Health service use among ex-serving Australian Defence Force members

In 2019–20, around 201,000 ex-serving members accessed at least one of the five in-scope health services, equivalent to 88% of ex-serving members who served since 1985. This proportion was slightly higher than it was in 2013–14, when 86% of ex-serving members accessed at least one health service. 

A slightly higher proportion of females accessed any health service than males in 2019–20 (90% of females compared with 88% of males), and this pattern was consistent throughout the period. The proportion of ex-serving members who accessed health services varied by age group. Almost all (95%) ex-serving members aged 65 and over accessed a health service in 2019–20, while the age group least likely to access a service was those aged 17 to 24 years (82%). This pattern is consistent with known age-related differences in health service use seen more broadly in the Australian population (AIHW 2024).

The proportion of ex-serving members who accessed health services remained relatively stable between 2013–14 and 2019–20:

• MBS services were the most commonly accessed health service each year, with 83% of ex-serving members accessing them in 2019–20, compared with 81% in 2013–14.
• PBS (including RPBS) services (in other words medication dispensed under either of these funding arrangements) were accessed by 69% in 2019–20, compared with 67% in 2013–14.
• Hospital admitted care was accessed by 17% of ex-serving members in 2019–20, compared with 15% in 2013–14. 
• ED care was accessed by 15% of ex-serving members in 2019–20, compared with 14% in 2013–14.
• Among DVA clients (those eligible for and receiving DVA-funded health services), 55% accessed DVA-funded MBS equivalent services in 2019–20, compared with 50% in 2013–14.

Across the different health subservices analysed, GP services were accessed by the greatest proportion of ex-serving members in 2019–20 (77%) and in 2013–14 (75%). Figure 1 shows the proportion of ex-serving members who accessed each health service.

Note: DVA-funded MBS equivalent services are considered as a proportion of DVA clients only.

Mental health services

Mental health services accessed by ex-serving ADF members were identified based on mental health prescriptions dispensed under the PBS and RPBS, Medicare-subsidised mental health services, mental health-related ED presentations, and mental health-related hospitalisations. However, it is important to acknowledge that prescriptions for mental health (psychotropic) medications may not always be linked to a formal mental health diagnosis. For example, some medications have more than one therapeutic indication, and may be prescribed to treat non-mental health, or off-label conditions, such as some antidepressants which are used off-label for neuropathic pain (AIHW 2019). As such, the presence of a prescription alone does not necessarily indicate that a mental health condition was identified or treated. 

In 2019–20, 30% of the ex-serving population (69,000 ex-serving members) accessed at least one mental health service, compared with 26% (50,000 ex-serving members) in 2013–14. The proportion of ex-serving members who accessed mental health services in 2019–20 was higher for females than it was for males (38% compared with 29%), a pattern which was consistent throughout the period.

In 2019–20, the proportion of ex-serving members who accessed a mental health service was generally consistent across those aged from 25 to 64 years. In comparison, a slightly higher proportion of those aged 65 years and over accessed a mental health service (32%), while the lowest proportion was for those aged 17 to 24 years (23%).

The most commonly accessed mental health service across ex-serving members in 2019–20 was PBS/RPBS services (25%) followed by MBS services (10%) and DVA funded MBS equivalent services (7%). Among DVA clients (those eligible for and receiving DVA-funded health services), 19% accessed a mental health DVA-funded MBS equivalent service in 2019–20.

The patterns of ex-serving ADF members who accessed non-mental health services in 2019–20 were similar to that of overall health services (mental and non-mental health combined). Nine out of ten (90%) females accessed non-mental health services and slightly less males accessed non-mental health services in 2019–20, and access was highest among those aged 65 years and older (95%).

Characteristics associated with accessing health services

This section presents the results of logistic regression analyses examining the characteristics associated with ex-serving members’ accessing any health service at least once in 2019–20. Analyses were conducted for any in-scope health service, as well as for mental health services and specific health service types separately, including MBS, PBS and ED/hospital services. Full methodological details are provided in the Technical Notes.

The associations reported here are expressed as crude odds ratios (OR). This means that the observed associations between the outcome and the factor of interest may reflect differences related to other demographic, health, or ADF service-related factors. An OR above 1 indicates greater odds of accessing a health service relative to the reference group.

Comparisons are presented relative to a designated reference group for each characteristic. Reference groups were selected based on the category with the largest number of individuals (most frequent group), to provide stable comparisons. For example, males, being aged 45-54 years and those who separated voluntarily from ADF were used as reference groups for analyses of sex, age and separation reason as these were the most common categories in the cohort.

Those who were more likely to access health services (including mental and non-mental health) at least once in 2019–20 were:

• females compared with males (OR=1.32)
• aged 65 or over compared with 45–54 years (OR=3.14)
• separated from the Air Force compared with Army (OR=1.27) (this association may partly reflect that those separated from the Air Force were older on average)
  • Ex-serving members separated from Navy had similar likelihood compared with Army
• those who served for 20 or more years compared with 1 to 5 years of service (OR=2.57) (this association may partly reflect that who served for longer were older on average)
• involuntary medical separated compared to voluntarily separated (OR=2.98)
• DVA clients compared with non-DVA clients (OR=2.53)
  • DVA Gold card holders compared with white card holders (OR=6.54) (this association may partly reflect greater access to health services for DVA clients and Gold card holders).

More detailed findings on characteristics associated with each service type can be found in Supplementary Table S3.1.