Geography and time-specific health data for environmental analysis

About the data source

Data on Medicare Benefits Schedule (MBS) service claims are sourced from the Medicare Benefits Schedule data collection.

Medicare is Australia’s universal health insurance scheme. Medicare provides access to free or subsidised treatment by health professionals such as doctors, specialists, optometrists, and in specific circumstances, dentists, and other allied health practitioners. Medicare also provides free treatment as a public patient in a public hospital. 

All Australian residents and overseas visitors covered by a reciprocal health-care agreement requiring immediate medical attention are eligible for subsidised treatment under Medicare. The Medicare Benefits Schedule (MBS) is a listing of services that qualify for a benefit under the Health Insurance Act 1973. The associated MBS claims data comprise information on MBS services claimed through Medicare. These include visits to a GP or to certain specialists and allied health professionals, and hospital visits by a private patient in a public or private hospital. 

The claims data do not include information on public patients in public hospitals or services that are not listed on the MBS.

The MBS data collection accessed for this report is maintained by the Commonwealth Department of Health and Aged Care. Information on patterns in MBS service use over time may be found at: Medicare Benefits Scheme funded services over time and Medicare Benefits Scheme funded services: monthly data, Dashboard.

Methodology

Data were extracted on MBS service claims for services provided out-of-hospital. Data were extracted for the variables shown in Table 6. 

Data were extracted for select groupings of item numbers (Table 7), and the constructed data set reports the count of services associated with each of these groupings. The crude rate is also reported. Rates were calculated by dividing the count data by the estimate of population for the relevant week and geographical area derived as described in the Population data section.

Notes

1. Includes out-of-hospital services only.
2. For item descriptions associated with specific item numbers, including for items that have been removed from the MBS, see: Department of Health and Aged Care 2023 Medicare Item Map [data set]. Department of Health and Aged Care, Australian Government, accessed 20 November 2023.
3. Asthma action plans may also be developed outside of the asthma cycle of care (for which there is no specific MBS item) and it is likely that these items capture a small proportion of the people with a written plan. In addition many people may not have a written asthma action plan (see: Using PBS and MBS data to report on the treatment and management of chronic respiratory conditions 2016–17).

The data were aggregated by MBS item grouping, week and SA4.

• Week was based on the date of service, with weeks (Monday to Sunday) being identified by their start date and forming a continuous time series with no overlap of weeks spanning calendar years. 
• SA4 was derived from the postcode of the patient’s Medicare enrolment address (at the time of processing the claim). Postcodes were mapped to SA4 based on an ABS population-based correspondence. Where the area of a postcode crossed more than one SA4 the data were proportionally allocated to SA4 according to the population proportions.

A representation of the items is shown in figure 7.

Figure 7: Representation of relationship between item groupings in Medicare Benefits Schedule data

Note: The size of the boxes does not reflect the volume of services associated with each category.

Reporting of results

In line with AIHW Policy on reporting to manage confidentiality as well as data management protocols for this data set, some data have been suppressed. In particular, where counts of a given MBS item grouping on a given week in a given SA4 were less than 6, the data were not reported. Secondary suppression was also applied throughout in the event that a suppressed cell could be identified from a higher-level aggregation.

Data considerations and limitations

Association with health conditions

While MBS data provide useful information on medical services used, they provide limited information about why a service was used – and therefore it is not possible to determine, solely from MBS data, the reason a patient was accessing the MBS item.

Specifications of geolocation

The geolocation of the data is based on patients’ Medicare enrolment address, and not the place of service provision. The patient’s address may differ from the location of the patient at the time of condition onset, and any exposure to an environmental influence. 

Quality of geolocation data

All the data in this release are presented according to a common geographical structure – 2016 ASGS SA4. However, in the source MBS data, geographical area is identified by the patients’ Medicare enrolment address postcode. A single mapping file from 2016 is used to map from postcodes to 2016 ASGS SA4s, based on the distribution of the population within the postcode in 2016, and the intersection of its boundaries with the boundaries of the SA4. 

In this context, quality of the data is not affected where postcodes completely fall within a single SA4. However, quality will be affected for postcodes which are divided across SA4s, and for which the geographical distribution of the population has changed over time.

Seasonality

Data for this report were based on the date that the service occurred. When comparing data from different time periods, the impact of public holidays on the volume of services should be considered. For example, ‘service days’ vary from year to year, and variation seen in the data may be at least partly due to this.

Coverage of mental health services items

The data in this release relate only to services claimed under specific mental health care MBS item numbers. Therefore, the reported number of services is unlikely to represent all service use by people who receive mental health care as it is unclear how many people receive GP mental health-related care that is billed as a consultation against, for example, a general MBS item number. In addition, people may receive mental health care from service providers or practitioners that are not subsidised by the MBS.

Coverage of asthma cycle of care items

Asthma cycle of care involves at least 2 asthma-related consultations with a GP within 12 months for a patient with moderate-to-severe asthma.

Note that patients may manage their asthma with other service items, and this would not be captured in the asthma cycle of care data (AIHW 2018). Around one-third of people with asthma (30% of males and 38% of females) have a written asthma action plan (see: Chronic respiratory conditions: Asthma).

Asthma cycle of care items were removed from the Medicare Benefits Schedule as of 1 November 2022.

Policy changes

Service utilisation can be affected by MBS policy changes. Some such relevant changes in more recent years are described below. Further detail on policy changes to the MBS may be found at MBS-funded services data – technical notes.

• 1 January 2004: New extended Medicare safety net (EMSN) introduced to further protect families and individuals who face high out-of-pocket costs for non-hospital patient billed services. This safety net was based on out-of-pocket costs between the benefit and the fee charged. Once legislated thresholds for out-of-pocket costs were exceeded, MBS non-hospital services for the remainder of the calendar year attracted higher rebates. The original safety net continued to apply.
• 1 January 2010: Introduction of the capping of EMSN benefits, which placed a maximum limit on the amount of EMSN benefit that could be paid, was applied to selected MBS items.
• 13 March 2020: New telehealth items, including telephone consultations items, introduced into the MBS to protect patients and doctors during the COVID-19 pandemic. From March 2020, new temporary bulk billing incentive items for patients vulnerable to COVID-19 were introduced and there was a doubling in the rebate for bulk billing incentives, up to and including 30 September 2020. Substantial lockdowns impacted on Medicare utilisation in 2020. A catch-up in service provision in 2021 occurred particularly for services impacted upon by the lockdown – for example, diagnostic imaging.

For respiratory function tests:

• From 1 November 2018 there were a number of changes to the MBS items for respiratory function tests, including those for spirometry. For further detail, see Changes to diagnostic services for respiratory function tests.

For diagnostic imaging:

• November 2009: A new bulk billing incentive was introduced into the MBS for out-of-hospital diagnostic imaging services. Rebates are paid at 95% of Schedule fee for the item (except for some items). In addition to the new incentive, providers receive an additional bulk billing incentive for unreferred diagnostic imaging services that are bulk billed to patients aged under 16 or concessional patients.

For mental health services items:

• November 2006: Introduction of Better Access to Mental Health Care Initiative (Better Access). The program funded up to 12 individual and 12 group mental health sessions per year (plus an additional 6 sessions in exceptional circumstances) for eligible patients.
• July 2011: Mental health videoconference items introduced for eligible patients in regional/remote areas. These items are rendered by specialists or consultant physicians.
• November 2011: Better Access scheme reduced to 10 individual and 10 group sessions per calendar year. GP rebates for mental health items changed to time-dependent (minimum of 20 minutes).
• March 2012: Additional six Better Access sessions in exceptional circumstances reinstated for transition period ending 31 December 2012.
• November 2017: Better Access telehealth videoconference items introduced for eligible patients in regional/remote areas. These items are rendered by allied health practitioners (clinical psychologists, psychologists, occupational therapists, and social workers).
• November 2019: MBS mental health items for eating disorder treatment introduced.
• January 2020: Bushfire response mental health items, including telehealth. Up to 10 items per calendar year, which do not count against Better Access quota.
• March 2020: Additional mental health telehealth (including telephone) items introduced in response to the COVID-19 pandemic available across Australia.
• October 2020: Better Access Pandemic Support. Additional 10 individual sessions per calendar year up to 31 December 2022.
• December 2020: Better Access items for residential aged care facilities to allow access up to 20 individual services each calendar year.

References

AIHW (Australian Institute of Health and Welfare) (2018) Using PBS and MBS data to report on the treatment and management of chronic respiratory conditions 2016–17, AIHW, Australian Government, accessed 14 December 2023.