Palliative care services in Australia

In 2020–21, 514,700 people received 1.17 million palliative care-related prescriptions. This section provides information related to these prescriptions and the characteristics of the people who received them over the period 2016–17 to 2020–21. Further information about how palliative care prescriptions are identified through the Pharmaceutical Benefits Scheme (PBS) and the Repatriation Pharmaceutical Benefits Scheme (RPBS) are described below and in the Data sources section.

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

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Who were dispensed these prescriptions?

Nationally, 514,700 people were dispensed with at least one palliative care-related prescription in 2020–21, that is 2.0% of the Australian population (or 2,000 per 100,000).

In 2020–21, among people dispensed with palliative care-related prescriptions:

• Slightly more were females – 263,200 compared with 251,500 for males, equating to 2,031 per 100,000 females and 1,977 per 100,000 males (Table PBS.2.).
• 2 in 5 (43%) were aged 65 and over – increasing from 8.1% to 18% between the ages 25 and 74, and then declining to 9.5% for those aged 85 and over. However, as a proportion of the population those aged 85 and over had the highest prescription rate (9,100 per 100,000), 2–3  times as high as those aged 55–74.
• Those from Inner and Outer regional areas were more likely to be dispensed with palliative care-related prescriptions (2,500 per 100,000 in each) than those in other areas (1,800 in Major cities and 1,700 in Remote and Very remote areas combined; Figure PBS.1). Note that medicines distributed through Remote Area Aboriginal Health Services are not included in these data. This could contribute to the low rate observed in remote areas.

Figure PBS.1: Number of prescriptions and people receiving palliative care-related presciptions from Palliative Care Schedule, by age and remoteness, 2020–21

How many prescriptions were dispensed?

In 2020–21, 1.17 million palliative care-related prescriptions were dispensed, at an average of 2.3 presciptions per person (Table PBS.2). 

In 2020–21, among people dispensed with a palliative care-related prescription:

• On average, females received more prescriptions than males – 2.4 prescriptions per person among females and 2.2 among males, consistent with the higher number of females receiving these prescriptions.
• Number of prescriptions per person increased steadily from age 15 (1.3 prescriptions per person) to age 64 (2.3) and then plateaued at 2.7–2.9 prescriptions per person for those aged 65 and over; those aged 15 and under had an average of 1.7 prescriptions per person (Figure PBS.1).
• 9 in 10 (89%) prescriptions were for pain relief – this equates to 1.0 million prescriptions or 4,000 per 100,000 population (Figure PBS.2). The next most common prescription type was for gastrointestinal symptoms (83,800 prescriptions; 300 per 100,000; see Table 1 in Data sources for further details on these prescriptions).
• Tasmania had the highest rate of prescriptions dispensed, 1.5 times the national average rate – 6,900 and 4,500 per 100,000 population respectively (Figure PBS.2). Prescriptions for pain relief accounted for the highest rate of palliative care-related prescriptions in all states and territories, ranging from 3,100 per 100,000 population in the Northern Territory to 6,400 in Tasmania.

Figure PBS.2: Number of prescriptions from the Palliative Care Schedule by medication group, prescriber type, and states and territories, 2020–21

Who prescribed these medications?

In 2020–21:

• General practitioners (GPs) prescribed the majority (92%) of palliative care-related prescriptions – other clinicians (including medical specialists from other disciplines and nurse practitioners) prescribed 7.7% of the medications, followed by palliative medicine specialists (0.5%; Figure PBS.4).
• 9 in 10 prescriptions by GPs were for pain relief – other clinicians and palliative medicine specialists also predominately prescribed pain relief, but to a lesser extent (86% and 57% respectively).   
• Palliative medicine specialists were 3 times as likely to prescribe medications for gastrointestinal symptoms than GPs and other clinicians – 25%, compared with 7.0% for GPs and 7.6% for other clinicians. Similar patterns of higher prescribing by palliative medicine specialists than other clincians were also observed for neurological, respiratory and psychological symptom medications.
• Over 90% of palliative care-related prescriptions were prescribed by GPs in most states and territories, except in Western Australia where the proportion was 89%. This lower proportion in Western Australia is due to prescriptions from other clinicians accounting for a considerable proportion (10%; Figure PBS.4).
   

Figure PBS.4 Number and rate of palliative care-related prescriptions from the Palliative Care Schedule, by medication type and prescribing clinician, 2020–21

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

In the 5 years to 2020–21, the number of palliative care-related prescriptions dispensed increased overall by 28% (from 908,100 to 1.17 million), however in recent years this increase has slowed and declined in the 12 months to 2020–21. The largest increase over this period occurred between 2016–17 and 2017–18 (25% increase), then slowed in the 12 months to 2018–19 (6.8% increase), then stablised and declined (by 4.2%) in the 12 months to 2020–21 (Figure PBS.5). This trend was largely driven by changes in the number of medications prescribed for pain relief, which makes up 89% of all palliative care-related prescriptions.

Prescriptions increased for all types of palliative care-related medications between 2016–17 and 2020–21 (Table PBS.5). The largest average annual increase over the 5-year period was for prescriptions for gastrointestinal symptoms (13% increase), followed by neurological symptoms (12%) and the smallest increase was for pain relief (5.5%). The number of medications prescribed for pain relief peaked in 2018–19 (1.11 million) and has decreased since (1.04 million in 2020–21).   

Palliative care-related prescribing by all clinicians has increased overall between 2016–17 and 2019–20, with a slight dip in 2020–21. However, over this period there have been slightly different patterns by specific prescribers, particularly in the 12 months to 2020–21. The number of prescriptions by GPs, the largest prescriber of palliative-care related prescriptions, increased steadily between 2016–17 and 2019–20 before declining by 4.7% in the 12 months to 2020–21. This decrease was driven by changes in prescriptions of pain relief medications, which may be due to some of these items being delisted in 2020–21. For palliative medicine specialists, the number of prescriptions  also steadily increased over the 5 year period, with the largest increases occurring in the 12 months to 2020–21 (30% increase compared with 13% increase between 2018–19 and 2019–20).  For other clinicians, the numbers remained relatively stable over the 4-year period to 2020–21.  

Impacts of the COVID-19 pandemic

By looking at monthly PBS data, we can assess the effect of the public health response to the COVID-19 pandemic on PBS service utilisation during 2020 and 2021. In March 2020, there was a 19% increase in palliative care-related prescriptions from February 2020 levels and 13% higher than the corresponding period in 2019. Following this spike, there was a 20% drop in April 2020 from March 2020 and 7% drop from April 2019 levels (Table PBS.12).

This pattern was observed across most medication types, not only those relating to palliative care, and was largely due to changes in consumer behaviour coinciding with the introduction and then easing of restrictions during the COVID-19 pandemic in 2020. Also, in response to this dramatic increase in demand for medicines during early March which resulted in reported shortages in medicines, the Australian Government implemented temporary changes to medicines regulation to support continued access to PBS medicines (AIHW 2020).

Between July and December 2020 the number of prescriptions was relatively similar to previous years, before another large drop was observed for most months between January to May 2021 (3–15% below the 2019 levels for the corresponding months). These trends were largely driven by trends in the number of prescriptions for pain relief by GPs.

For more information see: Impacts of COVID-19 on Medicare Benefits Scheme and Pharmaceutical Benefits Scheme: quarterly data (AIHW 2021).

Figure PBS.5 Trends in palliative care-related prescriptions from the Palliative Care Schedule, by medication type and prescribing clinician, 2016–17 to 2020–21

How much was spent on these medications?

During 2020–21:

• $22.9 million was paid nationally in benefits for medications included on the Palliative Care Schedule, this was an increase of 61% (in current prices) from $14.3 million in 2016–17 or a 51% increase after adjusting for inflation (in real terms; Table PBS.9). Consistent with the number of prescriptions each year, a much larger increase in expenditure occured between 2016–17 and 2017–18 (41% increase in real terms) compared to subsequent years.
• Nationally, the cost per person dispensed with at least one palliative care-related prescription was $45 – this ranged from $25 per patient in the Northern Territory to $59 per patient in Tasmania (Table PBS.8), consistent with the prescription rate in each state and territory, where Tasmania had the highest and Northern Territory the lowest.
• Pain relief prescriptions made up 86% of this expenditure ($19.7 million), followed by prescriptions for gastrointestinal symptoms (11% or $2.6 million), and prescriptions for respiratory symptoms (1.9% or $433,700). The proportion of benefits paid for pain relief medications ranged from 79% in South Australia to 92% in Northern Territory (Table PBS.8).