Palliative care services in Australia

In 2021–22, 14,500 people received 69,100 Medicare Benefits Schedule (MBS)-subsidised palliative medicine attendance and palliative medicine case conference services provided by palliative medicine physicians/specialists. This section provides information related to these services and the characteristics of the people who received them (see Data sources section for further information on these services).

The information in this section was last updated in May 2023.

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Who received these services?

In 2021–22, 14,500 people received at least one MBS-subsidised palliative medicine attendance or case conference service provided by palliative medicine physicians/specialists, at a rate of 56 people per 100,000 population. Among people receiving these services (Figure MBS.1):

• Slightly more were males – 7,300 males compared with 7,200 females (or 57 compared with 55 per 100,000 population, respectively).
• 3 in 4 (77%) were aged 65 and over – the population rate increased steeply from age 55, from 65 to 617 per 100,000 between the age groups 55–64 and 85 and over. Only 4 in 100 (4.0%) were aged under 45.
• Those living in Major cities were 3.4 times as likely to receive these services as those living in Remote and very remote areas – 62 per 100,000 population in Major cities compared with 18 per 100,000 in Remote and very remote areas combined. It should be noted that the vast majority of employed palliative medicine physicians and nurses work in Major cities (see Palliative care workforce for further details).
• Queensland had the highest population rate at 73 per 100,000 population, followed by Western Australia (71 per 100,000 population) and Australian Capital Territory and Northern Australia had the lowest at 15 per 100,000 population.
• The population rates varied across the Primary Health Network (PHN) areas, ranging from 6.4 per 100,000 in New South Wales Nepean Blue Mountains PHN area to 169 per 100,000 population in the Northern Sydney PHN area (Table MBS.2).

Figure MBS.1: People who received MBS-subsidised palliative medicine attendance and/or case conference services provided by palliative medicine physicians/specialists, 2021–22

How many services were provided?

In 2021–22, 69,100 MBS-subsidised palliative medicine attendance and case conference services were provided by palliative medicine physicians/specialists, at an average of 4.8 services per person. Among these services (Figure MBS.2):

• Males and females received similar number of services, on average – 4.7 and 4.8 services per males and females, respectively.
• The number of services per person was relatively similar for those aged 25 and over – ranging from 4.4 to 5.3, except for those aged 35–44 where it dipped to 3.4 services per person, which was the same as that for those aged 15–24. For those aged under 15, the number of services per person was considerably lower, at 1.3 services per person. 
• 4 in 5 services were for attendances/consultations in a consulting room or hospital – 55,900 or 81% with a further 6.3% (4,300) for consultations in other settings (such as in person’s place of residence) and 13% (8,900) for case conferences.
• People living in Major cities were 4 times as likely to receive attendance services and 12 times as likely to receive case conference services than those living in Remote and very remote areas combined (264 vs 60 per 100,000 for attendances and 42 vs 3.7 per 100,000 for case conferences). The average number of services for attendances was also higher for those in Major cities than in other areas (5.6 declining to 3.5 in Remote and very remote areas), while for case conferences, the number of services were relatively similar across remoteness areas (1.4–1.8 services per person).
• Western Australia had the highest population rate of services, including for attendances, almost double the national average rate – 480 and 268 per 100,000 and 442 and 234 per 100,000 population for attendances, respectively. The Australian Capital Territory had the lowest rate of services (34 per 100,000 population). The highest rate for case conferences was recorded in Queensland (48 per 100,000 population), and the lowest rate was in South Australia (1.2 per 100,000 population). Note that data for palliative medicine attendances and palliative medicine case conferences in Tasmania, Australian Capital Territory and Northern Territory are not presented due to small numbers (see Table MBS.4).

Figure MBS.2: MBS-subsidised palliative medicine attendance and case conference services provided by palliative medicine physicians/specialists, 2021–22

How have these services changed over time?

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

How much was spent on these services?

The Australian Government’s expenditure through the MBS for palliative medicine attendances and case conferences 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 (DHAC 2022) for further details).

In 2021–22, for these MBS-subsidised palliative medicine attendances and case conferences:

• over $5.6 million was paid in benefits, equivalent to an average of $389 per patient; 81% of these benefits were for palliative medicine attendances (Table MBS.8)
• the benefits paid accounted for 0.2% of benefits paid for all MBS-subsidised specialist attendances ($2.8 billion; Table MBS.7)
• Northern Territory had the highest average benefits per patient at $639, followed by Western Australia ($513 per patient), while the Australian Capital Territory had the lowest average benefits per patient ($200). This was largely consistent with the rate of services in each state and territory, where Western Australia had the highest (480 per 100,000) and Australian Capital Territory had the lowest service rate (34 per 100,000; Figure MBS.4).

Trends

Between 2012–13 and 2018–19, MBS benefits paid for palliative medicine attendance and palliative medicine case conference services increased by 51% (from $4.7 million to $7.1 million) and then declined by 21% in 2021–22 ($5.6 million). However, after adjusting for inflation, this represented a 35% increase in the 6 years to 2018–19 (from $5.6 million to $7.6 million) and a 26% decline in the 3 years to 2021–22 (Figure MBS.4).

A similar pattern was also observed for benefits paid for palliative medicine attendances – 45% increase between 2012–13 to 2018–19 (from $4.2 million to $6.0 million) and then declining by 24% to reach $4.6 million in 2021–22. For case conferences, the growth was steeper and decline slower over this period – benefits paid doubled between 2012–13 and 2017–18 (from $547,400 to $1.17 million) and then fell slightly by 8.9% in 2021–22 ($1.06 million).

These patterns were broadly consistent with that for MBS benefits paid for all specialist attendances, except benefits increased each year between 2012–13 and 2020–21 (47% increase over this period) and then fell slightly by 2.9% in 2021–22 (Table MBS.9). 

In terms of average benefits paid per person, this had declined since 2018–19 for palliative medicine attendances (from $365 to $316 per person; Figure MBS.4). In contrast, average benefits per person for case conferences had increased over this period, consistent with the patterns observed for all specialist attendances (Table MBS.9). These patterns reflected the trends in people/services reported in the previous section.

Figure MBS.4: Benefits paid for MBS-subsidised palliative medicine attendance and case conference services provided by palliative medicine physicians/specialists, 2021–22