Medicare-subsidised palliative medicine services

This section provides information on the number and types of Medicare Benefits Schedule (MBS) subsidies for palliative care-related services provided by palliative medicine specialists, along with the characteristics of patients who received these services.

The Royal Australian College of Physicians (RACP) describes palliative medicine as ‘the specialist care of people with terminal illnesses and chronic health conditions in community, hospital and hospice settings. Palliative Medicine Physicians work collaboratively with a multidisciplinary team of health professionals to provide end of life care, provide relief from pain and symptoms of illness, and optimise the quality of life for a patient. Palliative medicine treats the physical aspects of illness, but also integrates psychological and spiritual facets of patient care’ (RACP 2020).

A palliative medicine specialist is a medical specialist who is a Fellow of the RACP and has completed the College’s training program in palliative medicine, a Fellow of the Australasian Chapter of Palliative Medicine, or both (ANZSPM 2008).

The MBS data presented in this section relate to services provided on a fee-for-service basis for which MBS benefits were paid. The year is determined from the date the service was processed by Services Australia rather than the date the service was provided. The data presented relates only to specialised palliative medicine attendances and not all services rendered by palliative medicine specialists. It does not include referred attendances by palliative medicine specialists to: public patients in public hospitals; public hospital outpatients; or patients covered by Department of Veterans’ Affairs arrangements. Therefore, the presented data are an underestimate of total palliative care activity.

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The information in this section was last updated in May 2021.

Key points

  • 88,605 MBS-subsidised palliative medicine specialist services were provided by palliative medicine specialists in 2019–20. This represents an average increase of 4.4% per year over the last 5 years, from 74,555 in 2016–17.
  • 17,000 patients received an MBS-subsidised palliative service in 2019–20. Patients each received an average of 5.2 services.
  • $7.1 million was paid in benefits for MBS-subsidised palliative medicine specialist services in 2019–20, at an average of $417 per patient.
  • Nationally, the rate of subsidised palliative medicine specialist services provided in 2019–20 was 347.2 per 100,000 population.

Patients who are referred to palliative medicine specialists usually have:

  • intermediate and fluctuating needs that might result in unplanned use of hospital and other services, and/or
  • complex and persistent needs (physical, social, emotional or spiritual) that are not effectively managed through established protocols (PCA 2018).

It should be noted that a patient may access more than one type of MBS-subsidised palliative medicine specialist service during the reporting period presented and that each service presented in this section is counted separately.

The data presented relate only to those palliative care services that are both provided by a palliative medicine specialist and are claimed under specialist palliative care MBS item numbers. In other words, the reported number of patients who receive palliative medicine services is an underestimate of total palliative care activity. This is due to the fact that other medical practitioners (general practitioners and medical specialists) and health professionals also attend to terminally ill patients and provide palliative care, without the service being eligible to be claimed specifically as a palliative care-related service under MBS. Palliative care specialists may also at times use other MBS item numbers when attending to palliative care patients, such as general consultation MBS items (PCA 2015).

The information presented in this chapter relates to MBS-subsidised palliative medicine specialist services in the financial year 2019–20. To provide information on changes over time, data are also presented for the reporting periods 2015–16 to 2019–20. More detailed information on the scope and coverage of the data presented in this chapter is provided in data sources.

Types of MBS-subsidised palliative medicine specialist services

Broadly, the MBS-subsidised palliative medicine specialist services can be categorised as follows:

  • Palliative medicine attendances (specialist consultation with patient)
    • Attendances at hospital or surgery
    • Home visits
  • Palliative medicine case conferences (multidisciplinary team meetings)
    • Community case conference—organisation and coordination
    • Community case conference—participation
    • Discharge case conference—organisation and coordination
    • Discharge case conference—participation

In 2019–20 there were 88,605 MBS-subsidised services provided by palliative medicine specialists (see Table MBS.3). Palliative medicine attendances in hospital or surgery made up the majority (71,077; 80.2%) of all MBS-subsidised palliative medicine specialist services in 2019–20 with a further 1 in 11 (8,369; 9.4%) of all services being consultations in the patient’s home. Of all palliative medicine specialist attendances (i.e. specialist consultation with a patient), 89.5% were in a hospital or surgery and 10.5% were home visits. Palliative medicine specialists were more likely to organise and coordinate case conferences for patients (7.4%) than to participate at such conferences initiated by other care providers (2.9%).

MBS-subsidised palliative medicine specialist services by state and territory and remoteness

The rate of MBS-subsidised palliative medicine specialist services in 2019–20 varied among states and territories. Western Australia recorded the highest rate (707.7 per 100,000 population), around double the national average rate (347.2 per 100,000 population) (Figure MBS.1). This was mainly accounted for by the high rate of palliative medicine attendances in Western Australia (659.6 per 100,000 population). The highest rate of palliative medicine case conferences was also recorded in Western Australia (48.2 per 100,000 population), followed by Queensland (45.4).

Figure MBS.1: MBS-subsidised palliative medicine specialist services, by state and territories, rate per 100,000 population, 2019-20.

Vertical bar chart showing the rate per 100,000 population of MBS-subsidised palliative medicine specialist services by state or territory. NSW 280.0, Vic 263.9, Qld 475.6, WA 707.7, SA 139.6, Tas 286.8, ACT 216.5, NT 104.2, Total 347.2. Refer to Table MBS.4.

Source data: Medicare-subsidised palliative medicine services Table MBS.4

In 2019–20, the highest rate of MBS-subsidised palliative medicine specialist services was recorded in Major cities, followed by Inner regional areas (390.0 and 288.0 per 100,000 population, respectively) (Figure MBS.2). The rate in Major cities is nearly 4 times that for Remote and Very Remote areas (101.9 per 100,000 population and 103.2 per 100,000 population, respectively).

Figure MBS.2: MBS-subsidised palliative medicine specialist services, by remoteness area, rate per 100,000 population, 2019-20

Vertical bar chart showing the population rate per 100,000 by remoteness for MBS-subsidised palliative care medicine specialist services. Major cities 390.0, Inner regional 288.0, Outer regional 178.3, Remote 101.9, Very Remote 103.2, Total 349.3. Refer to Table MBS.6.

Source data: Medicare-subsidised palliative medicine services Table MBS.6

MBS-subsidised palliative medicine specialist services over time

Between 2015–16 and 2019–20, the total number of MBS-subsidised palliative medicine specialist services increased from 74,555 to 88,605, an annual average increase of 4.4% (see Table MBS.7). As a population rate, this represents an increase from 310.8 per 100,000 in 2015–16 to 347.2 in 2019–20, an average rate of increase of 2.8% per year.

Over the 2015–16 to 2019–20 period, the rate of increase was steeper for the number of palliative medicine case conferences than for palliative medicine attendances — an average rate of increase of 7% per year compared with 4.1% respectively.

COVID-19 and MBS-subsidised palliative medicine specialist services

From 2018–19 to 2019–20, the total number of MBS-subsidised palliative medicine specialist services slightly decreased by 0.9% (see Table MBS.7). This may, in part, be driven by a 30.6% reduction in the item participate in a community case conference. The location of attendances also appeared to change slightly, with a 0.9% decrease in attendance at a hospital or surgery, and a 5.1% increase in home visits.

These changes may have been affected, in part, by the onset of the COVID-19 pandemic in early 2020 and subsequent changes to health care resources. Additionally, in response to the pandemic, palliative care specialists were able to use new MBS general telehealth items, which may reduce the use of standard palliative care items. The data presented here covers less than 6 months from the onset of the pandemic in Australia and use of the new MBS items. Further monitoring across subsequent years will provide clarity as to whether or not these changes are linked to the timing of the pandemic. More information about this can be seen in the Data sources section.

Characteristics of patients receiving palliative medicine specialist services

Nationally, 17,000 patients received an MBS-subsidised palliative medicine specialist service during 2019–20, a rate of 66.6 patients per 100,000 population. During this time period, 88,605 MBS-subsidised palliative medicine specialist services were provided, an average of 5.2 services per patient.

Approximately half the patients who received MBS-subsidised palliative medicine specialist services were male (51.6% compared with 48.4% for females). The vast majority (89.6%) of patients receiving an MBS-subsidised palliative medicine specialist service were aged 55 and over, and almost three-quarters (74.4%) were aged 65 and over. Less than 1 in 100 patients (0.6%) receiving MBS-subsidised palliative medicine specialist services were aged 24 or under in 2019–20. The population rate increased substantially with age from age 55—87.4 per 100,000 population (55–64 age group) to 187.0 (65–74), 378.6 (75–84) and 675.6 (for those aged 85 years and over; Figure MBS.3). Interestingly, the number of services per patient remained relatively stable (about 5 per patient) from the ages of 35–45 and above.

Western Australia had the highest rate of MBS-subsidised palliative care patients at 92.8 per 100,000 population, followed by the Australian Capital Territory and Queensland, with 86.1 and 77.1 per 100,000 respectively.

Figure MBS.3: Patients (per 100,000 population) receiving MBS-subsidised palliative medicine specialist services, by age group, 2019-20

Vertical bar chart showing the rate per 100,000 population of MBS-subsidised palliative medicine specialist patients by age group. <15 0.8, 15–24 1.8, 25–34 4.1, 35–44 12.2, 45–54 34.2, 55–64 87.4, 65–74 187.0, 75–84 378.6, 85+ 675.6. Refer to Table MBS.2

Source data: Medicare-subsidised palliative medicine services Table MBS.2

Australian Government expenditure on MBS-subsidised palliative medicine specialist services

This section outlines the Australian Government’s expenditure through the MBS for palliative care-related services provided by palliative medicine specialists in 2019–20. Benefits paid are based on the MBS, with the schedule allocating a unique item number to each service, as well as indicating the scheduled payment amount. Further information on the specific MBS items and item groups for palliative medicine specialists can be found in the Medicare Benefits Schedule Book (DoH 2020).

Almost $7.1 million was paid in benefits for MBS-subsidised palliative medicine specialist services during 2019–20, equivalent to an average of $417 per patient. The Northern Territory had the highest average benefits per MBS patient at $647 (see Table MBS.8). Over four-fifths (84.9%) of total benefits paid were MBS items claimed for palliative medicine specialist attendances.

Between 2015–16 and 2019–20, the MBS benefits paid for all palliative medicine specialist services increased by 25.7%, from $5.6 million to $7.1 million (current prices), an average annual increase of 5.9%. The rate of increase for benefits paid during the 5-year period was greater for palliative medicine case conferences than for palliative medicine attendances (average annual rate of 8.8% compared to 5.4%, respectively; see Table MBS.9). The greatest average annual rate increases were observed for home visits (16.1%) and participation in a discharge case conference (26.9%).