The number of people receiving MBS-subsidised palliative medicine attendances and case conferences increased between 2012–13 and 2018–19 (44% increase, or from 11,400 to 16,500 people), remained relatively stable in 2019–20 and 2020–21, and then declined by 9.6% in the 12 months to 2021–22 to 14,500 (Figure MBS.3). This equates to an increase of 50 to 65 per 100,000 people receiving these services between 2012–13 to 2018–19 and then declining to 56 per 100,000 in 2021–22, which was similar to the rate in 2014–15. This was broadly consistent with the pattern observed for the number of services for palliative medicine attendances and case conferences over this period – increasing from 63,900 to 90,600 (42% increase) between 2012–13 and 2018–19, before declining by 7% in each of the following 2 years and then declining steeper by 12% in the 12 months to 2021–22.
These patterns were driven by trends in the number of people receiving palliative medicine attendances (35% increase between 2012–13 and 2018–19 and 13% decline in 12 months to 2021–22), given that these services accounted for the vast majority (87%) of palliative medicine attendance and case conference services in 2021–22. For case conferences a different pattern emerged, with the number of people receiving case conferences increasing each year – more than doubling from 2,500 to 5,600 or increasing from 11 to 22 per 100,000 population between 2012–13 and 2021–22. This steep increase in case conferences resulted in the number of people receiving palliative medicine attendances declining from 92% to 87% of all palliative medicine attendance and case conference services over this period.
When examining trends in the number of services provided a different pattern emerged. There was an 18% decline in services for palliative medicine case conferences between 2017–18 and 2021–22, despite the number of people receiving these services increasing by 14% over this period. Services for palliative medicine attendances also declined over this period, by 26% between 2018–19 and 2021–22, a steeper decline than that observed for people receiving these services (20% decline).
The decline in services for palliative medicine attendances in the 4 years to 2021–22, differed from the trend observed for all specialist attendances (including palliative medicine specialists/physicians) which had increased each year, except for a slight fall in 2021–22 (5.1% decline for palliative medicine specialists/physicians and 4.1% decline for all specialists). The decline in palliative medicine attendance services since 2018–19 may reflect the increasing use of telehealth services by palliative medicine physicians/specialists in recent years – increasing from 4,900 in 2019–20 to 14,700 in 2021–22, or a total of 30,900 services over this period (refers to all attendances provided by palliative medicine physicians/specialists, not just those for specialist palliative care). It may also reflect that palliative medicine specialists/physicians are increasingly using other MBS items – in 2012–13, 84% of attendance services from palliative medicine specialists/physicians were claimed to palliative medicine attendances, which had declined steeply to 48% in 2021–22 (Table MBS.6).
The large falls in people receiving palliative medicine attendances or case conferences since 2019–20 may also reflect the effect of the public health measures (such as lockdowns and restrictions) to contain the spread of the coronavirus and its variants during 2020 and 2022. Coinciding with these measures, the number of people receiving palliative medicine attendances fell steeply, more so than for all specialist attendances. Compared with the corresponding months in 2019, the number of people receiving palliative medicine attendance and/or case conference services fell in April 2020 (by 33%), in May (by 23%), in August–October 2020 (by 21–23%), in October 2021 (by 30%), with even larger falls in January 2022 (by 39%) and April 2022 (by 38%). While for people receiving all specialist attendances the levels only dipped below 2019 levels and with more modest falls in March–May 2020 (3.0%–17% lower), August 2020 (2.6% lower), and in January 2022 (8.8% lower) and April 2022 (3.6% lower; Table MBS.7). For more information see: Impacts of COVID-19 on Medicare Benefits Scheme and Pharmaceutical Benefits Scheme (AIHW 2022).
Figure MBS.3: Trends in MBS-subsidised palliative medicine attendance and case conference services provided by palliative medicine physicians/specialists and people receiving them, 2012–13 to 2021–22