Calculating Medicare Benefits Schedule services
The Medicare Benefits Schedule (MBS) is part of Australia’s public health insurance scheme. Through the MBS the Australian Government subsidises the costs of a broad range of health services. The MBS subsidies pay all or part of the costs of these services, dependent on factors such as patient eligibility, the type of service and choices by health practitioners regarding the fees they charge for their services.
MBS benefits are claimable only for services rendered by an appropriate health practitioner and which are listed on the Medicare Benefits Schedule. Services that are eligible for Medicare benefits are listed in the Medicare Benefits Schedule. Medicare benefits data only includes details of services for which benefits were paid by Services Australia. They do not include:
- services provided to public inpatients and public outpatients of hospitals;
- services provided in public Accident and Emergency Departments of hospitals;
- services that are funded directly under other Australian government programs (for example, health screening services); and
- services funded directly under state/territory government programs.
It should be noted that most consultations, diagnostic imaging and pathology services that occur in a hospital, are captured as non-hospital services in Medicare Benefits statistics unless hospital facilities are required for the services.
The MBS analysis was limited to records with a date of service between 1 January 2021 and 31 December 2021. The statistics are reported using date of service to reflect the period in which a service was provided.
MBS Broad type of service (BTOS) variable was used in calculating the total number of MBS services by BTOS (see Table 1.3). The Medicare item numbers included under each broad type of service can be found at Medicare Australia – Statistics – Appendix 2: Mapping of Medicare items to Broad Type of Service.
Broad Types of Service (BTOS) | Description | Terminology in this report |
|---|---|---|
| 0101 0102 0103 | Non referred attendances – GP Non referred attendances – enhanced primary care Non referred attendances – other | GP attendances |
| 0200 | Specialist Attendances | Specialist attendances |
| 0150 | Other Allied Health includes diabetes education, audiology, exercise physiology, dietetics, mental health, occupational therapy, physiotherapy, podiatry, chiropractic, osteopathy, psychology, speech pathology | Other allied health |
| 0300 | Obstetrics | Obstetrics |
| 0400 | Anaesthetics | Anaesthetics |
| 0501 0502 | Pathology collection items Pathology tests | Pathology |
| 0600 | Diagnostic Imaging | Diagnostic imaging |
| 0700 0800 | Operations Assistance at operations | Operations |
| 0900 | Optometry | Optometry |
| 1000 | Radiotherapy and therapeutic nuclear medicine | Radiotherapy therapeutic and nuclear medicine |
| 1100 | Other MBS services Includes:
| Other MBS services |
GP mental health treatment plans
The number of GP mental health treatment plans was investigated in this analysis. The variable for mental health GP treatment plan was derived from the following MBS item numbers: 00272, 00276, 00281, 00282, 02700, 02701, 02702, 02710, 02715, 2717, 92112, 92113, 92116, 92117, 92118, 92119, 92122, 92123, 92125, 92128, 92129, 92130, 92131, 92134, 92135, 93400, 93401, 93402, 93403, 93404, 93405, 93406, 93407, 93408, 93409, 93410, 93411, 93431, 93432, 93441, 93442, 92124.
Bulk-billing rates
The Medicare bill type code variable was used to define bulk-billed services. Bulk-billing rates were derived by the total number of services which had a bill type code of D (direct billed), over the total number of services. Direct billed claims are claims when the service provider accepts the Medicare benefit as full payment for the service. Claims that are charged to the patient and subsequently claimed on Medicare are not included as bulk-billed in this definition.
Specialty for non-hospital specialist consultations
Specialty type for non-hospital specialist consultations were derived from the Medicare registered specialty code variable on the MBS extract. Only services that were within the BTOS 0200, specialist attendances, were included in this analysis.