Introduction

This research is the third in a series of publications that analyse the use of health services by ex-serving Australian Defence Force (ADF) members to 30 June 2020. The publications add to a picture of health service use and the factors associated with variations in health service use (see Health services use by ex-serving Australian Defence Force members).

The purpose of this report is to provide insights into the health service use patterns of ex-serving ADF members to understand their interactions with different health services including mental and non-mental health services. It also highlights variations in health service use associated with demographic and ADF service-related characteristics. This can identify subgroups who may require additional support. The report provides important context on health service use for the other reports on health service use in the research series.

AIHW has previously released research on ex-serving members who have accessed medications (AIHW 2019) and those who have accessed hospital care (AIHW 2024). The research on ex-serving members who accessed hospital care was released in 2024 and was the first using the AIHW developed Veteran Health Dataset (VHD). This report also draws on the VHD to analyse health service use patterns over time, including not just hospitals but also use of medications and primary health care services. More information is included in the Health services use by ex-serving Australian Defence Force members.

The publication of this report follows the release of the Final Report of the Royal Commission into Defence and Veteran Suicide and Government response to the Final Report. Importantly it further builds the evidence base on the physical and mental health of ex-serving ADF members.

About this report

The scope for this was report all ex-serving ADF members (excluding WA and NT) with 1 day or more of service since 1 January 1985 as identified from the Department of Defence personnel system (PMKeyS) and historical defence personnel datasets for 1 July 2013 to 30 June 2020. There were around 193,000 ex-serving members in scope in 2013–14 and 228,000 in 2019–20.

AIHW examined ex-serving members use of health services across some primary care (Medicare Benefit Schedule or MBS) services, public hospital services (admitted care and emergency department), Pharmaceutical Benefits Schedule (PBS) and Repatriation Pharmaceutical Benefits Scheme (RPBS) services and DVA-funded public hospital and primary care during the study period. It is important to note that some health services included in this report, particularly those funded by the Department of Veterans’ Affairs (DVA) are only available to DVA clients. In 2019–20, about 36% of the ex-serving cohort were DVA clients and therefore eligible for some DVA-funded health services.

There are also other health services that were not included in the research due to data availability and limitations. This includes use of private hospital services, community mental health services as well as health services funded out-of-pocket or through workers compensation arrangements or private health insurance (AIHW 2024). For more information see Box 1.

Box 1: Key data and methodology limitations

There are various limitations to this research which are detailed in Technical notes. Some of the key limitations are:

  • Health services funded out-of-pocket, by Defence, by Open Arms (such as mental health and counselling services), private health insurance and workers compensation arrangements are not included in the VHD. Consequently, these services are not included in this analysis which means that use of health services are an underestimate.
  • Emergency department care and public hospital admitted patient care were analysed separately. Therefore, people who presented to ED who were subsequently transferred to admitted care will have been counted as using two services. This should be considered when interpreting the results.
  • The analysis included persons from all jurisdictions except for Western Australia and Northern Territory, due to data limitations.

Characteristics of ex-serving ADF members

This research included analysis of the characteristics of ex-serving members (see Supplementary Table S1.1) to provide context to the changes in health services use over time. Compared with 2013–14, in 2019–20 a higher proportion of ex-serving members were:

  • aged 45 years and over: 69% (around 157,000 ex-serving members), up from 55%
  • separated from the ADF 20 or more years ago: 51% (116,000), up from 40%
  • separated from the ADF voluntarily: 45% (43,000), up from 39%
  • DVA clients: 36% (82,000), up from 25%
  • living with one or more comorbidities based on the prescription-based comorbidity index (RxRisk): 46% (105,000), up from 42%, including conditions such as hypertension, mental health disorders, respiratory, and musculoskeletal diseases
  • had low continuity of general practitioner (GP) care (not seeing the same GP each time): 35% (78,700), up from 32% and low regularity of GP care (not having regular GP appointments): 35% (79,000), up from 31%.

 

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