Chronic disease management services among health check patients


This chapter presents exploratory analysis on the number and proportion of health check patients in 2023 who also received a chronic disease management (CDM) service in 2023, split by age group and sex.

CDM services are GP services on the MBS that are available to people with a chronic or terminal medical condition. A chronic medical condition is defined as one that has been or is likely to be present for 6 months or longer, including, but not limited to asthma, cancer, heart disease, diabetes, arthritis and stroke (Department of Health and Aged Care 2014).

CDM services include:

  • GP Management Plans (GPMP), which provide an organised approach to care, emphasising regular reviews, tailored self-care strategies, and coordination of services with specialists.
  • Team Care Arrangements (TCA), which coordinate care between the patient’s GP and allied health providers.

It is common for patients to have both a GPMP and TCAs, with 83% of GPMP patients having TCAs, and 97% of TCA patients having a GPMP in 2019 (AIHW 2022).

These types of comprehensive and coordinated care services are an important part of the attempts to address the high prevalence of chronic conditions among First Nations people (AIHW & NIAA 2020).

The rates of MBS services for both GPMPs and TCAs were around 1.5 times as high among First Nations people as among non-Indigenous Australians in 2017–18, after adjusting for age structure difference (AIHW 2020).

For more information about chronic disease management services, see Use of chronic disease management and allied health Medicare services and the Aboriginal and Torres Strait Islander Health Performance Framework website’s measure, 3.05 Chronic disease management.

For background information on health checks, see Health checks section.