Medicare-subsidised GP, allied health and specialist health care across local areas: 2013–14 to 2018–19

About the data source

Data for the report were sourced from the Medicare Benefits Schedule (MBS) claims data, which are managed by the Australian Government Department of Health. The claims data are derived from administrative information on services that qualify for a Medicare benefit under the Health Insurance Act 1973 and for which a claim has been processed by Services Australia.

When a health practitioner provides a clinically relevant service to a Medicare-eligible person, the practitioner or patient can make a claim with Medicare. Medicare will then provide a rebate, or benefit, to cover all or part of the cost of the service. For more detailed information on the MBS services and item types, see the Department of Health MBS Online website www.mbsonline.gov.au.

Scope of the MBS claims data

Under MBS arrangements, Medicare claims can be made by eligible persons: this includes Australian and New Zealand citizens and holders of permanent residence visas. Applicants for permanent residence may also be eligible depending on circumstances. In addition, persons from countries with which Australia has reciprocal health care agreements might also be entitled to benefits under MBS arrangements.

It is important to note that some Australian residents may obtain similar medical services through other arrangements. MBS claims data do not include:

• services provided to patients where no MBS benefit has been processed (even if the service is eligible for a rebate)
• services provided to public patients in hospitals
• services subsidised by the Department of Veterans’ Affairs
• services delivered in public outpatient departments, or public accident and emergency departments
• services for a compensable injury or illness for which the patient’s insurer or compensation agency has accepted liability
• non-hospital services subsidised by private health insurance
• services provided through other publicly funded programs including jurisdictional salaried GP services provided in remote outreach clinics
• health screening services.

Some areas and service types have a higher proportion of services that are not Medicare‑subsidised than others and this may affect comparability when estimating total health care use in Australia. In particular, caution should be taken when interpreting use of Medicare-subsidised allied health services, which with the exception of optometry are generally only available to patients with chronic, developmental or mental health conditions with a referral from a GP or specialist medical practitioner. Some Australians also access subsidised allied health services through their general (‘ancillary’ or ‘extras’) private health insurance, or pay for services entirely out‑of‑pocket. At present, there is no national data on allied health service use outside of Medicare or private health insurance (AIHW 2018). To assist with interpretation of Medicare‑subsidised allied health data, general private health insurance data by state and territory are included in the accompanying data tables.

This report provides non-hospital Medicare-subsidised services data based on year of processing. 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 from 2013–14 to 2018–19:

• GP attendances, broken down into 26 sub-groups
• Allied health attendances, broken down into 18 sub-groups
• Specialist attendances, including Psychiatry and Early Intervention Services for children with autism, pervasive developmental disorder or disability
• Attendances provided by Practice Nurses, Aboriginal Health Workers, Midwives and Nurse Practitioners
• Diagnostic Imaging services.

See Technical Information, a separate section containing details on the service groups, including descriptions of how MBS items are allocated to each group, reported in this publication.

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 they are processed (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’s Annual Medicare Statistics (Department of Health 2019b).

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 population of the area.

See Table A for how each measure is defined.

All Medicare service groups listed in the Technical Information are reported by Primary Health Network (PHN) areas and by smaller geographic areas known as Statistical Areas Level 3 (SA3s, or ’local areas’) (ABS 2016). Note, GP aged care attendances are only reported by PHN area.

To support comparisons between similar areas, PHN areas are grouped into metropolitan and regional PHN areas. Results for SA3s are grouped by similar socioeconomic status (higher, medium and lower) for SA3s in Major cities, and by remoteness areas for SA3s in Inner regional, Outer regional, and Remote areas. See Geography – metropolitan and regional PHN areas and Local areas (SA3) groups for more information.

Where possible, measures are disaggregated by sex and age (0–14, 15–24, 25–44, 45–64, 65–79, 80+ years).

What are the limitations of the data?

The MBS is managed by the Department of Health, and over time MBS items are introduced, amended, deleted or replaced (see www.mbsonline.gov.au 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, and 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 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 (for example, 30 June 2018 for 2018–19 data). 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 2018 but who claimed a service in 2018–19.
• 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 (e.g. 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 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 (ABS 2019).

Reporting year

Data are reported by the financial year in which the service is processed, not the date the service occurred. Most non-hospital Medicare services (approximately 98%) occurred within the same year as the year of processing. Approximately 2% occurred in the previous year, and less than 0.1% occurred more than 2 years before the processing date. The gap between date of processing and date of service varies across Australia and across provider groups.

Number of patients

‘Number of patients’ refers to patients who claimed at least one eligible service in total (for the respective service type) in the reporting year, as identified through the Patient Identification Numbers (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.

Percentage of people or proportion of population

The terms ‘people’ or ‘population’ refer to the Australian Bureau of Statistics (ABS) Estimated Resident Population (ERP) at 30 June at the end of the previous financial year (e.g. 30 June 2013 for 2013–14 results). This release used the final ERPs at 30 June 2013, 2014, 2015 and 2016, and the preliminary ERP at 30 June 2017 and 2018.

Expenditure

Expenditure results are not adjusted for inflation. In the analysis, if a service was flagged as bulk billed, the fee charged was equal to the benefit paid.

Australian Government expenditure associated with bulk billing incentives for non-hospital non-referred services (items 10990, 10991 and 10992) are not included in the analysis, as it is not possible to allocate the expenditure with specific services. In 2018–19, this amounted to $653 million nationally (Table B; Services Australia 2020). Most of this expenditure will relate to GP attendances, but may also relate to Practice Nurse/Aboriginal Health Worker items, pre-operative anaesthesia attendances, obstetrics, operations and assistance at operations. As such the Medicare benefits paid, and the resulting provider fees reported in this release, are underestimated for GP attendances and Practice Nurse/Aboriginal Health Worker services.

(a) Expenditure results are not adjusted for inflation.

Source: Services Australia 2020.

Disaggregation by age and sex

In addition to results for the total population in an area, results by PHN area and SA3 are reported by sex and by the following age groups:

• PHN area level analysis by six age groups (0–14, 15–24, 25–44, 45–64, 65–79, 80+).
• SA3 analysis by four age groups (0–24, 25–44, 45–64, 65+). Due to smaller populations, SA3 results by age and sex are reported for the ‘total’ Medicare service groups only.

Where the group was too small to report, age groups were combined where possible (e.g. 0–24 and 25–44 becomes 0–44 years) for 2013–14 to 2017–18. This method was revised for 2018−19 with data presented for six age groups by PHN and four age groups by SA3, where possible. Data were not published if it met any of the suppression rules (see Suppression).

Measures that are disaggregated by age group and sex use the patient’s date of birth and sex as recorded at the last claim processed (for any MBS service) in the reporting year. Where multiple claims were processed on the last date of processing, age and sex was taken from the last date of service on that date of processing.

If a patient’s age was recorded as unknown or over 116, their records were excluded from the age group results. Similarly, if a patient’s sex was missing, their records were excluded from the sex group results.

Age standardised rates

Age standardised rates are hypothetical rates that would have been observed if the populations studied had the same age distribution as the standard population. This facilitates comparisons between populations with different age structures and changes over time within an area. This adjustment is important because the prevalence of health conditions and rates of health service use vary with age.

The direct method of age standardisation was applied to the data (AIHW 2005). Age standardised rates were derived by calculating crude rates by five year age groupings of 0–4 years to 85+ years. These crude rates were then given a weight that reflected the age composition of the standard population (ABS ERP for Australia as at 30 June 2001). If a patient’s age was recorded as unknown or over 116, their records were excluded from the age standardised rates.

Suppression

Information about an area was suppressed (marked ‘n.p. – not published’) if any of the following conditions were met:

• there were fewer than six patients or fewer than six health service providers in the area (SA3/PHN)—note a patient/provider was only included if they provided or received at least one service in the area
• one provider provided more than 85% of services or two providers provided more than 90% of services
• one patient received more than 85% of services or two patients received more than 90% of services
• the number of attendances/services was fewer than 20 for an area
• the total population of an area was fewer than 1,000
• the population of the reported age group or sex group in an area was fewer than 300.

Consequential suppression was applied to manage confidentiality. This is the process of suppressing information which, whilst not necessarily confidential, may be used to derive confidential data.

For age standardised rates, if the population of an area (denominator) was fewer than 30 in any of the standard age groupings, then the rate was marked ‘interpret with caution’, as these rates are considered potentially volatile. For each of these interpret with caution rates, the effect of increasing the numerator by one on the rank of the area was examined. If the rank changed considerably so that the area was on the cusp of changing two deciles, the rate was suppressed.