Medicare Benefits Scheme

Statistics in this release were extracted by the AIHW from the Medicare Benefits Schedule (MBS) claim records data in the Australian Government Department of Health Enterprise Data Warehouse.

The MBS provides a subsidy for services listed in the MBS, for all Australian residents and certain categories of visitors to Australia.  The major elements of Medicare are contained in the Health Insurance Act 1973. See details of the services covered by the MBS.

Medicare benefits are claimable only for ‘clinically relevant’ services rendered by an appropriate health practitioner. A ‘clinically relevant’ service is one which is generally accepted by the relevant profession as necessary for the appropriate treatment of the patient.

In general, MBS statistics exclude services:

  • To public inpatients and public outpatients of public and private hospitals;
  • To patients in public Accident and Emergency Departments;
  • Covered by the Department of Veterans’ Affairs National Treatment Account
  • Covered by an entitlement conferred by legislation other than the Health Insurance Act. (e.g. services covered by third partly or workers’ compensation)
  • Covered by other publicly funded programs.

The statistics in this release are reported by the month of processing, for the period September 2018 to August 2020. It should be noted that this is not always the same as the month of service (the month in which the visit to a health practitioner occurred, the month in which a procedure was performed, or the month in which a test was undertaken).

Statistics are available on the total number of services and benefits paid, in and out of hospital, by region within state and territory. In addition, MBS-subsidised services are reported using the broad type of service (BTOS) classification, whereby each MBS item is allocated to a BTOS category. The BTOS groups presented in this report are:

  • Un-referred (GP) attendances
  • Practice nurse services on behalf of a GP
  • Specialist attendances
  • Obstetrics
  • Anaesthetics
  • Pathology
  • Diagnostic imaging
  • Operations
  • Assistance at operations
  • Optometry
  • Radiation therapy
  • Other allied health
  • Other MBS.

On the 13th March 2020 telehealth via video conferencing and telephone items were introduced into MBS. Statistics on these new items as well as the pre-existing items are published in this release to provide an overview of the impact of the new items on overall utilisation of MBS. Details of the changes to the MBS on account of COVID-19, are available in a Circular on the MBS website.

Statistics in this release are presented separately for non-hospital and hospital MBS subsidised services. Non-hospital MBS subsidised services refer to services provided in non-inpatient settings, and include services in private outpatient clinics. Hospital MBS subsidised services include all services to private inpatients of public and private hospitals, and services rendered as part of a privately insured episode of hospital-substitute treatment.