigating through various administrative processes at multiple points of care is cumbersome for patients as well because they may need to register and fill out multiple forms, manage appointments, and work through insurance documentation, depending on the site of care and healthcare services received.

The increased aging population and the high prevalence of chronic diseases result in more patients at hospitals; therefore, the workflow becomes complicated, and facilitating a smooth patient journey becomes more difficult. Patient records continue to be in multiple repositories, even within the hospital, and are not linked to non-clinical solutions to help manage the workflow better.

While the clinical IT segment continues to advance, the non-clinical IT segment (including patient appointments, lab request system, prescription system, and billing system) has not progressed as fast in enabling the seamless flow of information as the patient moves between care points within the hospital. As a result, despite heavy investments in EMR systems, the operational staff at most hospitals still date back and consolidate information manually for ordering, billing, and claims processing, which take up a significant amount of resources and create immense frustration among the non-clinical staff and patients.

Additionally, as the healthcare industry is moving toward patient-centric care, providing an excellent experience throughout the patient’s hospital journey is becoming crucial. Even with many medical billing and patient administration solutions on the market, a single application base across various hospital systems using common processes and one data reference source is still largely unavailable. The market has some integrated EMR and PAS solutions; however, these solutions are not customized to the Australian market, and they lack the capability to integrate with the national health record system called My Health Record.

A continuous information exchange between hospitals and general practices (GPs) is needed to ensure high-quality patient care as well as smooth medical workforce management. The Department of Human Services has invested in online platforms to streamline medical claims processing that can interface with information systems used by various care providers. Managing and automating all these processes require specialized software solutions that are collectively called medical billing and practice management solutions.

The need to manage the workflow at hospital and medical practices as well as the need for efficiency in billing and finance processes in the market that has multiple payers are the top most drivers for this market. However, budget constraint and comfort with paper based system are some restraints hampering market growth.

The market is segmented into hospitals and primary care; with hospital segment further sub-segmented into tertiary and secondary hospitals while the primary care segment is further sub-segmented into general practitioners (GPs) and specialist clinics.

This research identified that during the forecast period 2018-2023, emerging technologies such as cloud, wearables, IoT, mobile platform and artificial intelligence are gaining entry in the healthcare industry in Australia and have the potential to revolutionize the PMS market in the country.