Impact on MBS service utilisation
Since 13 March 2020, COVID-19 telehealth items have been introduced into the MBS at different stages, to reduce the risk of transmission of COVID-19 by providing telephone and video conferencing options for consultations. In addition, schedule fees for bulk billing incentive items for non-referred services were doubled until 1 October 2020.
The introduction of COVID-19 telehealth items changed the profile of Medicare services provided to patients. For patients located in COVID-19 hotspots, or those required to isolate or quarantine because of public health orders, telehealth consultations provided easy access to medical care. For non-isolating patients in lockdown areas, even though they were still able to leave home to seek medical care, the use of telehealth consultations increased as well.
From the June to September quarters 2021, GP attendances increased 8.9%, driven by increases in suitability for COVID vaccine assessments (up by 193.7%) and microbiology testing on referral, including COVID-19 tests (up by 71.5%).
Lockdowns significantly impacted MBS utilisation for some broad type of service groups. For example, the volume of optometry services decreased sharply during lockdowns for two reasons:
- During the quarter ending June 2020, a large number of optometry practices were closed (services were down 38.4% on the March quarter 2020, but this decrease was picked up in the September quarter 2020). The fall in optometry services in the September quarter 2021 compared to the September quarter 2020 was due to the high base in the September quarter 2020.
- During lockdowns optometry practices could remain open but were limited to essential or time critical care to patients (as opposed to routine check-ups) in many cases.
Cancellation of elective surgery in some states in some quarters reduced MBS utilisation for anaesthetics and surgical operations.
For the quarter ending September 2021, points of note are:
Compared with the quarter ending June 2021
- There was an increase of 7.0% in the total number of Medicare services processed to 131.9 million services, and an increase of 6.8% in the amount of benefits paid to $7.5 billion.
- The increase in services was mainly driven by an increase in pathology services (up by 13.8% to 49.5 million services) and non-referred GP attendances (up by 8.9% to 51.7 million services).
- Driving the increase in pathology services was the large number of microbiology tests. This included those COVID-19 tests funded through the MBS (and not those funded through mechanisms such as state and territory run testing clinics). Microbiology tests for Australia were up 71.5% to 11 million services and benefits were up 147.5% to $715.4 million.
- The increase in non-referred GP attendances can also be linked to COVID-19 vaccinations, because of the number of vaccine suitability assessments. In the quarter ending September 2021, there were 9.5 million attendances rendered to assess a patient’s suitability for a COVID-19 vaccination, which amounted to 18.4% of all GP attendances in the quarter, and an increase of 193.7% on the quarter ending June 2021.
- The increase in pathology services was particularly apparent in both New South Wales (up by 40.4% to 20.6 million services) and the Australian Capital Territory (up by 27.2% to about 856,000 services). Benefits paid for pathology services also increased (up by 96.9% to $676.3 million and 52.1% to $22.4 million respectively for New South Wales and the Australian Capital Territory). For New South Wales, microbiology tests were up 175.6% to 5.8 million services and benefits were up 351.0% to $430.0 million. This shows that the increase in pathology service and benefit volumes was driven by COVID-19 testing, along with its relatively high Medicare rebate, when compared to other pathology services.
- New South Wales also experienced strong growth in GP attendances (up by 13.8% to 17.8 million services). This increase was due to growth in both the vaccine suitability assessments and COVID testing on referral.
- In contrast to GP attendances and pathology services, the service volumes in many other broad type of service (BTOS) categories fell. The categories experiencing the largest falls were optometry (down by 22.3% to 1.9 million services), other allied health (down by 5.4% to 4.0 million services) and diagnostic imaging (down by 4.9% to 7.3 million services). These falls can be attributed to COVID-19 lockdowns in New South Wales, Victoria, and the Australian Capital Territory, and patients deferring non-urgent allied health attendances and diagnostic imaging.
- Of all the MBS services in the quarter ending in September 2021, 11.0% or 14.5 million services were delivered via telehealth consultations, an increase of 50.7% from the quarter ending in June 2021, where 7.8% or 9.6 million services were delivered via telehealth consultations.
- In terms of mode of delivery, telehealth consultations for COVID-19 related MBS items often replaced face-to-face consultations (for example, GP videoconferences replacing GP face-to-face attendances and in-person consultant physician attendances replaced by phone calls). COVID-19 related face-to-face consultations reduced by 15.3% to 36.3 million consultations, whereas telephone consultations increased by 43.1% to 12.7 million consultations, and video conferencing consultations increased by 165.5% from about 615,000 to 1.6 million consultations. The shift from face-to-face consultations to telehealth consultations across the COVID-19 related items can be seen particularly in New South Wales, Victoria and the Australian Capital Territory, which were heavily affected by lockdowns during this period. The guide to the COVID-19 telehealth items is available through MBS Online. Refer to the technical notes for more details.
Compared with the quarter ending September 2020
- There was an increase of 13.2% in the number of Medicare services processed, and 6.5% in the amount of benefits paid.
- There was, however, a decrease in the percentage of services delivered via telehealth consultations with 13.3% of all MBS services or 15.5 million telehealth consultations in the quarter ending September 2020 as opposed to the 11.0% or 14.5 million telehealth consultations in the quarter ending September 2021.
- When comparing BTOS groups, the biggest increases were seen in GP attendances and pathology (up by 21.1% and 16.7% respectively), which can be explained by the introduction of the COVID-19 vaccine suitability assessments in early 2021 and the increase in COVID-19 testing. At the Australia level, microbiology services were up 61.6% to 11.0 million services (driven by COVID-19 testing services, which are within the microbiology MBS group).
- The biggest decrease was in optometry (down by 20.1%), which was heavily impacted by lockdowns as optometrists were generally limited to only providing essential or time critical services to patients.
- In relation to mode of delivery associated with COVID-19 related items, all the other states and territory saw a decrease in proportion of consultations delivered via telehealth consultations, except New South Wales (from 25.6% or 4.3 million telehealth consultations in the quarter ending September 2020 to 38.3% or 6.3 million telehealth consultations in the quarter ending September 2021) and the Australian Capital Territory (from 20.4% or about 141,000 telehealth consultations in the quarter ending September 2020 to 31.1% or about 212,000 telehealth consultations in the quarter ending September 2021).
- COVID-19 related allied health attendances delivered via telehealth consultations experienced the largest percentage change variation in service volumes, from a 42.4% decrease to about 3,200 telehealth consultations in the Greater Hobart area to a 150.0% increase to about 255,000 telehealth consultations in Greater Sydney. Two other regions had an increase of more than 50%, these were: the Australian Capital Territory (up by 91.6% to about 14,400 telehealth consultations), and the Rest of New South Wales (up by 52.6% to about 81,400 telehealth consultations), which again could be attributable to COVID-19 lockdowns.
- Other medical practitioner (OMP) services delivered via telehealth consultations also experienced a large variation. The Greater Hobart area had an increase of 53.8% to nearly 2,700 services.
- GP/OMP brief attendances delivered via telehealth consultations increased by over 100% in each of the following areas: Greater Darwin (up by 187.6% to about 3,900 telehealth consultations), the Australian Capital Territory (up by 133.5% to about 13,400 telehealth consultations) and Greater Sydney (up by 110.5% to almost 400,000 telehealth consultations).
Comparing the year ending September 2021 with the year ending September 2020
- The number of services increased by 11.1% to 481,3 million services and the benefits paid increased by 10.2% to $27.9 billion between the two 12-month periods.
- Anaesthetics was the BTOS group with the highest percentage change over the 12-month period (up by 15.3% to 3.9 million services). Other BTOS categories experiencing a large percentage change in the number of services were: Pathology (up by 15.1% to 174.5 million services), Other allied health (up by 12.8% to 16.3 million services) and GP attendances (up by 10.0% to 180.5 million services).
- In relation to the COVID-19 related items, the number of services increased by 4.7% to 200.3 million services and the benefits paid increased by 7.1% to $11.1 billion between the two 12-month periods. The service increase was mainly driven by allied health attendances (up by 17.3% to 15.7 million services), specialist attendances (up by 6.9% to 30.3 million services), and obstetric attendances (up by 6.1% to 1.7 million services).
- Among all the states and territories, Victoria, the Australian Capital Territory, Western Australia, and New South Wales are the top four jurisdictions who had the largest growth in services for COVID-19 related items (up by 8.5% to 54.0 million services, 4.5% to 2.7 million services, 4.0% to 18.7 million services, and 3.6% to 65.4 million services respectively). In contrast, there was a decrease of 1.5% to 1.2 million services in Northern Territory.
Interactive charts showing: (a) overview of temporary COVID-19 related items introduced to the MBS by quarter; (b) BTOS comparison; (c) COVID-19 related items by mode of delivery; (d) standard GP attendance items by mode of delivery; and (e) bulk billing incentives for non-referred services.
Note: Quarters of a calendar year are used in the report. For example: Sep 2021 or September quarter 2021 refers to July to September 2021, which is the first quarter of FY 2021-2022.