Indigenous health checks and follow-ups

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 MBS data, accessed through the Department of Health’s Enterprise Data Warehouse.

In this report, data are presented for:

• Indigenous‑‍specific health checks – listed as items 715, 228, 92004, 92011, 92016, 92023, 93470 and 93479 on the MBS.
• Indigenous‑‍specific health check follow‑‍up services – listed as items 10987, 81300–‍81360, 93048, 93061, 93200, 93202, 93546–‍93558, 93571–‍93573, 93579–‍93591, 93592 and 93593 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 also be 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 6 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 items 93470 and 93479 in Residential Aged Care Facilities (available from 10 October 2020 to 30 June 2022)
• Video-‍conference MBS items 92004 and 92011 (available from 30 March 2020)
• Telephone MBS items 92016 and 92023 (available from 30 March 2020 to 30 June 2021)

MBS items 715, 92004, 92016 and 93470 relate to health checks provided by a vocationally registered general practitioner (GP), while items 228, 92011, 92023 and 93479 relate to health checks provided by non-vocationally registered GPs. In all cases, suitably qualified health professionals 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. In 2021, with support from the Department of Health, the National Aboriginal Community Controlled Health Organisation (NACCHO) and Royal Australian College of General Practitioners (RACGP) released 5 Indigenous‑‍specific health check templates for testing, designed for different age groups, and downloadable from the RACGP website. The CSIRO is also developing Smart Forms for Indigenous health checks that are intended to streamline the collection and sharing of clinical information to improve patient outcomes.

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

For the data period presented in this report, note that telehealth items were introduced late in 2019–‍20.

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 Indigenous‑‍specific health check, people can access the following:

• MBS item 10987: Follow‑‍up services provided by a practice nurse or registered Aboriginal and Torres Strait Islander health practitioner 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 10/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.
• MBS items 93546–‍93558: Allied health follow‑‍up services (initial/long attendances) delivered in Residential Aged Care Facilities after a health check. There are 13 separate items, 1 for each eligible allied health profession shown in Table 2 (available from 10 December 2020 to 30 June 2022).
• MBS items 93571–‍93573: Allied health follow‑‍up services (additional physical therapies) delivered in Residential Aged Care Facilities after a health check. There are 3 separate items: 1 for exercise physiologists; 1 for occupational therapists; 1 for physiotherapists (available from 10 December 2020 to 30 June 2022).
• MBS items 93579–‍93591: Allied health follow‑‍up services (subsequent/standard attendances) delivered in Residential Aged Care Facilities after a health check. There are 13 separate items, 1 for each eligible allied health profession shown in Table 2 (available from 10 December 2020 to 30 June 2022).
• Telehealth MBS items 93200 and 93202: Video-‍conference or telephone follow‑‍up services provided by a practice nurse or registered Aboriginal and Torres Strait Islander health practitioner on behalf of a GP after a health check to a maximum of 10/calendar year (available from 20 April 2020).
• Telehealth MBS items 93048 and 93061: Allied health follow‑‍up services after a health check to a maximum of 10/calendar year, delivered via video-‍conference or telephone (available from 30 March 2020).
• Telehealth MBS items 93592 and 93593: Allied health follow‑‍up services delivered in Residential Aged Care Facilities after a health check, delivered via video-‍conference or telephone (available from 10 December 2020 to 30 June 2022).

For the data period presented in this report, note that telehealth items were introduced late in 2019–‍20.

The ABS’ 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. The ABS also estimates how the Indigenous population would change, projected forward, based on various sets of assumptions. The most recent available projections cover the period from 30 June 2017 to 30 June 2031 (ABS 2019). Populations in years prior to the 2016 Census were also revised or ‘backcast’ by applying assumptions back in time, to create a smooth data series.

In this report, most rates were calculated based on the available ABS’ 30 June estimates and (series B) projections – averaged to approximate the midpoints of the various financial years. For certain geographies (Remoteness, GCCSA, PHN, SA3), the ABS did not publish the required population data, so the AIHW approximated these from available data.

Remoteness, GCCSA, PHN and SA3 estimates

To derive population data for remoteness, GCCSA, PHN and SA3, the AIHW undertook a method for disaggregating higher-‍level ABS projections (state/territory, combined remoteness areas), called Iterative Proportional Fitting. This was supported by 2016 Census counts downloaded from ABS TableBuilder, and small area ERPs for 30 June 2016, where available.

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.

Patient 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 age and location can be derived (location is detailed later in the notes). In this report, different tactics were used for different analyses:

• For annual rates of health checks and for health check patients who received a follow‑‍up service in the 12 months following the health check: where patients had more than 1 health check in a financial year, age was calculated from the date of the first health check for odd-‍numbered Patient Identifier Numbers (PINs) and from the last health check for even-‍numbered PINs in that financial year.

• This tactic was used to reduce bias in the derivation of age, and was used to select from multiple patient postcodes as well. Upward bias on age is introduced when age is calculated at the date of the last health check in a financial year for patients with more than 1 health check, because birthdays are likely to have passed by the time of the second health check. A PIN’s final digit is effectively random, so this tactic splits the patient records into 2 groups, with upward bias on half and downward bias on the other half. Age could otherwise have been calculated at the 31^st of December to reduce bias, but then a separate tactic would need to be used for managing multiple postcodes.

• For numbers of health checks between July 2016 and June 2021: where patients had more than 1 health check over the period, age was calculated from the date of the last health check in the reference period.

• This tactic was used to better align with the population structure at the end of the reference period.

Note: Since patients are assigned to only one age group in a given year, it is safe to combine data from multiple age groups if required. Similarly, combining data from multiple regions is generally safe, however rounding errors may compound to give slightly inaccurate sums. Patient counts for face-‍to-‍face services and telehealth services should not be summed, since this could lead to double-‍counting of patients who had at least one of each type of service. Also, conflicting patient counts may occur when an individual’s age group and/or location was assigned differently for telehealth and face-‍to-‍face records.

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 2021, which were processed on or before 30 April 2022. 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 2021, but not processed until 1 May 2022, 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, 2020–‍21 refers to the period from 1 July 2020 to 30 June 2021.

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
• defining geographic boundaries for postcodes is an imprecise process – postcodes can also change over time
• people may not keep their postcode information up-‍to-‍date with Medicare
• postcodes linked to patient records may belong to PO boxes, making correspondence to small geographic areas less accurate (see Box 5).

Due to these issues, various decisions need to be made about how best to allocate the postcode data to geographic regions. There will be some degree of inaccuracy in the resultant estimates, which will affect data in certain areas more than others – see Box 5.

For this report, postcodes were re-‍assigned to 6 different geographies (based on the 2016 Australian Statistical Geography Standard) – Statistical Areas Level 3 (SA3s), Indigenous Regions (IREGs), Primary Health Networks (PHNs), remoteness areas, Greater Capital City Statistical Areas (GCCSA) and states and territories. Where postcodes fell across the boundaries of multiple areas (for example, multiple SA3s), data were apportioned based on the population distribution of Indigenous Australians, according to AIHW analysis of ABS population estimates at 30 June 2016. Records with invalid postcode information could not be assigned to sub-‍national areas.

For patients who had more than one health check in a given reference period, the same selection process was followed as described in the ‘Counting services and people’ section earlier.

See Box 2 for information about how the different geographic areas in this report relate to one another and how areas have been classified as Metropolitan, Non-metropolitan and Combination in certain figures.

Time between Indigenous‑‍specific health checks

To report the time interval between patients’ consecutive Indigenous‑‍specific health checks (based on date of service), 2 slightly different methods were used to convert the days to months:

For ranges of months (e.g. ‘Less than 12 months’, ’12–14 months’), the number of fully elapsed calendar months were calculated – where a calendar month has fully elapsed when the day's date returns to or surpasses the same-‍numbered day in consecutive months.

For example, a patient who received a health check on both 01/01/2018 and 01/01/2019 saw 12 calendar months elapse between health checks, whilst a patient who received a health check on both 01/01/2018 and 31/12/2018 saw only 11 calendar months elapse between health checks.

For mean and median time intervals, days were converted to months based on the average number of days per month {days ÷ (365.25/12)}. This allowed for higher precision and accuracy compared with calculating means and medians from the number of fully elapsed months. Estimates were rounded downward to 0.1 of a month.

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. Age and location were also determined in a slightly different way to some other reports (see ‘Counting services and people’ and ‘Location’, presented earlier).

In addition, as described in ‘Population data’, this report primarily uses population estimates and projections, based on the 2016 Census, when calculating rates. The rates may also differ to those released in future updates of this report (or in other reports) when revised estimates based on the 2021 Census are available (see also Box 1).

The analysis of time between health checks has also been refined in this edition in 3 key ways:

• Earlier Indigenous‑‍specific health check items from 1999–‍2010 were included in the analysis.
• The reference periods for all analyses were restricted to 1 financial year, rather than 2 financial years pooled.
• Mean and median numbers of months between health checks were calculated from the number of days (see ‘Time between Indigenous‑‍specific health checks’ presented earlier).

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).

Established in 2015, the Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013–‍2023 set goals for increasing the use of Indigenous‑‍specific health checks by 2023 (Table 4).

To maintain continuity, data for the Implementation Plan goals relating to Indigenous‑‍specific health checks are based on: date of processing; age approximated from date of service and false date of birth (1 January of birth-‍year); calculated using the number of health checks; calculated using population projections based on the 2011 Census; and do not include MBS items for residents of Aged Care facilities at this time. Thus, the rates used for tracking progress against the Implementation Plan goals do not align with the rates shown in this report (which are based on date of service, based on actual age, relate to the number of people who received at least 1 health check, use population projections based on the 2016 Census, and include health checks in Aged Care facilities). Both rates are shown in Table 4, for comparison.

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.