GP and specialist services overview

The following pages present data that are currently available on the use of primary and community-based secondary healthcare services by people with dementia through services provided under the Medicare Benefits Schedule (MBS). Data are sourced from linked health and aged care services data in the National Integrated Health Services Information Analysis Asset (NIHSI AA). Expand the Current data sources for assessing GP and community based specialist healthcare services used by people with dementia in Australia section for more information on the NIHSI AA. However, as dementia diagnostic information is not available in the MBS, we are unable to distinguish between dementia-specific services and services for the management of other health issues. In addition, as identification of people with dementia depends on their use of other health and aged care services (e.g. through admission to hospital and dementia being recorded in those data), these analyses will not include all people with dementia in Australia.

Refer to the GP and specialist services data tables for the underlying data presented in these pages. 

For more information on existing data gaps for dementia and future possibilities for filling in these gaps refer to the AIHW reports: Dementia data gaps and opportunities and Australia’s’ Health 2020 data insights.

Who was included in the linked data analysis?

The analysis focused on people aged 30 or over who used an MBS service in 2016–17 and who were alive between July 2016 and December 2017. These people were divided into 2 main groups:

  • People with dementia: includes people who had a dementia diagnosis recorded in a hospital admission, emergency department presentation, residential aged care record and/or were prescribed dementia specific medication between 2010–11 and 2016–17.
  • People without dementia: includes people who did not have a record of dementia in a hospital admission, emergency department presentation or residential aged care records, and were not prescribed dementia specific medication between 2010–11 and 2016–17.

Both groups were further sub-divided to examine the different health service usage of those living in residential aged care compared with those living in the community:

  • Living in residential aged care: includes people who were living permanently in a residential aged care facility for all, or part of the year in 2016–17.
  • Living in the community: includes people who were living in the community for all of the year in 2016–17. This may include people who used respite services in a residential aged care facility, as well as people who were living in other supported accommodation.

Expand the Key considerations of the analysis and who was included for factors to consider when interpreting information from this analysis and to the Technical notes for more information on diagnostic codes used to identify dementia in each data set and limitations of this analysis.

Profile of people with dementia who used an MBS service in 2016–17

In 2016–17, there were over 137,000 Australians who used at least 1 MBS service and were identified as having dementia in the linked data (referred to as ‘people with dementia’). In the same year there were 13.3 million Australians who were not identified as having dementia in the linked data.  

Figure 7.1 shows the age profile of people with dementia who used at least 1 MBS service in 2016–17, and the percentage who were living in permanent residential aged care at any point during the year. As the risk of dementia increases with age, it is not surprising the number of people with dementia increased steeply with age and peaked at ages 85–89 (at 33,600 people). The proportion of people with dementia who lived in residential aged care also increased with age; from less than half (44%) of people with dementia aged under 80 to 89% of people with dementia aged 95 and over.

Figure 7.1: People with dementia in 2016-17 identified in the linked data, by age and sex: (a) number of people and (b) percentage who were living in residential aged care 

Figure 7.1 is two bar graphs, the first graph shows the number of people with dementia in 2016–17 identified in the linked data, by age and sex. The second graph shows the percentage of people with dementia in the linked data who were living in residential aged care for all or part of 2016–17. The number of people with dementia and the proportion who lived in residential aged care increased with age. The number of people with dementia was highest between ages 85 and 89. The proportion who lived in residential aged care also increased from 37% of people with dementia aged 30–64 to 89% of people with dementia aged 95 and over.

Overall service usage by people with dementia by their place of residence

Service usage differed for those who were living in permanent residential aged care compared with those living in the community, but only at older ages (Figure 7.2):

  • for people with dementia aged under 80, the number of services used by people who were living in residential aged care was fairly similar to the number of services used by people who were living in the community
  • from age 80 onwards, the number of services used by people with dementia living in residential aged care was greater than the number used by similarly aged people with dementia living in the community.

The rate of services used by people with dementia living in residential aged care increased steeply with age—from 45 services per 1,000 people among those ages 80–84 to 241 services per 1,000 people among those aged 95 or over. This is likely due to the number of co-existing health conditions increasing and health needs becoming more complex as people age.

Figure 7.2: MBS services used by people with dementia in 2016–17, by sex, age and place of residence: number and rate (services per 1,000 people)

Figure 7.2 is two bar and line graphs showing the number and rate of MBS services used by people with dementia in 2016–17 and by sex and age; the first graph shows this among people with dementia living in the community and the second graph shows this among people with dementia living in residential aged care for all or part of 2016–17. Among people with dementia aged under 80, there was little difference in number of services used by people with dementia by place of residence. From age 80 onwards, the number of services used by people with dementia living in residential aged care was greater than among those living in the community. The rate of services used by people with dementia living in residential aged care increased steeply with age, from 45 services per 1,000 people among those aged 80–84 to 241 services per 1,000 people among those aged 95 or over.

What MBS services were most commonly used by people with dementia?

Of the MBS services used by people with dementia in 2016–17 (Figure 7.3):

  • 49% were for GP consultations—GP consultations accounted for a greater proportion of MBS services used by people living in residential aged care (57%) than for those living in the community (36%)
  • 25% were for pathology tests—Pathology tests accounted for a slightly smaller proportion of MBS services used by people living in residential aged care (22%) than they did for those living in the community (28%)
  • 12% were for consultations with medical specialists—Consultations with medical specialists accounted for a considerably smaller proportion of MBS services used by people living in residential aged care (8.4%) than they did for those living in the community (17%)
  • 4.2% were for diagnostic imaging—Diagnostic imaging accounted for a smaller proportion of MBS services used by people living in residential aged care (2.8%) than they did for those living in the community (6.4%).

When comparing the distribution of services used by people with dementia compared to people without dementia, differences were evident by place of residence. Among people living in residential aged care, GP consultations accounted for a greater proportion of services used by people with dementia (57%) than people without dementia (49%). All other services accounted for a similar or slightly smaller proportion of services used by people with dementia than people without dementia.

Among people living in the community, the distribution of services was more similar for both people with dementia and people without dementia. However, notably, GP consultations accounted for a slightly smaller proportion of services used by people with dementia (36%) than they did for people without dementia (40%) and specialist consultations accounted for a slightly greater proportion of services used by people with dementia (17%) than they did for people without dementia (13%).

Figure 7.3: MBS services provided to people with dementia and people without dementia in 2016–17: percentage by sex and place of residence

Figure 7.3 is a stacked bar graph showing the percentage of MBS services by service type used by people with dementia and people without dementia in 2016–17 for men, women and persons by place of residence. Overall, almost half (49%) of services for people with dementia were for GP consultations, and these accounted for a greater proportion of services used by people living in residential aged care (57%) than for those living in the community (36%). Overall, one-quarter of services (25%) for people with dementia were for pathology tests and 12% were consultations with medical specialists. Consultations with medical specialists accounted for a considerably smaller proportion of MBS services used by people living in residential aged care (8.4%) than for those living in the community (17%).

There were slight differences in service patterns between men and women with dementia; GP consultations accounted for a slightly greater proportion of services used by women (51% of MBS services) than men (46%), whereas specialist consultations accounted for a slightly greater proportion of services used by men (14%) than women (11%).

This difference was not seen among people without dementia, suggesting it may specifically be related to differences in the health status and service needs between men and women with dementia. Refer to How do care needs of people with dementia differ by place of residence? for information on the health status of men and women with dementia, including co-morbidities.