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:
- Provided to public admitted patients and public outpatients of public and private hospitals
- Provided 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 using date of processing, for the quarter ending December 2018 to the quarter ending September 2021. Date of processing and date of service are influenced by working day. Number of working days by month and state and territory is available at Services Australia. It should be noted that date of processing is not always the same as date of service (the date in which the visit to a health practitioner occurred, the date in which a procedure was performed, or the date in which a test was undertaken).
Statistics are available on the total number of services and benefits paid, in and out of hospital, mode of delivery, by region within state and territory. Out of hospital refers to services provided in non-inpatient settings, and includes services in private outpatient clinics. In hospital refers to all services to private inpatients of public and private hospitals, and services rendered as part of a privately insured episode of hospital-substitute treatment. Mode of delivery refers to services delivered by face-to-face, telehealth via telephone or telehealth via video conferencing. 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:
- Non-referred general practitioner (GP) attendances (including other medical practitioner attendances)
- Practice nurse services on behalf of a GP
- Specialist attendances
- Diagnostic imaging
- Assistance at operations
- Radiation therapy
- Other allied health
- Other MBS.
On 13 March 2020, telehealth via telephone and video conferencing items were introduced into MBS on account of COVID-19. 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.
From 13 March 2020 the Department of Health issued a series of MBS circulars:
All items listed in the circulars, including items newly introduced as well as pre-existing corresponding face to face items are treated as COVID-19 related items in the telehealth section of this report. COVID-19 related items are categorised into five groups:
- GP attendances
- Other medical practitioner attendances
- Specialist attendances
- Obstetric attendances
- Allied health attendances.
All telehealth items listed in the circulars as well as pre-existing telehealth items for people living in rural and remote areas are treated as telehealth items in the broad type of service groups analysis of this report.
Statistics are presented for states and territories, Statistical Area Level 3 (SA3), Primary Health Network (PHN) and Greater Capital City Statistical Areas (GCCSAs).
GCCSAs are geographical areas that represent the functional extent of each of Australia’s capital cities. These geographical areas have been developed by the Australian Bureau of Statistics (ABS) and include 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.
SA3s are geographical areas defined by the Australian Bureau of Statistics (ABS) that provide a regional breakdown for analysing data. There are 340 SA3s covering Australia. SA3s generally have a population of between 30,000 and 130,000 people.
PHNs connect health services across a specific geographic area so that patients, particularly those needing coordinated care, have access to a range of services, including primary care services, secondary care services and hospital services. There are 31 PHN areas covering Australia, with boundaries defined by the Australian Government Department of Health.
The Medicare enrolment postcode at the time the claim was processed, was used as a proxy for the patient residence as it corresponds to most people’s usual residence. Some patients changed enrolment postcodes during a quarter. In compiling statistics for the quarter, MBS data was allocated to a patient’s major enrolment postcode in each quarter based on the largest number of services, before being aggregated to quarterly statistics.
In considering the statistics presented in this report, it should be noted that since the enrolment postcode in MBS data is a mail delivery postcode, modifications were made to an ABS correspondence to accommodate those people who use a post office box (POB) postcode. POB and mailing address postcodes were proportionately allocated to Statistical Area Level 3 (SA3) using the modified correspondence. SA3s were then grouped to GCCSA using an ABS correspondence.
About the data
The Australian Government subsidises the cost of a wide range of prescription medicines through two separate schemes, the Pharmaceutical Benefits Scheme (PBS) and the Repatriation Pharmaceutical Benefits Scheme (RPBS). Claims for reimbursement for the supply of PBS- or RPBS-subsidised medicines are submitted by pharmacies through Services Australia for processing, and are provided to the Australian Government Department of Health. Subsidies for prescription medicines are available to all Australian residents who hold a current Medicare card, and overseas visitors from countries with which Australia has a Reciprocal Health Care Agreement. In general, patients pay a contribution to the cost of the medicine (co-payment), and the Australian Government covers the remaining cost. This remaining cost is referred to as the benefit paid.
PBS data in this report are from records of prescriptions dispensed under the two schemes, where either:
- The Australian Government paid a subsidy
- The prescription was dispensed at a price less than the relevant patient co-payment (under co-payment prescriptions) and did not attract a subsidy.
PBS data cover all PBS prescriptions dispensed by approved suppliers, including community pharmacies, public and private hospital pharmacies and dispensing doctors.
PBS does not cover:
- Over-the-counter purchases
- Private prescriptions
- Medicines supplied to admitted patients in public hospitals, although prescriptions to patients on discharge and non-admitted patients in all states and territories are in scope, except for New South Wales and the Australian Capital Territory.
Medicines dispensed through alternative arrangements where the patient cannot be identified, such as direct supply to Aboriginal health services and the Opiate dependence treatment program, are excluded.
The provision of some medicines may be under-represented in those remote areas with a high proportion of Aboriginal and Torres Strait Islander people who can access medicines through Aboriginal health services, particularly in the Northern Territory.
The number of prescriptions represents the total number of times that a prescribed medicine is supplied to a patient. For individual prescriptions where the quantity dispensed varied from the listed maximum quantity, no adjustment was made for increased or reduced quantity supplied. The supply was counted as one prescription.
Prescriptions dispensed and government benefits paid in this report are presented by quarter which is based on the date the medicine was supplied to the patient.
Prescription numbers presented in this report may vary slightly from previous reports due to processing of late claims, updates and cancellations.
The Schedule of Pharmaceutical Benefits
The Schedule of Pharmaceutical Benefits (the Schedule) is released monthly and provides information on the arrangements for the prescribing and supply of pharmaceutical benefits under the PBS. The Schedule lists all of the ready-prepared items subsidised under the PBS.
Prescriptions can be written either as one-off (original with no repeats) or original with repeats. Original prescriptions refer to dispensing of a prescription for the first time and repeat prescriptions refer to the subsequent supply from an original prescription.
The PBS allows for original and repeat prescriptions to be supplied at the same time, in certain circumstances, according to Regulation 49 (previously Regulation 24). A common use of this rule is for people living or travelling to very remote areas within Australia or overseas.
Anatomical Therapeutic Chemical (ATC) Classification
PBS listed medicines are organised into Anatomical Therapeutic Chemical (ATC) classification groups according to the body system or organ on which they act. See the World Health Organization Collaborating Centre for Drug Statistics Methodology (WHOCC) for further information on the ATC classification system.
The ATC Classification used in this report is from the Australian Government Department of Health’s version of the WHOCC ATC Classification, which has some minor differences from the WHOCC version, based upon a particular medicine’s usage in Australia. The Schedule of Pharmaceutical Benefits according to ATC groups can be viewed via browsing by body system.
PBS Programs Types
This web report has categorised PBS listed medicines into ‘program types’ which reflect the groupings in the Schedule and are described below.
Most PBS medicines are dispensed by community pharmacies and used by patients at home. These are known as ‘General Schedule’ medicines.
Section 100 of the National Health Act 1953 provides for an alternative method of medicine supply to patients when normal PBS arrangements are not appropriate.
Section 100 programs include:
- Highly Specialised Drugs Program
- Efficient Funding of Chemotherapy
- Botulinum Toxin Program
- Growth Hormone Program*
- In-Vitro Fertilisation Program.
Separate sub-schedules exist for specific prescribers or for a specific cohort of the population. These include:
Items annotated with an asterisk (*) were excluded from visualisation titled ‘Number of scripts dispensed by PBS program’.
Data is presented for Statistical Area Level 3 (SA3), Primary Health Network (PHN) and Greater Capital City Statistical Areas (GCCSAs).
SA3s are geographical areas defined by the Australian Bureau of Statistics (ABS) that provide a standard framework for analysing data at the regional level. There are 340 SA3s covering Australia. SA3s generally have a population of between 30,000 and 130,000 people.
PHNs assist patients through connecting health services across a specific geographic area so that patients, particularly those needing integrated and coordinated care, have access to a range of services, including primary care services, secondary care services and hospital services. There are 31 PHN areas covering Australia, with boundaries defined by the Australian Government Department of Health.
GCCSAs are geographical areas that represent the functional extent of each of Australia’s capital cities. These geographical areas have been developed by the ABS and include 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.
Medicare enrolment postcode at the time the claim was processed is used as a proxy for the patient residence as it corresponds to most people’s usual residence. If the patient postcode was unknown or invalid, the postcode of the dispensing pharmacy is used instead.
Postcodes are proportionately allocated to SA3 and PHN, and then grouping SA3s to GCCSA, using the respective ABS correspondence files.