Summary
This report examines health service use over a seven-year period from 2013–14 to 2019–20 among ex-serving Australian Defence Force (ADF) members with at least one day of service since 1 January 1985. There is limited knowledge on the health service use patterns of the ex-serving population. This analysis aims to describe the patterns of health service use over time and to identify differences in use of services by demographic and ADF service-related characteristics.
This report also explores subgroups among ex-serving members with distinct patterns of health service use to better understand variation in how care is accessed. Health service use data alone do not indicate unmet needs or adequacy of care and may indicate that adequate care is provided. However, identifying variation in use can highlight groups who may benefit from more tailored or coordinated support. Although direct comparisons with the general population were not undertaken, national data are referenced where relevant to help contextualise findings.
This report is part of a broader series of research on the use of health services by ex-serving 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. The results presented in this report give an overview of health service use which provides useful context for the other reports in the research series.
This report examines health service use across some primary care (Medicare Benefit Schedule or MBS services), public hospital services (emergency department (ED) and admitted care), Pharmaceutical Benefits Schedule (PBS) and Repatriation Pharmaceutical Benefits Scheme (RPBS) and Department of Veterans’ Affairs or DVA-funded public hospital and primary care, referred to in this report as ‘in-scope services’. Information on the specific types of health services that were included are in the Technical notes.
The research included two main components:
- descriptive analysis of health service use for ex-serving ADF members over the study period as well as logistic regression to provide insights on characteristics associated with accessing health service
- clustering analysis to identify subgroups of ex-serving members by their health service use in 2019–20.
Most ex-serving members accessed a health service each year
Between 2013–14 and 2019–20, the proportion of ex-serving members accessing at least one in-scope health service remained high and relatively stable, ranging from 86% to 88%. In 2019–20, around 201,000 ex-serving members (88% of the ex-serving population, or almost 9 in 10) accessed at least one in-scope health service. It should be noted that there may be some fluctuations in data in 2019–20 due to COVID-19.
The proportion of females who accessed any health service was slightly higher than males in 2019–2020 (90% of females compared with 88% of males) and this pattern was consistent throughout the period. The proportion accessing in-scope health services increased with age, from 82% among those aged 17-24 years to 95% among those aged 65 and over in 2019–2020.
The health service most likely to be accessed in 2019–20 was MBS services (83%) followed by PBS/RPBS services (69%), DVA-funded MBS equivalent services (55% of DVA clients), hospital admitted care (17%) and ED care (15%). The proportion of ex-serving members who accessed each of these health services increased modestly over the period. These proportions are not mutually exclusive, as many people accessed more than one type of service.
One in three ex-serving members accessed a mental health service in 2019–20
The proportion of ex-serving members who used mental health services gradually increased over the seven-year period. In 2019–20, 30% of ex-serving members (69,000 people) accessed at least one mental health service, compared with 26% (50,000 people) in 2013–14. Females were more likely to have accessed a mental health service than males (38% compared with 29% in 2019–20). The proportion of ex-serving members who accessed a mental health service was similar across most age groups (29 to 30%), except that it was lower among those aged under 25 years (23%) and slightly higher in those aged over 65 years (32%) in 2019–2020.
The most accessed mental health service across ex-serving members in 2019–2020 was PBS/RPBS services (25%) followed by MBS services (10%) and DVA- funded MBS equivalent services (7%). Among DVA clients, 19% accessed a DVA-funded MBS equivalent mental health service in 2019–20.
There are additional mental health services that were not included in this analysis due to data availability such as Open Arms and community mental health services (for more information see Research methods).
Some ex-serving members were more likely to access a health service at least once
Ex-serving members more likely to access a health service (including mental and non-mental health) at least once in 2019–20 were those who were:
- females compared with males
- aged 65 years and older, compared with 45–54 years
- separated from the Air Force compared with Army and Navy
- involuntary medical separated compared to voluntarily separated
- DVA clients compared with non-DVA clients.
Ex-serving members used more health services over time
The average number of health services used per person per year increased steadily between 2013–14 and 2019–20. These averages reflect use across the entire cohort, including ex-serving members who did not access health services. In 2019–20, ex-serving members used an average of 42.8 in-scope health services per person per year, up from 31.6 health services per person per year in 2013–14. Of ex-serving members who used a health service at least once in 2019–20, the average number of health services was 48.5 per user per year, up from 36.8 per user per year in 2013–14.
Although a higher proportion of females accessed health services compared to males, males had higher average use per person per year than females in 2019–20 (43.3 compared with 39.8), and this pattern was consistent across the period. Health service use increased with age, with those aged 65 and older using more than six times more health services per person per year than those aged 17 to 24 years (103.3 services per person per year compared with 16.3 services per person per year in 2019–20). The overall increase in health service use between 2013–14 and 2019–20 may be partly attributable to the increasing proportion of ex-serving members in older age groups (69% were aged 45 years and over in 2019–20 up from 55% in 2013–14).
The most used health services were for medication dispensing
The most used health service per person in 2019–20 was PBS/RPBS services (15.1) followed by MBS services (13.9) and DVA-funded MBS equivalent services (13.1). Among DVA clients (those eligible for and receiving DVA-funded health services), the average use of DVA-funded MBS equivalent services was 36.3 services per person per year in 2019–20.
Average mental health service use also increased over time, from 2.8 services per person per year in 2013–14 to 3.7 services per person per year in 2019–20. Females had higher average mental health service use per person per year than males in 2019–20 (4.8 compared with 3.5). Among ex-serving members who accessed a mental health service, average use of mental health services per user per year was 12.5 services in 2019–20, up from 10.7 in 2013–14.
Most mental health services that ex-serving members used were for PBS/RPBS services in 2019–20 (2.6 services) followed by DVA-funded MBS equivalent services (0.7 services). Among DVA clients, the average use of DVA-funded MBS equivalent mental health services was 2.0 per person per year in 2019–20.
Ex-serving members’ use of health services is similar to the Australian population
While direct comparisons with the general population were not conducted in this report, national data suggest that overall health service use among ex-serving members is broadly similar in terms of service access and frequency of use. However, ex-serving members also access DVA-funded health services that are provided in addition to those available to the general population, indicating relatively higher health service use among DVA clients. Mental health service use, particularly for prescriptions and hospital care, appears higher among ex-serving members, likely reflecting differences in eligibility, access, engagement with care, underlying health conditions or due to the unique impacts of ADF service.
Most ex-serving members were in moderate user groups with a growing high service user group
AIHW identified subgroups of ex-serving members based on their volume of health service use in 2019–20. The majority of ex-serving members were moderate users (66% or around 151,000 ex-serving members), with one in five being minimal users (20% or about 46,000 ex-serving members) and the remainder being high users (13% or nearly 30,000 ex-serving members). These groups were identified using a data-driven method (latent class analysis), with labels that reflect relative levels of use across groups rather than fixed cut-offs.
There was a gradual increase in the proportion of ex-serving members in the high user group over time, from 11.8% in 2013–14 to 13.4% in 2019–20 (which may have been due to the ex-serving population becoming older over the period). Over the same period, the proportion of minimal service users decreased slightly, from 23.4% to 20.2%.
These findings highlight variation in health service use within the ex-serving members cohort and provide a baseline for monitoring changes in health service use over time.