Medicare Benefits Schedule
Statistics in this release were extracted by the Australian Institute of Health and Welfare (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 (for example, services covered by third party 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
- diagnostic imaging
- assistance at operations
- radiation therapy
- other allied health
- other MBS.
On the 13 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 Factsheet: COVID-19 Temporary MBS Telehealth Services.
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.
The geographical representation of data presented in this release is by region (capital city and other), statistical area (SA3) and primary health network (PHN).
In compiling the statistics by geographical classification, the patient’s postcode has been allocated to the different classifications. As there is not a one-to-one relationship between postcode and the various geographical classifications presented here, standard statistical concordance processes have been applied to generate the data to create these classifications.
In considering the data presented here, it should be noted that since the patient postcode in MBS data is a mailing address postcode, statistical modifications had to be made to accommodate those people who use a PO Box and so forth. Also, as some patients changed enrolment postcodes during a month, services were allocated to their postcode with the largest number of service, before their data were allocated to a region.
Greater Capital City Statistical Areas (GCCSAs) are geographical areas that represent the functional extent of each of Australia’s capital cities. This geographical area has been developed by the Australian Bureau of Statistics and includes people who regularly socialise, shop or work within the city, but live in the small towns and rural areas surrounding the city. GCCSAs are not bound by a minimum population size criterion.
PHNs are organisations that connect health services across a specific geographic area (PHN areas). There are 31 PHN areas that cover the whole of Australia with the boundaries defined by the Department of Health.
Statistical Areas Level 3 (SA3s) is a type of geographical classification defined by the Australian Bureau of Statistics (ABS) to provide a regional breakdown of Australia. There are 336 geographical areas covering Australia, with boundaries defined by the ABS. Each SA3 generally has a population of between 30,000 and 130,000 people. Allocation to an SA3 for Medicare data is based on the patient’s usual place of residence, rather than where they received treatment.