Health services use

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Introduction Use of health services Use of health services in the year before death by suicide Use of health services in the year before and after hospitalisation for intentional self-harm Use of admitted patient care services Use of medications

AIHW has analysed ex-serving members’ use of health services by non-DVA clients including use in the year before death by suicide, use of health services before and after a self-harm or injury hospitalisation, use of admitted patient care services and use of medications.

Box 3: Interpreting health service use

Every day, millions of Australians come into contact with the health system. A key role of the health system is to respond to the needs of individuals by providing safe, effective, accessible and appropriate treatment and other services (AIHW 2024). Australia’s health system is complex with multiple different service types. The primary aim of these health services is to treat the injury or disease presented using the types of procedures and care that can be provided within that setting.

While serving members have access to a specific Defence health system, ex-serving members generally access health services that are available to the Australian population including those who never served in the ADF. Ex-serving members who are DVA clients also have access to additional health services such as through the Repatriation Pharmaceutical Benefits Scheme (RPBS) or Open Arms, or they may access health services that are available to all Australians such as hospital and primary care (which can be funded by DVA).

Ex-serving members, and DVA clients in particular, may be more likely to access private hospital care which was not considered in the following sections and therefore health service use may be underestimated.

When interpreting the following figures on health service use of DVA clients it should be noted that many DVA funded services accessed by DVA clients are provided through the private sector and therefore numbers here may be underestimates.

Use of health services

AIHW analysed the health services use of ex-serving members between 2013–14 and 2019–20 (for more information see Health service use among ex-serving Australian Defence Force members). The report was part of a series of research (Health services use by ex-serving Australian Defence Force members) which included reports on health service use before death by suicide and intentional self-harm (see following sections).

Most (85%) ex-serving members who were non-DVA clients accessed at least one health service across some primary care, medication and hospital services (see Research methods - Health service use among ex-serving Australian Defence Force members for more information on the included health services) in 2019–20. However, this proportion was lower than for DVA clients (94%). The proportion of non-DVA client ex-serving members who accessed each health service in 2019–20 was:

  • 84% for Medicare Benefit Schedule or MBS services compared with 81% for DVA clients (this is possibly due to DVA clients accessing some of these services through DVA funding which is considered separately)
  • 63% for Pharmaceutical Benefits Scheme/Repatriation Pharmaceutical Benefits Scheme (PBS/RPBS) services compared with 80% for DVA clients (this is due to increased support provided to DVA through access to the RPBS)
  • 15% for emergency department (ED) presentations compared with 17% for DVA clients
  • 12% for hospital admitted care compared with 25% for DVA clients (note that this was limited to public hospital care).

Ex-serving members who were non-DVA clients used a much lower rate of health services per person compared with DVA clients. In 2019–20, non-DVA clients on average used 25 health services per person, compared with 74 services per person for DVA clients. However, the services received by DVA clients include DVA-funded MBS equivalent services, which are services that non-DVA clients are not eligible to receive. When analysed excluding the DVA services that non-DVA clients were not eligible to receive, DVA clients used 37 health services per person on average, still higher than the average use for non-DVA clients.

Average health service use per person for non-DVA clients in 2019–20 compared with DVA clients was:

  • 14.4 MBS services compared with 13 for DVA clients
  • 10.4 prescriptions dispensed under PBS compared with 23.3 prescriptions dispensed under PBS/RPBS for DVA clients
  • 0.2 ED presentations compared with 0.3 for DVA clients
  • 0.3 hospital admitted care services compared with 0.7 for DVA clients.

One in four (24%) ex-serving members who were non-DVA clients accessed at least one mental health service in 2019–20 (see Health service use among ex-serving Australian Defence Force members for more information on how these services were defined). This proportion was much lower than for DVA clients (41%). The proportion of non-DVA clients who had accessed a mental health service has increased slightly over time, up from 22% in 2013–14 (the proportion for DVA clients has similarly grown, up from 38%).

Use of health services in the year before death by suicide

AIHW analysed the health services use of ex-serving members who died by suicide in their last year of life over 2010–11 to 2019–20 and compared this with other ex-serving members who were alive over the same period. For more information see Health service use in the year before death by suicide among ex-serving ADF members.

Of ex-serving members who died by suicide, non-DVA clients were less likely to access at least one public hospital service, prescription medication (that is on PBS/RPBS), and primary care (that is included in the MBS or an equivalent service funded by DVA) in the last year of life. Non-DVA clients were also less likely to have accessed a mental health service in the year before death compared with DVA clients. However, these patterns were also observed in the comparison group (ex-serving members who were alive).

Non-DVA clients who died by suicide were more likely to have accessed a mental health service in the last year of life compared with non-DVA clients who were alive. This pattern was the same for DVA clients but relative to DVA clients, non-DVA clients showed a greater difference in mental health service use between those who died by suicide and those who were alive.

Use of health services in the year before and after hospitalisation for intentional self-harm

AIHW analysed the health services use of ex-serving members who were admitted to public hospital for intentional self-harm injuries over 2010–11 to 2019–20 and compared this with ex-serving members who were admitted for reasons other than an injury, excluding both self-harm and non-self-harm injuries. For more information see Health service use in the year before and after intentional self-harm among ex-serving ADF members.

This section presents the odds of accessing a health service (using odds ratio modelling) and the rate of using health services (using rate ratio modelling) for those who were admitted for self-harm compared with those were admitted for non-injury reasons, after adjustment for comorbidities.

Ex-serving member non-DVA clients who were admitted for self-harm were more likely to have been dispensed a prescription under PBS/RPBS (odds ratio, OR=1.56), to have presented to an ED (OR=3.3) or to have been admitted to hospital (OR=1.33) in the year before admission for self-harm, compared with ex-serving member non-DVA clients admitted for reasons other than injury. These patterns were consistent with those for DVA client ex-serving members.

Ex-serving member non-DVA clients who were admitted for self-harm had higher odds of accessing at least one mental health service compared with non-DVA client ex-serving members who were admitted for reasons other than an injury (OR=7.05). These patterns were consistent with those for DVA client ex-serving members (OR=7.52).

In addition, the report considered the rate of health services used by ex-serving members. Non-DVA clients who were admitted for self-harm had a 40% higher rate of health service than non-DVA clients admitted for reasons other than injury in the year before (rate ratio, RR=1.40) and a 47% higher rate in the year after admission (RR=1.47). There were also higher rates of mental health service use among non-DVA clients admitted for self-harm, but patterns were generally consistent with DVA clients. These patterns were similar for DVA clients, but relative to DVA clients, non-DVA clients showed a greater difference in any health service use and mental health service use between those who were admitted for self-harm and those admitted for reasons other than injury.

Use of admitted patient care services

AIHW released a report titled Characteristics of ex-serving Australian Defence Force members hospitalised for suicidality and intentional self-harm in July 2024. It showed that 14,300 (11,400 male and 2,900 female) ex-serving non-DVA clients were admitted to public hospitals in 2019–20 (excluding Western Australia and the Northern Territory).

The proportion of ex-serving members (males and females) who were admitted to a public hospital who were non-DVA clients was smaller in comparison with the proportion of the total ex-serving population (admitted and non-admitted) who were non-DVA clients.

It should be noted that some differences in admitted care service use between DVA clients and non-DVA clients could be due to variance in age or because of different access to private hospital care.

In 2019–20, symptoms and signs without a clear diagnosis, for example, fatigue, pain, headache or abnormal blood work, was the most common reason for ex-serving non-DVA client admissions to public hospitals (2,900 patients or 20.5%). This was also the most common reason for DVA client admissions to public hospitals.

The proportions of reasons for admission were mostly similar between non-DVA clients and DVA clients. However, there were a few differences. Of ex-serving members admitted to a public hospital in 2019–20:

  • Admissions for mental and behavioural disorders were proportionally lower for male non-DVA clients (6.1%) and female non-DVA clients (4.6%), compared with male DVA clients (8.5%) and female DVA clients (6.1%).
  • Admissions for eye diseases were proportionally higher for male non-DVA clients (2.0%) compared with male DVA clients (1.4%).
    • However, analysis of both public and private hospital admissions (based on Queensland data in 2019–20) showed that there was a lower proportion of admission for eye diseases for non-DVA clients (4.3% compared with 6.0%).
  • Admissions for respiratory diseases were proportionally lower for male non-DVA clients (5.9%) compared with male DVA clients (7.3%).
    • However, analysis of both public and private hospital admissions (based on Queensland) showed that admission for respiratory diseases was similar for male non-DVA clients and male DVA clients.
  • Admissions for digestive diseases were proportionally higher for male non-DVA clients (16.9%) compared with male DVA clients (14.3%).
    • However, analysis of both public and private hospital admissions (based on Queensland) showed that admission for digestive diseases was similar for male non-DVA clients and male DVA clients.

Analysing the types of care associated with suicidality and self-harm, there were some differences between non-DVA clients and DVA clients. Of ex-serving members admitted to public hospitals in 2019–20:

  • A lower proportion of non-DVA clients (0.7% for males and 0.6% for females) were admitted for stress related disorders compared with DVA clients (3.2% for males and 2.1% for females).
  • A lower proportion of male non-DVA clients were admitted for depression (0.8%) and for dementia (0.1%) compared to male DVA clients (1.4% and 0.4% respectively).
  • A higher proportion of male non-DVA clients (1.7%) were admitted for schizophrenia and other related disorders compared with male DVA clients (0.9%).
    • This pattern was also observed for ex-serving males admitted to Queensland public and private hospitals in 2019–20.
  • While admission for any alcohol or other drug diagnosis for non-DVA clients and DVA clients was similar, there were slightly lower proportions of admission for ex-serving non-DVA client males for anti-epileptic and antiparkinsonian drugs, and all other drugs (excluding opioids).
  • A lower proportion of non-DVA clients (0.8% for males and 1.4% for females) were admitted for intentional self-harm compared to DVA clients (1.5% for males and 3.1% for females).
    • However, analysis of both public and private hospital admissions (based on Queensland) showed that admission for intentional self-harm was similar for non-DVA clients and DVA clients.

Use of medications

AIHW released a report titled Medications dispensed to contemporary ex-serving Australian Defence Force members in 2017–18 in 2019. This report investigated the medications dispensed to Australians who had served in the ADF since January 2001 but separated prior to July 2017, defined as contemporary ex-serving members. Non-DVA client status in this report included ADF members with service since 2001 who have not had medication dispensed under the Repatriation Pharmaceutical Benefits Scheme (RPBS).

There were two non-DVA client groups:

  • concession cardholders (contemporary ex-serving members who have never held a Gold or White card and were dispensed at least 1 medication as a concession cardholder in 2017–18)
  • general beneficiaries (contemporary ex-serving members who have never held a Gold or White card and were not dispensed any medications as a concession cardholder in 2017–18).

Of contemporary ex-serving members who were dispensed at least one medication in 2017–18:

  • non-DVA client concession cardholders averaged 20 dispensings per person
  • non-DVA client general beneficiaries averaged 9 dispensings per person
  • DVA clients average 27 dispensings per person.

Non-DVA clients who were dispensed at least one medication in 2017–18 were younger than DVA clients. For example, of ex-serving members who were dispensed at least one medication, three quarters (74%) of non-DVA clients were under 50 years old compared with half (49%) of DVA clients.

The most common medications dispensed for non-DVA clients were similar to those by DVA clients. The top 5 categories were those relating to the cardiovascular system, nervous system (including mental health medications), general anti-infectives, alimentary tract and metabolism, and musculoskeletal system.

 

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