Scope and measures of the report
This report provides non-hospital Medicare-subsidised services data based on financial year of service. In this report, non-hospital Medicare-subsidised services refers to services provided in non-inpatient settings. This excludes services delivered to patients admitted to hospital at the time of receiving the service or where the care was provided as part of an episode of hospital-substitute treatment where the patient received a benefit from a private health insurer. While services provided in-hospital are excluded, the data do include services provided in places like private outpatient clinics (which may or may not be located within the grounds of a hospital).
The geography is based on a person's Medicare enrolment postcode and not the location or availability of health care services in these areas.
The report includes information about use of the following non-hospital Medicare‑subsidised services between 2017–18 to 2024–25:
- general practitioner (GP) attendances – broken down into 27 sub-groups
- diagnostic imaging services
- allied health services – broken down into 18 sub-groups
- specialist attendances – including Psychiatry and Early Intervention Services for children
- nursing and Aboriginal and Torres Strait Islander health worker services.
For details on the service groups, including descriptions of how Medicare Benefits Schedule (MBS) items are allocated to each group, reported in this publication, see description of non-hospital Medicare-subsidised services.
Medicare service groups are defined by the MBS item billed for the service, not the health care providers' specialty.
Data are reported by the financial year in which the Medicare service was rendered (see Reporting year).
These analyses exclude services delivered to patients admitted to hospital at the time of receiving the service or where the care was provided as part of an episode of hospital-substitute treatment where the patient received a benefit from a private health insurer. Further information about out-of-hospital Medicare-subsidised services, by broad type of service, are available in the Department of Health, Disability and Ageing's Annual Medicare Statistics.
The following information is reported for each Medicare service group:
- percentage of the population who claimed the service
- services per 100 people
- Medicare benefits per 100 people
- number of patients
- number of services
- total Medicare benefits paid
- total provider fees
- estimated resident population of the area.
See Table 1 for how each measure is defined.
All Medicare service groups listed in the description of non-hospital Medicare-subsidised services are reported by Primary Health Networks (PHNs) and by smaller geographic areas known as Statistical Area Level 3 (SA3, or 'local areas'). GP aged care attendances are only reported by PHN area.
To support comparisons between similar areas, PHNs are grouped into metropolitan and regional areas. Results for SA3s are grouped by similar socioeconomic groups (higher, medium and lower) for SA3s in Major cities, and by remoteness areas for SA3s in Inner regional, Outer regional, and Remote and very remote areas. See Geography for more information.
Where possible, measures are disaggregated by sex and age (PHN age groups: 0–14, 15–24, 25–44, 45–64, 65–79, 80+ years, and SA3 age groups 0–24, 25–44, 45–64 and 65+).
What are the limitations of the data?
The MBS is managed by the Department of Health, Disability and Ageing, and over time MBS items are introduced, amended, deleted or replaced (see Department of Health, Disability and Ageing's MBS online for the latest MBS). This may affect comparability over time, for instance changes to patient eligibility or provider incentives to claim the item. In some cases, providers may bill a 'general' item (for example, items in 'GP Standard (Level B)') for a service that could have qualified as a health-specific item (for example, GP Health Assessment). This may underestimate the true use of more specific service types.
MBS claims data are an administrative by-product of Services Australia's administration of the Medicare fee-for-service payment system. There may be some administrative errors in the recording of the MBS item billed, patients' location, age, and sex. Discrepancies may also occur as a result of negative adjustments made after the service was first processed (for example, due to cancelled cheques).
For some results that are disaggregated by age, the number of patients is higher than the Estimated Resident Population (ERP). Affected results have been annotated with a footnote to interpret these with caution. This may be due to several factors (including the above MBS data limitations):
- This release uses the ERP at the beginning of the financial year. As the population changes, some people may be included in the numerator (MBS data), but not the denominator (ERP), for instance a person who migrated to Australia after 30 June 2024 but who claimed a service in 2024–25.
- The ERP includes people who usually live in Australia, that is, people who have been residing in Australia for a period of 12 months or more over the last 16 months. Some temporary visitors who are not included in the ERP are able to claim Medicare services, for instance through reciprocal health care agreements. However, some residents who usually live in Australia (for example, international students or those on working visas) are not eligible for Medicare.
- The ERP, the official estimate of the Australian population, is produced by the Australian Bureau of Statistics (ABS) using a range of data sources, including the Census of Population and Housing and births, deaths, and migration administrative data. ERP data sources are subject to non‑sampling error, which may arise from inaccuracies in collecting, recording, and processing data.
| Measure | Calculation |
|---|---|
| Percentage of population who claimed the service (%) | Numerator: Number of patients who had at least one eligible service rendered in the reporting year for the specified service type. The unique number of patients were identified through the Patient Identification Numbers (PINs) in the Medicare claim records. Denominator: ABS ERP as at 30 June at the end of the previous financial year Calculation: (Numerator ÷ denominator) x 100 |
| Services per 100 people | Numerator: Sum of services from eligible claims for the specified service type. This does not include any bulk billed incentive items or other top-up items. Denominator: ABS ERP as at 30 June at the end of the previous financial year Calculation: (Numerator ÷ denominator) x 100 |
| Services per 100 people (age-standardised) | Numerator: Sum of services from eligible claims for the specified service type. This does not include any bulk billed incentive items or other top-up items. Denominator: ABS ERP as at 30 June at the end of the previous financial year Standard population: ABS ERP at 30 June 2001 Method: Direct age standardisation method (see 'Age standardised rates'). Note: This measure is reported for the following service groups (as defined in the description of non-hospital Medicare-subsidised services) by PHN area:
|
| Medicare benefits per 100 people ($) | Numerator: Sum of benefits paid for eligible claims for the specified service type. Results are rounded to the whole dollar. This does not include any payments associated with bulk billed incentive items or other top-up items. Denominator: ABS ERP as at 30 June at the end of the previous financial year Calculation: (Numerator ÷ denominator) x 100 Note: Expenditure results are not adjusted for inflation. |
| No. of patients | Number of patients who had at least one eligible service in total rendered in the reporting year for the specified service type. The unique number of patients were identified through the PINs in the Medicare claim records. Totals and subtotals of patients may be less than the sum of each service group as a patient may receive more than one type of service but will be counted only once in the relevant total. |
| No. of services | Sum of services from eligible claims for the specified service type. This does not include any bulk billed incentive items or other top-up items. |
| Total Medicare benefits paid ($) | Sum of benefits paid by Medicare for eligible claims for the specified service type. Results are rounded to the whole dollar. This does not include any payments associated with bulk billed incentive items or other top-up items. Note: Expenditure results are not adjusted for inflation. |
| Total provider fees ($) | Sum of fees charged by the health care provider for eligible claims for the specified service type, comprising the benefits paid by Medicare and patients’ out-of-pocket costs. Results are rounded to the whole dollar. Note: Expenditure results are not adjusted for inflation. |
| Estimated Population | ABS Estimated Resident Population (ERP) as at 30 June at the end of the previous financial year (for example, 30 June 2024 for 2024–25 results). |
| GP attendances per residential aged care patient | Numerator: Sum of services from eligible claims for the specified service type. This does not include any bulk billed incentive items or other top-up items. Denominator: Number of patients who had at least one GP attendance in a residential aged care facility rendered in the reporting year. Calculation: (Numerator ÷ denominator) x 100 |