Specialist consultations and other health services

Services provided by other medical specialists

Around 12% of all MBS services used by people with dementia were specific consultations with, or services provided by medical specialists (other than GPs). On average, a person with dementia had 5 specialist services in 2016–17.

Of the specialist services provided to people with dementia:

  • 1 in 5 (22%) were provided by haematologists (who treat blood-related conditions), and this was slightly lower for people without dementia (19%)
  • 1 in 7 (15%) were provided by geriatricians (who treat conditions that affect older people, including dementia), and this was substantially lower for people without dementia (1.1%)
  • 1 in 10 (10%) were provided by ophthalmologists (who treat eye-related conditions), and this was similar for people without dementia (11%) (Table S7.7).

Services provided by cardiologists (who treat heart diseases) and oncologists (who treat cancer) contributed to a greater proportion of specialist services for people without dementia (14% and 9.3%, respectively) than with dementia (11% and 3.4%, respectively).

The type of specialist services used by people with and without dementia varied extensively by age, and whether they lived in residential aged care (Figure 7.8). Services provided by psychiatrists and neurologists were most frequent among people with younger onset dementia (aged under 65), irrespective of where they lived. Services provided by specialists who treat age-related conditions including geriatricians and ophthalmologists increased with age among people with and without dementia.

Figure 7.8: Specialist services used by people with and without dementia: percentage by place of residence, sex and age in 2016–17

Figure 7.8 is a stacked bar graph showing the percentage of specialist services (as described by medical specialty) used by people with and without dementia in 2016–17 by sex, age and place of residence. Among people with dementia living in the community, 30% of specialist services were provided by haematologists, 16% through geriatricians and 11% through general practitioners. Among people with dementia living in the community 15% of services were provided through haematologists, 14% through cardiologists and 14% through geriatricians. Overall, 22% of specialist services provided to people with dementia were provided by haematologists, 15% were provided by geriatricians and 10% were provided by ophthalmologists. Among people without dementia, only 1.1% of specialist services were provided by geriatricians. Services provided by psychiatrists and neurologists were most frequent among people with younger onset dementia (aged under 65), irrespective of where they lived. Services provided by specialists who treat age-related conditions including geriatricians and ophthalmologists increased with age among people with and without dementia.

Allied health, diagnostic imaging and other services

Besides consultations with GPs and other medical specialists, there are a number of other services claimed under the MBS that are specific to diagnosing health conditions (such as pathology tests and diagnostic imaging) as well as treating or managing health conditions (such as services provided by allied health professionals). However, it is not possible to determine whether or not these services are provided for the diagnosis, treatment or management of dementia specifically—only that they are services provided to someone with dementia.

In 2016–17, for every 100 people with dementia there was an average of:

  • 999 pathology services—this was 1.8 times as many as used by people without dementia (567 services)
  • 146 allied health services—this was 2.1 times as many as used by people without dementia (69 services), and the greatest difference was in the younger age groups. Note this only includes allied health services that are subsidised under the MBS
  • 169 diagnostic imaging services—this was similar to the average number used by people without dementia (155 services) (Figure 7.9).

Figure 7.9: Allied health, pathology, diagnostic imaging and other MBS services used by people with and without dementia (services per 100 people) by place of residence in 2016–17

Figure 7.9 is a bar graph showing the rate of allied health, pathology, diagnostic imaging and other MBS services for people with and people without dementia (services per 100 people) in 2016–17 by place of residence. Overall, the rates of pathology services and allied health services used by people with dementia were considerably higher than the rates of these services used by people without dementia, with much of the differences in these rates due to higher rates among people with dementia living in the community. While the overall rate of diagnostic imaging services for people with dementia was similar to the rate for people without dementia, people without dementia living in residential aged care had higher rates of diagnostic imaging services than people with dementia, but this pattern was reversed for those living in the community.

There was little difference in the rate of people who used these services by sex but there were vast differences by age and whether they lived in residential aged care (Figure 7.10).

Among people living in the community the number of services used per 100 people was:

  • higher for people with dementia aged under 80 than those without dementia for each group of services, with the greatest differences between those aged under 65. This suggests there are much higher health service needs for people with younger onset dementia to diagnose and manage their dementia than for people of similar age without dementia
  • similar or lower for people with dementia aged 80 or over than those without dementia for most service groups. 

Among people living in residential aged care, the number of services used per 100 people was:

  • lower for people with dementia than those without dementia across all age groups for each group of services, with the greatest difference seen for pathology tests and diagnostic imaging services.

The average number of diagnostic imaging and pathology services may be higher among people with dementia who are living in the community and are currently being assessed for dementia but who have not received a formal diagnosis. Unfortunately, this group of people could not be identified in the latest year of data using the available linked data. The AIHW is currently investigating if patterns of MBS service usage can be used to predict dementia using MBS data alone and a report on this should be available on the AIHW website in late 2021.

Figure 7.10: Allied health, pathology, diagnostic imaging and other MBS services used by people with and without dementia (per 100 people) by sex, age, and place of residence in 2016–17

Figure 7.10 is a bar graph showing the rate of allied health, pathology, diagnostic imaging and other MBS services for people with and people without dementia (services per 100 people) in 2016–17 by sex, age and place of residence. Among people aged under 80 living in the community, the rate of services used was generally higher for people with dementia than those without dementia. For people aged 80 and over living in the community, rates were typically similar or lower among those with dementia aged 80 or compared with those without dementia for most service groups. Among people living in residential aged care, the rate of services used for each group of services was generally lower among people with dementia compared to those without dementia across all age groups.