Overview of Medicare-subsidised allied health services

Allied health encompasses a range of services provided by university qualified health practitioners with specialised expertise in preventing, diagnosing and treating a range of conditions and illnesses. The practitioners have autonomy of practice, a defined scope of practice, a regulatory mechanism and a national organisation with clearly defined entrance criteria. Examples include psychologists, optometrists and physiotherapists. Patients being managed under the CDM services may be eligible for Medicare-subsidised individual or group allied health services.

Individual allied health services

Patients may be referred for Medicare-subsidised individual allied health services where the care is deemed beneficial to their condition by their GP or medical practitioner (Department of Health 2021a). There are 13 eligible individual allied health services (item numbers are provided in the Technical notes):

  • Aboriginal and Torres Strait Islander health services
  • diabetes education services
  • audiology
  • exercise physiology
  • dietetics
  • mental health services
  • occupational therapy
  • physiotherapy
  • podiatry
  • chiropractic services
  • osteopathy
  • psychology
  • speech pathology.

To access these services, patients must have either:

  • a GPMP and TCA
  • for people living in residential aged care, a multidisciplinary care plan which their GP or medical practitioner has contributed to
  • a Health Care Home shared care plan[1].

Eligible patients may access up to 5 individual health services (of any type) per calendar year. More services in a calendar year are not available under any circumstances (Department of Health 2014). Each service must run for at least 20 minutes. The allied health provider will supply a report on their treatment to the referring GP or medical practitioner after a patient’s first and last service, or more often if clinically necessary (Department of Health 2014).

Group allied health services

Patients with type 2 diabetes may be referred for group allied health services: diabetes education services, exercise physiology and/or dietetics (Department of Health 2021b; item numbers are provided in the Technical notes). To be eligible for these services, patients must have either:

  • a GPMP
  • for people living in residential aged care, a multidisciplinary care plan that their GP or medical practitioner has contributed to
  • a Health Care Home shared care plan.

Following referral from their GP, the diabetes educator, exercise physiologist or dietitian will conduct an individual assessment. This involves assessing the patient’s suitability for the group services based on their medical history and care needs and preparing the patient for the group service. If suitable, the patient is eligible for up to 8 group services per calendar year. Group services are attended by between 2 and 12 patients and run for at least 60 minutes. After the last service, the allied health provider will supply a report on their treatment to the referring GP or medical practitioner. Group allied health services are available in addition to the individual allied health services.

Allied health services in Australia

In Australia, allied health services are provided in a range of settings, such as hospitals, private practice, residential aged care, community care, schools and universities (Department of Health 2021c). The allied health services accessible through CDM services and featured in this report represent one source of Medicare-subsidised allied health services available for people with chronic conditions, and of all allied health activity in Australia. People with chronic conditions may choose to access allied health services through these other channels depending on their eligibility, availability of services or programs in their area, the recommendation of their care provider and/or personal preference. They may use these channels either in addition to, or instead of the CDM allied health services.

Other Medicare-subsidised allied health services

In addition to outpatient services provided in public hospitals, Medicare-subsidised allied health services are generally available to people with specific and complex care needs that would benefit from specialised care. Other programs and initiatives which may be accessed by people with a chronic condition include:

  • The Better Access initiative: access to psychologists, appropriately trained GPs and other medical practitioners, occupational therapists and social workers for people with a diagnosed mental disorder referred by a GP, other medical practitioner, psychiatrist or paediatrician.
  • Follow-up Allied Health Services for people of Aboriginal or Torres Strait Islander descent: access to Aboriginal health workers, diabetes educators, audiologists, exercise physiologists, dietitians, mental health workers, occupational therapists, physiotherapists, podiatrists, chiropractors, osteopaths, psychologists and speech pathologists for Aboriginal and Torres Strait Islander people who have had a health assessment. (Department of Health 2011)
  • Better Start for Children with Disability: access to psychologists, speech pathologists, occupational therapists, audiologists, optometrists, orthoptists and physiotherapists for children with selected disabilities.
  • Helping Children with Autism: access to psychologists, speech pathologists, occupational therapists, audiologists, optometrists, orthoptists or physiotherapists for children with autism or other pervasive developmental disorders (Services Australia 2020).

Medicare-subsidised optometry services are also available without referral.

Other subsidised allied health services

Outside of Medicare, people may access subsidised allied health services through a variety of channels, including:

  • treatment in public hospitals and community health centres
  • older people can receive allied health services at home or in residential aged care
  • services provided by Primary Health Networks
  • services provided through the Department of Veterans’ Affairs
  • National Disability Insurance Scheme
  • services covered by third-party compensation (Department of Health 2021d).

Privately funded allied health services

People with chronic conditions can also access allied health services by paying out-of-pocket. Those with private health insurance general treatment cover (known as ‘ancillary’ or ‘extras’ cover) may have part of the cost subsidised by their insurance provider. As at 31 December 2021, 14.1 million Australians had general treatment cover, representing 55% of the population (APRA 2022a). Physiotherapy was the most claimed service in 2020 (10.8 million), followed by chiropractic (9.1 million) and podiatry (2.8 million) (APRA 2022b). With currently available data, it is not possible to determine how many CDM patients also accessed privately funded allied health services, either completely out-of-pocket or with a partial rebate through their private health insurance coverage. It is also not possible to know how many people with chronic conditions accessed allied health services outside of those provided through CDM allied health services.

Number of allied health services funded by Private Health Insurance in 2020, selected allied health services

This figure shows the number of allied health services funded by Private Health Insurance in 2020 for selected allied health services

Source: APRA 2022b.

Overview of Medicare-subsidised allied health service use associated with CDM services

In 2019, over 2.4 million patients received Medicare-subsidised allied health services associated with the CDM services, a rate of 95 patients per 1,000 Australians (Table 4a and 4b). A total of over 8.2 million individual allied health services were claimed in this period, which equates to an average of 3.4 services per patient. The top 3 most commonly used individual allied health services by number of patients were:

  1. Podiatry: over 1.1 million patients received 3,520,654 services
  2. Physiotherapy: 887,317 patients received 2,811,866 services
  3. Dietetics: 264,016 patients received 450,270 services.

Around 17,400 patients with type 2 diabetes received 83,438 group allied health services (3.3 per 1,000 population). Exercise physiology was the most used service.

Table 4a: CDM Medicare-subsidised individual allied health services, number of services and patients, 2019

Type of individual allied health

Item number

Number of services

Rate of services per 1,000 population (crude)

Number of patients

Rate of patients per 1,000 population (crude)

Aboriginal or Torres Strait Islander health service

10950

2,674

0.1

2,029

0.1

Audiology

10952

3,527

0.1

2,900

0.1

Chiropractic service

10964

499,014

19.7

148,073

5.8

Dietetics

10954

450,270

17.8

264,016

10.4

Diabetes education

10951

96,901

3.8

61,439

2.4

Exercise physiology

10953

351,750

13.9

163,100

6.4

Mental health service

10956

8,434

0.3

3,152

0.1

Occupational therapy

10958

77,276

3.0

29,225

1.2

Osteopathy

10966

235,590

9.3

75,766

3.0

Physiotherapy

10960

2,811,866

110.9

887,317

35.0

Podiatry

10962

3,520,654

138.8

1,132,596

44.7

Psychology

10968

38,089

1.5

13,689

0.5

Speech pathology

10970

149,779

5.9

44,024

1.7

Total individual allied health service1

 

8,245,824

325.1

2,416,511

95.3

Total allied health service1

 

8,329,262

328.4

2,418,777

95.4

Note: 1. Totals and subtotals of patients may be less than the sum of each service group as a patient may receive more than one type of service but will be counted only once in the relevant total.

Source: AIHW analysis of MBS data maintained by the Department of Health and Aged Care and sourced from Services Australia.

Table 4b: CDM Medicare-subsidised group allied health services, number of services and patients, 2019

Type of group allied health

Item number

Number of services

Rate of services per 1,000 population (crude)

Number of patients

Rate of patients per 1,000 population (crude)

Diabetes education – assessment for group services

81100

2,213

0.1

2,213

0.1

Diabetes education – group service

81105

1,491

0.1

586

0.0

Dietetics – assessment for group services

81120

1,185

0.0

1,185

0.0

Dietetics – group service

81125

2,398

0.1

977

0.0

Exercise physiology – assessment for group service

81110

11,698

0.5

11,697

0.5

Exercise physiology – group service

81115

64,453

2.5

11,637

0.5

Total group allied health service1

 

83,438

3.3

17,458

0.7

Total allied health service1

 

8,329,262

328.4

2,418,777

95.4

Note: 1. Totals and subtotals of patients may be less than the sum of each service group as a patient may receive more than one type of service but will be counted only once in the relevant total.

Source: AIHW analysis of MBS data maintained by the Department of Health and Aged Care and sourced from Services Australia.

[1] The Health Care Homes trial began in October 2017, with patient enrolment extended in December 2018 up until 30 June 2019. The program ceased on 30 June 2021.