Data sources and notes

This page provides:

Medicare Benefits Schedule data

The MBS is a listing of Medicare services that are subsidised by the Australian Government. It is part of the Medicare Program that is managed by the Department of Health, and administered by the Department of Human Services.

The statistics in this publication are based on AIHW analysis of the Medicare Benefits Schedule data, accessed through the Department of Health’s Enterprise Data Warehouse.

In this report, data are presented for:

  • Indigenous-specific health checks—listed as item 715 on the MBS
  • Indigenous-specific health check follow-up services—listed as items 10987, 81300–81360 on the MBS.

The data presented on these items do not provide a complete picture of all health checks and associated follow-up care provided to Indigenous Australians. Some Indigenous Australians may be receiving similar primary health care through other MBS items (that is, items that are not specific to Indigenous Australians). A person may be also provided with equivalent care from a health care provider who is not eligible to bill Medicare—for example, through state- or territory-funded primary health care services and public hospitals, which are ordinarily not eligible to bill to Medicare.

MBS Indigenous-specific health checks

All Indigenous Australians, regardless of age, are eligible for an Indigenous-specific health check. There are 2 Indigenous-specific health check items listed on the MBS:

  • MBS item 715 (available from 1 May 2010)
  • MBS item 228 (available from 1 July 2018).

MBS item 715 relates to health checks provided by a general practitioner (GP), while item 228 relates to health checks provided by a medical practitioner (excluding specialist or consultant physicians). In both cases, suitably qualified health professions can assist under the supervision of the practitioner. The requirements of an Indigenous-specific health check, which are set out in the relevant sections of the MBS, include an assessment of the patient’s health, including their physical, psychological and social wellbeing. The check also assesses what preventive health care, education and other help should be offered to the patient to improve their health and wellbeing.

Although the use of a specific form to record results of a health check is not mandatory, proformas for Indigenous-specific health checks are available from the Department of Health website (with separate forms for children aged 0–4, people aged 15–54, and people aged 55 and over). A guide to Medicare for Indigenous health services—designed to support staff working in organisations that provide Medicare services to Indigenous Australians—is available from the Department of Human Services website.

Indigenous Australians can receive a health check using either item 228 or 715 once in a 9-month period. If the GP or medical practitioner bulk bills the item, there is no charge to the patient.

MBS item 228 is relatively new—available from July 2018. 

For the data period presented in this report, only item 715 was available for claiming; consequently, the data presented relate to item 715 only.

MBS Indigenous-specific follow-up services

Indigenous-specific follow-up items were added to the MBS in November 2008 to support the Indigenous‑specific health check, as checks alone have limited capacity to improve health outcomes. Based on health needs identified during an MBS 715 health assessment, people can access the following:

  • MBS item 10987: Follow-up services provided by a practice nurse or registered Aboriginal Health Worker for or on behalf of a GP after a health check to a Maximum of 10/calendar year (increased from 5/calendar year in 2009)
  • MBS items 81300-81360: Allied health follow-up services after a health check to a maximum of 5/calendar year. There are 13 separate items, 1 for each eligible allied health profession shown in Table 2. The professionals need to meet specific eligibility requirements, be in private practice and register with Medicare Australia in order to claim the follow-up items.

Table 2: Eligible allied health professionals and relevant MBS item numbers

Eligible allied health professionals

MBS items number

Aboriginal health worker/Aboriginal and Torres Strait Islander health practitioner

81300

Diabetes Educator

81305

Audiologist

81310

Exercise physiologist

81315

Dietician

81320

Mental health workers

81325

Occupational therapist

81330

Physiotherapist

81335

Podiatrist

81340

Chiropractor

81345

Osteopath

81350

Psychologist

81355

Speech pathologist

81360

Population data

The ABS’s estimated resident population (ERP) is the official measure of the Australian population. ERP estimates are based on results of the 5-yearly Census of Population and Housing, with adjustments for net undercount as measured by the Post Enumeration Survey.

ERP estimates for Indigenous Australians based on the 2016 Census are available for 30 June 2016 (ABS 2018). However, times series estimates (that is, for reference periods other than 30 June 2016) were not available at the time of analysis. The most recently published time series estimates are projections based on the 2011 Census (ABS 2014). A full time-series of population estimates and projections based on the 2016 Census (that is, for periods other than June 2016), is due for release in July 2019

In this report—except when looking at changes over time—rates of health checks were calculated using 2016 Census-based estimates for 30 June 2016. The most recent MBS data in this report relate to the period 2017–18. Consequently, the population estimates are likely to be slight underestimates (as the population will have increased since June 2016) and therefore the rates of health checks for 2017–18 calculated using these data might be slight over-estimates. 

When looking at changes over time—in the ‘Change over time in annual rate of health checks’ section—estimates and projections (series B) of the Indigenous population based on the 2011 Census (ABS 2014) have been used. Rates based on these population data should not be compared with rates shown in other sections.

PHN estimates

The ABS does not routinely produce Indigenous population estimates for Primary Health networks (PHNs). Indigenous population estimates for 30 June 2016 based on the 2016 Census by Statistical Area level 2 and Indigenous Regions (IREG) are available on the ABS website (ABS 2018). Using these estimates, as well as information from the 2016 Census on the distribution of the Indigenous population (mesh block level), the AIHW developed PHN-level population estimates for June 2016. These estimates have been used as the denominator for calculating rates of health checks by PHN for 2017–18.

Technical notes about the analysis

Counting services and people

This report presents data using 2 different counting units:

  • services—that is, the number of health checks (or follow-ups, as applicable) provided in the specified period
  • patients—that is the number of people who received 1 or more health checks (or follow-ups, as applicable) in the specified period.

In any given period (for example, 12 months), the number of health check patients may be smaller than the number of services provided. This occurs when patients have received more than 1 health check in that period.

In this report, most figures and explanatory text relate to the number of patients (rather than services). Rates have been calculated using the number of patients only.

Demographic information in the MBS data set is attached to each service. Thus, when analysing data for patients, there can be more than 1 service from which the demographic information (such as sex, age and postcode) can be derived. In this report, when counting people who had:

  • at least 1 health check in a specified period, the demographic information was taken from the last service for a health check in that period.
  • at least 1 follow-up in a specific period, the demographic information was taken from the last service for a follow-up in that period
  • at least 1 follow-up within 12 months of a health check in a specific period, the demographic information was taken from the record for the health check service that preceded the follow-up.

Dates and reference periods

The MBS data set includes information on the date the service was provided, as well as the date that the claim was processed by Medicare. These dates can differ due to a time lag between when a service is provided and when the claim for that service is processed by Medicare Australia.  

The data in this report relate to services provided between 1 July 2010 and 30 June 2018, which were processed before 19 January 2019. Data are reported by date of service as this more accurately reflects when the service was provided. Due to lags between date of service and date of processing, there will be a small proportion of services provided during the reference period that are not captured in these data. For example, if a service was provided on 29 June 2018, but not processed until 22 January 2019, it will not be included in the data.

Data in this report are presented for financial years (1 July to 30 June ).These are written with the second year abbreviated—for example, 2017–18 refers to the period from 1 July 2017 to 30 June 2018.

Location

Geographic correspondences (sometimes referred to as concordances or mapping files) can be used where the location information in an original data is not available at the geographic level required for analysis and reporting. Geographic correspondences are a mathematical method for reassigning data from one geographic classification (for example, a postcode) to a new geographic classification (for example, remoteness area).

Geographic correspondences enable postcode data to be reported at various other geographic levels. However, there are various limitations associated with the use of postcode data for this purposes. Key issues include:

  • postcodes do not fit neatly into the boundaries of geographic areas typically used for statistical reporting
  • some postcodes do not represent residential areas—for example, postcodes for PO Boxes (see Box 4).

Due to these issues, various decisions need to be made about how best to allocate the postcode data to geographic regions. There will some degree of inaccuracy in the resultant estimates, which will affect data in certain areas more than others —see Box 4.

For this report, postcodes were re-assigned to 4 different geographies (based on the 2016 Australian Statistical Geography Standard)—Statistical Areas Level 3 (SA3s), Primary Health Networks (PHNs), remoteness areas and state and territories. For the first 3 of these geographies, where postcodes fell across the boundaries of multiple areas (for example, multiple SA3s), data were apportioned based on the population distribution of Indigenous Australians. State and territory data were derived by aggregating the derived SA3 data (SA3 data fit neatly into state/territory boundaries).

Box 4: Limitations of using postcode data to derive health check and follow-up rates

There are various limitations associated with the use of postcode data for analysing the use of health checks and follow-ups in sub-national regions.

A key issue is that postcodes do not fit neatly into the boundaries of geographic areas typically used for statistical reporting. For example, a single postcode can fall across multiple PHN boundaries. In such cases, the data for a single postcode need to be split across multiple areas—this requires decisions around how to divide the data across multiple areas that are normally made based on what is known about the population distribution within the area covered by the postcode. This method relies on the assumption that rates of health checks do not vary within postcodes, which will result in some inaccuracy.

Another key issue is that some postcodes do not represent residential areas—for example, postcodes for PO Boxes. Patients who use PO Box addresses may not necessarily live close to the post office where the PO Box is located. When performing the analysis, decisions need to be made about how to allocate data for non-residential areas. 

These issues and analysis decisions are likely to have a greater impact on some areas than others. Within the geographic areas presented in this report, the following areas are most likely to be impacted by are:

  • the following SA3s: Alice Springs (NT), Barkly (NT), Darwin City (NT), Melbourne City (Vic), Adelaide City (SA), Perth City (WA), East Arnhem (NT), Katherine (NT), Darwin Suburbs (NT), Parramatta (NSW), Palmerston (NT), Sydney Inner city (NSW), Goldfields (Qld), Canning (WA), and Swan (WA).
  • Remote and Very remote areas in the analysis by remoteness.

Comparisons with other reports

As described in the ‘Dates and reference periods’ section, the data in this report are based on the date of service (rather than date of processing), as this more accurately reflects when the service was provided. Data in this report may differ to those published elsewhere based on date of processing, including previous editions of this report. It may also differ to data published elsewhere based on date of service, where the date of processing cut-off is different.

In addition, as described in ‘population data’, this report primarily uses population estimates for 30 June 2016, based on the 2016 Census, when calculating rates. The rates may differ to other reports that have used 2011 Census-based data. The rates may also differ to those released in future updates of this report (or in other reports) when a full time series of data based on the 2016 Census is available (see also ‘population data’).

Timeline of major developments in health check implementation

The timeline of major developments  in health checks shows the increase in uptake from the date of implementation and highlights relevant major developments (described further in Table 3).

Table 3: Major developments

When?

What?

Why?

November 1999

55 years & over annual health check (MBS item 704) introduced

The first Indigenous-specific health check established as the Indigenous equivalent of health checks for non-Indigenous people aged 75 years and over

May 2004

15–54 years 2-yearly adult health check (MBS item 710) introduced

The extension of health checks to adults recognised that the conditions responsible for early deaths of Aboriginal and Torres Strait Islander people started before the age of 55.

May 2006

0–14 years annual child health check (MBS item 708) introduced

With this addition, Aboriginal and Torres Strait Islander people of all ages were eligible for preventive health checks.

December 2008

National Partnership Agreement implemented

The National Partnership Agreement on Closing the Gap in Indigenous Health Outcomes included the Indigenous Chronic Disease Package. This package was funded by the Australian Government over 4 years from 2009–2013 and included a number of elements relevant to improving uptake of Indigenous-specific health measures.

July 2009

Medicare Local Closing the Gap workforce established

Part of the Indigenous Chronic Disease Package, this workforce comprised:

  • 86 full-time equivalent Indigenous outreach workers to support Aboriginal and Torres Strait Islander people access primary health-care services and follow-ups
  • 86 full-time equivalent Indigenous health project officers to lead Aboriginal and Torres Strait Islander health issues within Medicare Locals, and raise awareness of Closing the Gap initiatives relevant to mainstream primary care.

This workforce assisted with the delivery of the Care Coordination and Supplementary Services and Improving Indigenous Access to Mainstream Primary Care programs.

March 2010

Practice Incentive Program Indigenous Health Incentive introduced

Part of the Indigenous Chronic Disease Package, the Indigenous Health Incentive was included under the Practice Incentives Program.

May 2010

Health check items 704, 708 and 710 combined

The 3 separate item numbers were replaced by a single item: MBS item 715. The frequency of health checks was standardised to annual, so Aboriginal and Torres Strait Islander people aged 15–54 were able to have a health check every year, instead of every 2 years.

2010

Indigenous status required by Royal Australian College of General Practitioners Standards

Existing requirements were strengthened, so practices seeking accreditation had to demonstrate they were routinely recording Aboriginal and Torres Strait Islander status in their active patient records.

July 2011–12

Divisions of General Practice transitioned to Medicare Locals

Divisions of General Practice (n = 112), as well as their national and jurisdiction level support structures (the Australian General Practice Network and 8 state-based organisations) were replaced with Medicare Locals (n= 62), as part of the National Health Reform Agenda.

June 2014

Australian Medicare Local Alliance abolished

Australian Medicare Local Alliance (the national coordination body for Medicare Locals) was abolished. Regional coordination and support of the Closing the Gap workforce undertaken by the Alliance also ceased.

July 2015

Medicare locals replaced by Primary Health Networks

Medicare Locals (n= 62) were replaced by Primary Health Networks (n = 31).  In 2015–16, funding for the Care Coordination and Supplementary Services and Improving Indigenous Access to Mainstream Primary Care programs was provided through Primary Health Networks.

July 2016

Integrated Team Care Activity started

Care Coordination and Supplementary Services and Improving Indigenous Access to Mainstream Primary Care program funding was combined into new Integrated Team Care Activity.

National goals for health checks

The Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013–2023set goals for increasing the use of Indigenous-specific health checks (Table 3).

See Tracking progress against the Implementation Plan goals for the Aboriginal and Torres Strait Islander Health Plan 2013–2023 for additional data and information about these goals

Table 3: 2023 Implementation Plan (IP) goal and national 2017–18 health check rates (per cent)

Age

2023 IP goal health check rate

2017–18 health check rate

0–4

69

30

5–14

46

30

15–24

42

25

25–54

63

31

55 and over

74

43

Note: Data for the IP goals are based on date of processing, and calculated using the number of health checks. Thus, the 2017–18 data in the table may not align with the 2017–18 data shown elsewhere in this report (which are based on date of service, and relate to the number of people who received at least 1 health check).