Data sources and notes

This page provides:

  • information about the MBS data used to analyse the use of Indigenous health checks and follow-ups
  • information about the population data used to calculate rates of health checks
  • key technical notes about the analyses
  • a timeline of major developments in health check implementation
  • information about national goals for health check use.

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 items 715, 228, 92004, 92011, 92016 and 92023 on the MBS.
  • Indigenous-specific health check follow-up services—listed as items 10987, 81300–81360, 93048 and 93061 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)
  • Video-conference MBS items 92004 and 92011 (available from 30 March 2020 through to 30 June 2021)
  • Telephone MBS items 92016 and 92023 (available from 30 March 2020 through to 30 June 2021).

MBS items 715, 92004 and 92016 relate to health checks provided by a general practitioner (GP), while items 228, 92011 and 92023 relate to health checks provided by other medical practitioners (excluding specialist or consultant physicians). In all 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. 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.

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 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.
  • 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 through to 30 June 2021).
  • Telehealth MBS items 93048 and 93061: Allied health follow-up services after a health check to a maximum of 5/calendar year, delivered via video-conference or telephone (available from 30 March 2020 through to 30 June 2021).

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

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

Any eligible allied health professional (telehealth)

93048, 93061

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. 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, PHN, SA3), the ABS did not publish the required population data, so the AIHW approximated these from available data.

Remoteness, PHN and SA3 estimates

To derive population data for remoteness, 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.

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.

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. 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 31st 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 2015 and June 2020: 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.

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 2020, which were processed on or before 28 February 2021. 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 2020, but not processed until 1 May 2021, 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, 2019–20 refers to the period from 1 July 2019 to 30 June 2020.

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 5 different geographies (based on the 2016 Australian Statistical Geography Standard)—Statistical Areas Level 3 (SA3s), Indigenous Regions (IREGs), Primary Health Networks (PHNs), remoteness areas and state 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.

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.

Box 5: 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 patients provide postcode details belonging to a PO Box address. 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 needed 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 more so than others. Within the geographic areas presented in this report, the areas most likely to be impacted 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), Daly - Tiwi - West Arnhem (NT), Parramatta (NSW), Palmerston (NT), Sydney Inner City (NSW), Goldfields (Qld), Canning (WA), and Swan (WA).
  • the following IREGs: Alice Springs (NT), Apatula (NT), Tennant Creek (NT), Katherine (NT), Nhulunbuy (NT), Darwin (NT), Jabiru - Tiwi (NT).
  • Remote and Very remote areas in the analysis by remoteness.

Time between Indigenous-specific health checks

To report the time interval between consecutive Indigenous-specific health checks, 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.

Means and medians calculated from the resulting discrete data may have been slightly different if they had been calculated from continuous interval data.

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 will differ from the previous edition (2019), which mainly used the estimated resident population at 30 June 2016 and some 2011 Census-based projections. 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 ‘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 in health check implementation

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.

2013

National Aboriginal and Torres Strait Islander Health Plan 2013–2023

As part of our efforts to close the gap, since 2011, the Australian Government worked with Aboriginal and Torres Strait Islander people to produce the National Aboriginal and Torres Strait Islander Health Plan, providing an opportunity to collaboratively set out a 10 year plan for the direction of Indigenous health policy

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.

2015

Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013-2023

The Implementation Plan outlines the actions to be taken by the Australian Government and other key stakeholders to give effect to the vision, principles, priorities and strategies of the Health Plan, including goals for increasing the use of Indigenous-specific health checks.

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.

July 2018

MBS health check item, 228, introduced for non-VR Medical Practitioners

Allows eligible non-vocationally recognised medical practitioners (other than GPs and specialists) to claim MBS subsidies for Indigenous-specific health checks.

March 2020

COVID-19 temporary telehealth health check and follow-up items introduced

To help reduce the risk of community transmission of COVID-19 and provide protection for patients and health care providers (available until 30 June 2021).

December 2020

COVID-19 temporary health check items, 93470 and 93479, introduced for Residential Aged Care Facilities

To improve access to multidisciplinary care for residents of residential aged care facilities (RACF) during the COVID-19 pandemic (available until 30 June 2022).

2021

Health check templates

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.

National goals for health checks

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).

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 4: 2023 Implementation Plan (IP) goals and national 2019–20 health check rates (per cent)

Age

2023 IP goal health check rate (%)

2019–20 health check rate (%) – counting health checks by date of processing

2019–20 health check rate (%) – counting patients by date of service

0–4

69

27

29

5–14

46

26

25

15–24

42

24

23

25–54

63

30

29

55 and over

74

41

38

Note: Data for the IP goals are based on date of processing, age determined from date of service and false date of birth (1 January of birth-year), and calculated using the number of health checks. Thus, the goals do not align with the rates 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). Both rates are shown in Table 4, for comparison.

References

Australian Bureau of Statistics (ABS) 2019. Estimates and Projections, Aboriginal and Torres Strait Islander Australians. Canberra: ABS.