Palliative care services in Australia

In 2020–21, 15,800 people received 77,000 Medicare-subsidised attendances and case conferences provided by palliative medicine physicians/specialists. This section provides information related to these services and the characteristics of the people who received them.  For further information on the Medicare Benefits Schedule (MBS) and the specific MBS items for attendances and case conferences involving palliative care physicians/specialists (defined as MBS-subsidised palliative medicine specialist services), refer to the data sources section.

The information in this section was last updated in May 2022.

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Who received these services?

Nationally, 15,800 people received an MBS-subsidised palliative medicine specialist service during 2020–21, that is a rate of 62 people per 100,000 population.

In 2020–21, among people who received at least one MBS-subsidised palliative medicine specialist service:

• Fewer were females –7,700 females (59 per 100,000 population) and 8,100 males (64 per 100,000 population; Table MBS.2).
• Three-quarters (76%) were aged 65 and over – the population rate increased steeply from age 55, from 72 to 656 per 100,000 between the age groups 55–64 and 85 and over. Only 4 in 100 (4.1%) were aged under 45 (Figure MBS.1).
• Almost 3 in 4 (72%) received an attendance in a consulting room or hospital – the next most common service was a palliative medicine physician/specialist participating in a community case conference (14%; Figure MBS.1).
• Western Australia had the highest population rate at 77 per 100,000 population and the Northern Territory had the lowest at 7.7 (Figure MBS.1). Western Australia also had the highest rate for palliative medicine attendances, however, for case conferences Queensland had the highest rate (32 per 100,000) and South Australia the lowest (0.6 per 100,000; Table MBS.5)

Figure MBS.1: Characteristics of people who received at least one MBS-subsidised palliative medicine specialist service, 2020–21

How many services were provided?

In 2020–21, 77,000 MBS-subsidised palliative medicine specialist services (attendances and case conferencing) were provided, at an average of 4.9 services per patient .

In 2020–21, among people receiving MBS-subsidised palliative medicine specialist services:

• On average, females received more services than males – 5.1 compared with 4.6 services, respectively, despite fewer total females receiving these services (Table MBS.2).
• The number of services per person was similar for those aged 25 and over – ranging from 4.6 to 5.1, while those aged 15–24 and under 15 received fewer services on average (4.2 and 1.4, respectively; Table MBS.2).
• 4 in 5 services were for palliative medicine attendances in a consulting room or hospital – 61,400 or 80% with a further 8.1% (6,300) being consultations in the person’s place of residence and 12% (9,300) for case conferences (Table MBS.3).
• The population rate of palliative medicine specialist services was 4 times as high in  Major cities than in Remote and very remote areas – 335 per 100,000 population in Major Cities, compared with 89 in Remote and very remote areas combined (Figure MBS.2). It should be noted that the vast majority of the employed palliative medicine physicians and nurses work in Major Cities (see Palliative care workforce for further details).
• Western Australia had the highest population rate of services, almost double the national average rate – 534 and 300 per 100,000 respectively (Figure MBS.2). This was largely due to the high rate of palliative medicine attendances in Western Australia (484 per 100,000 population). Northern Territory had the lowest rate of services, including attendances (25 and 23 per 100,000, respectively), which is consistent with rate of services decreasing with increasing remoteness. The highest rate of palliative medicine case conferences was recorded in Queensland (54 per 100,000 population), and the lowest rate was in South Australia (0.7 per 100,000 population).

Figure MBS.2: MBS-subsidised palliative medicine specialist services, by geography, 2020–21

How much was spent on these services?

The Australian Government’s expenditure through the MBS for palliative care-related services provided by palliative medicine physicians/specialists are based on allocating a unique item number to each service, as well as indicating the scheduled payment amount (see Medicare Benefits Schedule Book (DoH 2020) for further details).

• Over $6.3 million was paid in benefits for MBS-subsidised palliative medicine specialist services during 2020–21, equivalent to an average of $400 per patient; 83% of these benefits were for palliative medicine attendances (Table MBS.8).
• Western Australia had the highest average benefits per patient at $539 followed by Victoria ($475 per patient), and the Australian Capital Territory had the lowest average benefits per patient ($204). This is consistent with the rate of services in each state and territory, where Western Australia had the highest service rate.
• Between 2016–17 and 2020–21, the MBS benefits paid for all palliative medicine specialist services rose from $6.1 million to $6.3 million (current prices) over the 5 years. However after adjusting for inflation this represents a 3.3% decrease in MBS benefits in real terms (Table MBS.9).

How have these services changed over time, including during the COVID-19 pandemic?

In 2020–21, the total number of MBS-subsidised palliative medicine specialist services was at its lowest level in 5 years, continuing the declining trend that commenced between 2018–19 and 2019–20. Between 2016–17 and 2017–18 these services had increased by 11%. The rate of increase then slowed in the 12 months to 2018–19 (2.4% increase) before declining by 7.0% and 8.7% each year in the following 2 years (see below for further details and Figure MBS.3). These patterns were driven by a decline in palliative medicine attendances in the 2 years to 2020–21, given that these services account for the vast majority of palliative medicine specialist services (88% in 2020–21). Attendances in a person’s place of residence also followed a similar declining trend, although the rate of decline in these services was twice as steep than for attendances in a consulting room or hospital in the 12 months to 2020–21 (20% compared with 8.7% decrease, respectively).

Between 2016–17 and 2020–21, a different pattern was observed for palliative medicine case conferences. The number of services fluctuated somewhat from year-to-year but remained relatively stable over the total 5-year period, with an average annual change of 0.6%. While overall case conferences only increased by 1.6% between 2019–20 and 2020–21, steeper increases were observed for particular MBS items: a 32% increase for participating in a community case conference and a 15% increase for participating in a discharge case conference. In contrast, a large decline was observed for organising and coordinating a community case conference (24% decrease between 2019–20 and 2020–21).

Impacts of the COVID-19 pandemic

By looking at monthly MBS data we can assess the effect of the public health response to the COVID-19 pandemic on the delivery and receipt of MBS-subsidised palliative medicine specialist services during 2020 and 2021 (Figure MBS.3). In April, May and September 2020, there was a large drop in the number of MBS-subsidised palliative medicine specialist services received (30%, 16% and 17% decline from February 2020 levels and 25%, 12% and 18% decline from the corresponding month in 2019). These declines coincided with stricter public health restrictions for these months in some parts of Australia.

While the number of services was similar to or above March 2020 levels for most months between November 2020 and June 2021, it did not recover to the levels observed in the corresponding months in 2019 (remained 10–18% lower).

The introduction of COVID-19 telehealth items in March 2020 changed the profile of Medicare services provided to patients. These consultations replaced face-to-face consultations, particularly for patients located in COVID-19 hotspots or requiring to isolate or quarantine because of public health orders. The number of face-to-face specialist attendances declined by 26% and telehealth consultations increased by 90% between March and June 2020 (AIHW 2022). While there are no COVID-19 telehealth items specific to the delivery of palliative care, palliative care physicians/specialists were able to use these telehealth items from March 2020. This may account for the above mentioned decline in palliative medicine specialist services during 2020 and 2021. The data in this report has not captured the use of COVID-19 telehealth items by palliative physicians/specialists.

For more information see: Impacts of COVID-19 on Medicare Benefits Scheme and Pharmaceutical Benefits Scheme

Figure MBS.3: Trends in MBS-subsidised palliative medicine specialist services, 2016–17 to 2020–21