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 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 Royal Australasian College of Physicians 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 the Australian Government Department 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.

Data downloads

Medicare-subsidised palliative medicine services  2018–19 (38KB XLS)

Medicare-subsidised palliative medicine services 2018–19 (389KB PDF)

The information in this section was last updated in June 2020.

Key points

  • 16,778 patients received an MBS-subsidised palliative medicine specialist service in 2018–19.
  • 89,382 MBS-subsidised services were provided by palliative medicine specialists.
  • $7.0 million was paid in benefits for MBS-subsidised palliative medicine specialist services in 2018–19, at an average of $416 per patient.
  • Nationally, the rate of subsidised palliative medicine specialist services provided in 2018–19 was 355.0 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.

These data 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 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 2018–19. To provide information on changes over time, data are also presented for the reporting periods 2014–15 to 2018–19. 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 2018–19 there were 89,382 MBS-subsidised services provided by palliative medicine specialists. Palliative medicine attendances in hospital or surgery made up the majority (71,712; 80.2%) of all MBS-subsidised palliative medicine specialist services in 2018–19, with a further 1 in 11 (7,962) of all services being consultations in the patient’s home. Of all palliative medicine specialist attendances (i.e. specialist consultation with a patient), 90.0% were in a hospital or surgery and 10.0% were home visits. Palliative medicine specialists were more likely to organise and coordinate case conferences for patients (7.0%) than to participate at such conferences initiated by other care providers (3.9%).

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

The rate of subsidised palliative medicine specialist services in 2018–19 varied among states and territories. Western Australia recorded the highest rate (725.8 per 100,000 population), more than double the national average rate (355.0) (Figure MBS.1). This was mainly accounted for by the high rate of palliative medicine attendances in Western Australia (656.1).

The highest population rate of palliative medicine case conferences was recorded in Western Australia (69.6 per 100,000 population), followed by New South Wales (51.9).

 

Description of figure MBS.1 - Source: Medicare-subsidised palliative medicine services (38KB XLS)

In 2018–19, the highest rate of MBS-subsidised palliative medicine specialist services was recorded in Major cities, followed by Inner regional areas (405.1 and 277.1 per 100,000 population, respectively) (Figure MBS.2). The rate in Major cities is over 6 times that for Very remote areas (63.8).

 

Description of figure MBS.2 - Source: Medicare-subsidised palliative medicine services (38KB XLS)

MBS-subsidised palliative medicine specialist services over time

Between 2014–15 and 2018–19, the total number of MBS-subsidised palliative medicine specialist services increased from 71,574 to 89,382. As a population rate, this represents an increase from 302.8 per 100,000 in 2014–15 to 355.0 in 2018–19.

The total number of MBS-subsidised palliative medicine specialist services increased by an average of 5.7% each year between 2014–15 and 2018–19. During this same period, palliative medicine attendances experienced an average annual increase of 5.5%, and palliative medicine case conferences an increase of 7.3%.

Characteristics of patients receiving palliative medicine specialist services

Nationally, 16,778 patients received an MBS-subsidised palliative medicine specialist service during 2018–19, a rate of 66.6 patients per 100,000 population. During this time period, 89,382 MBS-subsidised palliative medicine specialist services were provided, an average of 5.3 services per patient.

The majority (88.9%) of patients receiving an MBS-subsidised palliative medicine specialist service were aged 55 and older, and almost three-quarters (72.9%) were aged 65 and older. For the 55–64 age group the population rate was 92.4 per 100,000 population, and the rate increases with subsequent age groups, to 195.4 per 100,000 for the 65–74 age group, 378.6 for the 75–84 age group and 633.8 for those aged 85 years and older (Figure MBS.3).

About 1 in 145 (0.7%) patients receiving MBS-subsidised palliative medicine specialist services were aged 24 or under in 2018–19.

Western Australia had the highest rate of MBS-subsidised palliative care patients at 90.0 per 100,000 population, followed by New South Wales and the Australian Capital Territory, with 80.0 and 73.1 per 100,000 respectively.

Approximately half the patients who received MBS-subsidised palliative medicine specialist services were male (50.6%) and half were female (49.4%).

 

Description of figure MBS.3 - Source: Medicare-subsidised palliative medicine services (38KB XLS)

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 2018–19. 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 2019).

Almost $7.0 million was paid in benefits for MBS-subsidised palliative medicine specialist services during 2018–19— equivalent to an average of $416 per patient. Western Australia had the highest average benefits per MBS patient of $580. Over four-fifths (84.6%) of total benefits paid were MBS items claimed for palliative medicine specialist attendances.

Between 2014–15 and 2018–19, the MBS benefits paid for all palliative medicine specialist services increased by 30.6%, from $5.3 million to $7.0 million (current prices). This equates to an average annual increase of 6.9%.

During this same period, the total benefits paid for palliative medicine attendances increased at an average annual rate of 6.7%, and the benefits paid for palliative medicine case conferences increased at a rate of 7.8% per year.


References

ANZSPM (Australian and New Zealand Society of Palliative Medicine) 2008. Defining the meaning of the terms consultant physician in palliative medicine and palliative medicine specialist. Canberra: ANZSPM. Viewed 25 February 2020.

DoH (Department of Health) 2019. Medicare Benefits Schedule Book, effective December 2019. Canberra: Department of Health.

PCA (Palliative Care Australia) 2015. Medicare Benefits Schedule (MBS) Review Taskforce Consultation: submission letter. Canberra: PCA.

PCA 2018. Palliative Care Service Development Guidelines. Canberra: PCA.

RACP (Royal Australian College of Physicians) 2020. Australasian Chapter of Palliative Medicine. Sydney: RACP. Viewed 25 February 2020.


Alternative text for Medicare-subsidised palliative medicine services

Figure MBS.1

Vertical bar chart showing the rate per 100,000 population of subsidised palliative medicine specialist services by state or territory. NSW 323.4, Vic 262.8, Qld 421.3 WA 725.8, SA 193.4, Tas 314.4 ACT 173.1, NT 85.7, Total 355.0. Refer to Table MBS.4. Back to figure MBS.1

Figure MBS.2

Vertical bar chart showing the population rate by remoteness for MBS-subsidised palliative care medicine specialist services. Major cities 405.1, Inner regional 277.1, Outer regional 176.3, Remote 134.7, Very Remote 63.8, Total 355.0. Refer to Table MBS.6. Back to figure MBS.2

Figure MBS.3

Vertical bar chart showing the rate per 100,000 population of MBS-subsidised palliative medicine specialist patients by age group. <15 0.7, 15–24 2.7, 25–34 4.6, 35–44 12.5, 45–54 35.8, 55–64 92.4, 65–74 195.4, 75–84 378.6, 85+ 633.8. Refer to Table MBS.2.  Back to figure MBS.3