Australian Institute of Health and Welfare (2022) Pathology, imaging and other diagnostic services, AIHW, Australian Government, accessed 28 November 2022.
Australian Institute of Health and Welfare. (2022). Pathology, imaging and other diagnostic services. Retrieved from https://www.aihw.gov.au/reports/diagnostic-services/pathology-imaging-and-other-diagnostic-services
Pathology, imaging and other diagnostic services. Australian Institute of Health and Welfare, 07 July 2022, https://www.aihw.gov.au/reports/diagnostic-services/pathology-imaging-and-other-diagnostic-services
Australian Institute of Health and Welfare. Pathology, imaging and other diagnostic services [Internet]. Canberra: Australian Institute of Health and Welfare, 2022 [cited 2022 Nov. 28]. Available from: https://www.aihw.gov.au/reports/diagnostic-services/pathology-imaging-and-other-diagnostic-services
Australian Institute of Health and Welfare (AIHW) 2022, Pathology, imaging and other diagnostic services, viewed 28 November 2022, https://www.aihw.gov.au/reports/diagnostic-services/pathology-imaging-and-other-diagnostic-services
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Pathology, diagnostic imaging and other diagnostic services assist medical and other health practitioners to describe, diagnose and monitor a patient’s illness or injury. Patients may receive such services in hospital, but for services provided in non‑hospital settings, patients are typically referred to these services by a medical practitioner. There are simple basic pathology tests, some imaging services and many other diagnosis services that patients do not require a referral to attract Medicare benefit.
As well as pathology and diagnostic imaging, there are a wide variety of other diagnostic services performed by, or under the direct supervision of, a medical practitioner (often a specialist). These services include electrocardiography (ECG), sleep studies, audiograms, and spirometry.
Whilst many diagnostic services are rendered in hospital, not all of these are subsidised through the Medicare Benefits Schedule (MBS). Common examples of non-MBS subsidised services include:
This page focuses on pathology, imaging and other diagnostic services subsidised through the MBS, and based on the financial year of processing between 2015–16 and 2020–21. It also highlights the impact of COVID-19 on diagnostic services processed until the end of December 2021.
Overall, in 2020–21, 17.8 million (69%) Australians accessed 204.1 million Medicare-subsidised pathology tests, imaging scans and a range of diagnostic services.
Most (91% or 185.1 million) Medicare-subsidised services included in this grouping were provided in non-hospital settings. The most common Medicare-subsidised services in this group were pathology (62% of people had at least one service) and diagnostic imaging services (39% of people had at least one service) (Table 1).
Type of service
Proportion of people receiving a service (%)
Number of services (million)
Number of services per patient (average)
Pathology – non-hospital(a) (b)
Diagnostic imaging – non-hospital(c)
Other diagnostic services – non-hospital(d)
Source: AIHW analysis of MBS data maintained by the Australian Government Department of Health; National, state and territory population, ABS 2021.
Overall, there was an increase in the proportion of people who had a Medicare-subsidised service within this group over the 5 years between 2015–16 and 2020–21. The proportion of people who had a pathology service increased from 55% to 62%, and the proportion who had diagnostic imaging services increased from 38% to 39%. Most of the growth in the number of patients receiving a pathology service occurred in 2020–21 and was due to the large number of patients receiving a polymerase chain reaction (PCR) test for COVID-19 (see Impact of COVID-19 on the use of pathology and diagnostic services).
The number of these services per 100 people increased between 2015–16 and 2020–21, from 502 to 587 pathology services and from 96 to 108 diagnostic imaging services. After adjusting for differences in the age structure of the population, this increase was still observed (475 to 549 pathology services, and 92 to 101 diagnostic imaging services). Please refer to Figure 1 for further details on the volume of pathology and diagnostic imaging services.
Figure 1: Diagnostic services, 2015–16 to 2020–21
Between 2015–16 and 2020–21, the number of Medicare-subsidised non-hospital diagnostic services and percentage of population receiving a service has increased for pathology (119.5 to 150.9 million services, 55.1% to 61.8%) and diagnostic imaging services (22.8 to 27.7 million services, 37.6% to 39.0%), but fell slightly as a percentage of population receiving a service for other diagnostic services (6.3 to 6.5 million services, 14.7% to 14.5%).
Older people were more likely to receive at least one of these Medicare-subsidised services. In 2020–21, 92% of people aged 65 and over had at least one pathology service, compared with 74% of people aged 45–64 and 49% of people aged 44 and under.
Females were more likely than males to have had one or more Medicare-subsidised pathology service (68% of females had at least one service, compared with 55% of males). This trend was also apparent for diagnostic imaging services, where 44% of females received a service compared with 34% of males.
In 2020–21, similar proportions of people living in Major cities, Inner regional and Outer regional areas received these types of services, compared with Remote and Very remote areas, where lower percentages of people received them. This was most apparent with diagnostic imaging, where 39% of people living in Major cities, Inner regional and Outer regional areas received a service, compared with 31% of people living in Remote areas and 23% of people living in Very remote areas.
In 2020–21, $8.7 billion was spent on Medicare-subsidised pathology, imaging and other diagnostic services in non-hospital settings. This comprised:
About $3.6 billion was spent on Medicare-subsidised pathology services in non-hospital settings, and $4.1 billion on diagnostic imaging services in 2020–21.
In 2020–21, 179 million (97%) of these diagnostic services were bulk-billed (indicating that patients did not incur costs for these services). Pathology services contributed a large proportion of this figure (Figure 2). For those who did incur out-of-pocket costs, diagnostic imaging had the highest average cost per patient ($195) in 2020–21, whereas pathology had the lowest ($75) for all services received in the year.
In the 5 years between 2015–16 and 2020–21, spending on Medicare-subsidised pathology, imaging and other diagnostic services outside of hospital increased:
For pathology services, the number of patients who had an out-of-pocket cost decreased – from around 305,000 in 2015–16 to 152,000 in 2020–21. Over the same period, the average cost per patient (for those who had out-of-pocket costs) also decreased from $77 to $75 per patient in real terms.
However, for diagnostic imaging services, the number of patients who had an out-of-pocket cost has been stable between 2015–16 and 2020–21 – approximately 2.1 million in each year. The average cost per patient (for those who had an out-of-pocket cost) increased in real terms from $187 in 2015–16 to $195 in 2020–21.
Figure 2: Diagnostic service fees and out-of-pocket costs, constant prices, 2015–16 to 2020–21
Between 2015–16 and 2020–21, provider fees for Medicare-subsidised non-hospital pathology and diagnostic imaging services increased ($2.6 to $3.6 billion and $3.6 to $4.6 billion, respectively), but remained static for other diagnostic services ($0.6 billion). The average fee per service over the same period for pathology increased ($21.5 to $23.7 per service) as well as diagnostic imaging ($159.4 to $164.7 per service), on the other hand, other diagnostic services decreased slightly ($93.3 to $86.5 per service). The percentage of fees covered by Medicare increased for pathology (99.1% to 99.7%) and diagnostic imaging (89.1% to 91.0%), but fell nearly 2percentage points for other diagnostic services (84.4% to 82.5%). Medicare benefit paid increased for pathology ($2.5 to $3.6 billion) and diagnostic imaging ($3.2 to $4.1 billion), but was stable for other diagnostic services ($0.5 billion). Out-of-pocket costs paid by patients reduced for pathology ($23.5 to $11.3 million) and increased for diagnostic imaging ($395.7 to $408.6 million) and other diagnostic services ($92.2 to $98.5 million).
The COVID-19 pandemic saw new Medicare items introduced on or after 13 March 2020 to provide funding for COVID-19 PCR testing by accredited public and private pathology laboratories (rapid antigen tests are not funded under the MBS). However, these new items do not include mass testing conducted at Government-run testing sites, as the Commonwealth component of this funding is covered under the National Partnership on COVID-19 Response. These items are listed under MBS group P03 – microbiology, and were the main driver in the increase in pathology services in the second half of 2021.
Since the June quarter 2020, the volume of services for COVID-19 testing formed a significant proportion of all microbiology services for non-hospital patients – in the range of 20–38%, which rose to 68% in the September quarter of 2021 and peaked at 73% of all microbiology services in the December quarter of 2021, when COVID-19 case numbers started to rise in south-eastern Australia in the previous quarter (Figure 3). The relatively high benefit for COVID-19 testing items made this effect even more pronounced when looking at Medicare benefits paid. In the December quarter 2021, 89% of all Medicare benefits paid for microbiology services related to COVID-19 testing.
Figure 3: Microbiology services, COVID-19 test items and all items, October 2018 to December 2021
In the December quarter of 2018, the number of Medicare-subsidised non-hospital services in the microbiology group of the pathology category was 3.9 million. By the December quarter of 2021, the volume of pathology services in the microbiology group had increased to 13.6 million, with 9.9 million (72.9%) of those services being for Medicare-subsidised COVID-19 testing. The effect of COVID-19 testing was even more apparent for the benefits paid, where $822.1 million (88.5%) of the total microbiology benefits of $928.9 million was for COVID-19 testing.
Diagnostic imaging saw the volume of services drop significantly in the June quarter 2020, down to 5.6 million from approximately 6.5 million in previous quarters (Figure 4). This decline could be attributed to the extensive lockdowns throughout Australia that occurred in this quarter, along with the postponement of elective surgeries in place for part of the quarter. The volume of imaging services bounced back and reached 7.1 million in the June quarter 2021.
Other diagnostic procedures, on the other hand, saw a more sustained fall in service volumes since the COVID-19 pandemic began. Similar to diagnostic imaging, there was a large initial drop in services in the June quarter of 2020 (Figure 4). Since that quarter, the service volumes did increase somewhat (to approximately 1.6 million services per quarter), but did not reach the numbers seen prior to the pandemic (about 1.8 million services per quarter).
Figure 4: Diagnostic imaging services by quarter, October 2018 to December 2021
The total number of pathology and other diagnostics services increased on a quarterly basis between December 2018 to December 2021 (42.0 million to 63.5 million), with a large increase of 9.9 million services between the September and December quarters of 2021. This 9.9 million service increase can be attributed to the increase in COVID-19 testing between the two quarters. When looking at the benefits paid for pathology and other diagnostics services, there was also a large increase on a quarterly basis ($1.7 billion to $2.8 billion), and a $0.4 billion increase between the September and December quarters of 2021, much of which can be attributed to COVID-19 testing.
Please refer to Impact on MBS service utilisation for additional details on how COVID-19 has changed the way Medicare-subsidised pathology medical services are delivered to patients.
For more information on pathology, imaging and other diagnostic services, see:
ABS (Australian Bureau of Statistics) (2011) Australian demographic statistics, Jun 2011, ABS, Australian Government, accessed 7 February 2022.
ABS (2021) National, state and territory population, Jun 2020, ABS, Australian Government, accessed 2 February 2022.
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