This body exists in the form it does because of one subsection of a Commonwealth Act.

Section 19(2) of the Health Insurance Act 1973 prevents a Medicare benefit being paid for a service rendered by, on behalf of, or under arrangement with a State. Its purpose was to stop double-dipping between Commonwealth and state funding, and in most settings that is exactly what it does.

Applied to prisons, its effect is that people in custody are outside Medicare and outside the PBS for the duration of their sentence. Their health care is a state responsibility, funded from a corrections or health budget, delivered by a separate service, on separate records.

Three consequences follow, and the third is the one this database can measure.

Continuity breaks at both ends. A person entering custody leaves the Medicare system; a person leaving re-enters it. Prescriptions, referrals, specialist waiting list positions and clinical records do not travel cleanly across that boundary in either direction.

The population is unusually unwell. People in custody have far higher rates of mental illness, blood-borne virus, chronic disease and substance dependence than the general population, so the group excluded from the national health financing system is the group that uses health care most.

And the exclusion ends at the gate, abruptly. On release, medication supply, prescriber relationship and funding source all change on the same day. See Exempt prison health services from the Medicare exclusion and Person released from prison re-establishes income, identity, health care and housing.

Reform has been argued for in the academic and clinical literature for years, generally as a targeted exemption from s 19(2) for prison health services rather than as repeal of the subsection.