Medicare Benefits Scheme funded services: monthly data

The Medicare Benefits Scheme (MBS) is part of Australia’s public health insurance scheme. Through the MBS the Australian Government subsidises the costs of a broad range of health services. The MBS subsidies pay all or part of the costs of these services, dependent on factors such as patient eligibility, the type of service and choices by health practitioners regarding the fees they charge for their services.

­MBS benefits are claimable only for services rendered by an appropriate health practitioner and which are listed on the Medicare Benefits Schedule.

Scope of MBS statistics

MBS statistics only include services for which an MBS benefit was paid. They do not include services:

• provided by hospital doctors to public patients
• provided under the Department of Veterans' Affairs National Treatment Account
• covered by third party or workers' compensation
• rendered to repatriation beneficiaries or defence personnel
• rendered for insurance or employment purposes
• that are funded directly by other Australian Government programs (such as health screening services)
• funded directly by State/Territory Government programs.

Statistics in this dashboard were extracted by the AIHW from the MBS claim records data in the Australian Government Department of Health and Aged Care’s Enterprise Data Warehouse.

The dashboard presents monthly statistics on the MBS subsidy rate (that is the proportion of the cost of the services funded through the MBS, as opposed to via patient contributions and other arrangements such as private health insurance). The monthly statistics also presents the usage rate of services covered by the MBS. The MBS services rate shows the average number of services per resident of a Local Government Area (LGA) for each broad type of service (BTOS) group, along with state/territory and national statistics for comparison.

The MBS benefit is the Australian Government paid benefit. For privately insured episodes of hospital treatment or hospital substitute treatment (treatment at home), the benefit paid in MBS claims data does not include any supplementary benefits paid by health funds.

Where patients have claimed on Services Australia before paying the treating practitioner, the fee charged amount is un-substantiated. Some practitioners subsequently accept a discounted fee for prompt payment, which may not be notified to Services Australia. Since co-payment for hospital services is not counted towards the Medicare safety nets, there is no incentive for patients to provide proof of the actual fee charged for these services to Services Australia.

Monthly statistics are reported using date of service to reflect the period in which a service was provided, from February 1984 to the latest published month. However, LGA statistics on services per resident are from July 2001 due to there being no LGA population published prior to that time.

It is possible for service volumes to change between releases of statistics due to the late lodgement of claims and adjustments to claims. The last 3 months of statistics are considered to be preliminary as they are incomplete and subject to revision because claims for MBS benefits are still being submitted to Services Australia for processing and payment.

Monthly statistics are reported as they are, and as rolling statistics of 3 months or 12 months (the month in question and the previous 2 months; or the month in question and the previous 11 months) to smooth seasonal variations and the timing of public holidays. The numerators and denominators are the totals over 3 months or 12 months, except for the resident population of an area, for which the population is from the last month. Monthly statistics are influenced by the number of working days from month to month.

MBS services are reported using the Broad Type of Service (BTOS) classification, whereby each MBS item is allocated to a BTOS category. The BTOS categories broadly correlate to different provider groups or services. Some smaller categories are combined with larger categories for reporting purposes. The BTOS groups presented in the dashboard (along with examples of services) are:

• general practitioner (GP) attendances (combined with practice nurse services on behalf of a GP) include:
  • standard GP attendances
  • urgent and after-hours GP attendances
  • GP treatment plans and GP mental health treatment plans
  • health assessments
  • services rendered by a practice nurse or an Aboriginal and Torres Strait Islander health practitioner on behalf of a GP
• specialist attendances include:
  • specialist and consultant physician attendances
  • consultant psychiatrist attendances
  • pre anaesthesia consultations
• obstetrics services include:
  • planning and management of a pregnancy
  • antenatal and postnatal attendances
  • management of labour and birth
  • caesarean sections and other obstetric procedures
• anaesthetics services include:
  • administration and management of a patient under anaesthesia
  • regional or field nerve blocks
• pathology services include:
  • standard pathology testing including chemical pathology and haematology
  • detection of bacteria or viruses (including COVID-19)
  • analysis of specimens to detect malignancy
  • genetic testing
  • collection and management of specimens
• diagnostic imaging services include:
  • X-ray imaging
  • ultrasound
  • computed tomography (CT)
  • magnetic resonance imaging (MRI)
  • nuclear medicine imaging, including positron emission tomography (PET)
• surgical operations (combined with assistance at operations) include:
  • all surgical operations; common operations include cataract surgery, endoscopies, removal of tumours or skin lesions, and knee and hip replacements
  • assistance at operations
• allied health services (combined with optometry) include:
  • optometry
  • services provided by relevant groups (for example clinical psychology, physiotherapy and other allied health professions), under team care arrangements, or under a shared care plan, or under both a GP management plan and team care arrangements, in managing a person’s chronic condition and complex care needs
• other MBS services (combined with radiation therapy) include
  • radiation oncology and therapeutic nuclear medicine
  • diagnostic procedures and investigations (for example electrocardiograms, audiograms, bone densitometry testing and sleep apnoea testing)
  • miscellaneous therapeutic procedures, including assisted reproductive services
  • bulk billing incentives for unreferred services other than diagnostic imaging (included with diagnostic imaging) and pathology (included with pathology).

Dashboard statistics can be compared between key policy age groups of 0–15, 16–64, and 65 and over. Treating practitioners receive an additional incentive payment when they bulk bill unreferred services for patients who are not admitted to a hospital, and who are under 16 years of age or possess a Commonwealth concession card. Unreferred services include GP attendances, simple basic pathology tests, non-requested type diagnostic imaging services, and other unreferred services.

Patients aged 65 and over are a proxy for concessional patients, as this information is not available in the MBS claims data at this point in time.

Statistics for a selected area for all 3 age groups can be compared. Statistics for a selected area for a single age group can also be compared to the state/territory and national statistics for the same age group.

Population statistics are sourced from the Australian Bureau of Statistics (ABS) Estimated Resident Population (ERP) statistics as at 30 June. ERP statistics by LGA are available from 2001.

In relation to services per resident of an area, the denominator is the total ERP of the area, as at the previous 30 June.

• For any month of the first half of a calendar year, the ERP is as at 30 June of previous year.
• For any month of the second half of the year, the ERP is as at 30 June of the year.
• The most current ERP is used when the relevant ERP has not been released.

Total ERP is used in all BTOS groups, except obstetrics services, for which the denominator is the total female ERP and services per female resident are calculated.

For services per resident disaggregated by age group, the total ERP from the relevant age group is used, with an exception to obstetrics services, for which the total female ERP from the relevant age group is used.

LGAs cover legally designated parts of a state or territory, for which incorporated local governing bodies have responsibility. The LGAs presented on the dashboard are ABS LGAs which are ABS approximations of official local government boundaries as defined by each state and territory. ABS approximations of administrative boundaries do not match legal boundaries and are used for statistical purposes only.

There are 544 LGAs in this release, covering the whole of Australia without gaps or overlaps. These LGAs included unincorporated areas which are areas in some states and territories not administered by incorporated bodies. An LGA can be abolished, created, or changed significantly in boundary. The LGA boundaries in this release have been applied historically for all years for comparison purposes. Latest LGAs will be used when correspondence from postcode to LGA becomes available.

Postcodes

Dashboard statistics are based on the location of the patient, not the location of the provider. Patients may travel outside their LGA to receive services. LGAs show where people live rather than where people access their services and may not reflect the practices of the providers who render their services in those LGAs.

The MBS enrolment postcode at the time of the claim being processed is used as a proxy for the patient residence. An enrolment postcode is a mail delivery postcode and this may differ from some patients’ residential address. Some postcodes that only represent Post Office boxes and not residential areas (for example: General Post Offices or mail delivery centres), have not been allocated to an LGA as they are not a good indicator of where the patient lives. However, they have been included in state/territory and Australian totals. Likewise, enrolment postcodes that cannot be allocated to an area, are included in the Australian total only.

Some patients change enrolment postcode during a month. In compiling statistics for the month, MBS records are allocated to a patient’s major enrolment postcode in each month based on the largest number of services, before being aggregated to monthly statistics.

An ABS correspondence is used to proportionately allocate postcode level data to LGA. The population distribution within any postcode (within an LGA or across more than one LGA) reflects that as of the 2016 Census.

During the late 1980s, Northern Territory postcodes moved from the range of 5750–5799 to their current range of 800–899. These previous postcodes are not present in the latest postal area to LGA correspondence, consequently statistics are unavailable at the LGA level for early periods for most Northern Territory LGAs.

Caution should be exercised when interpreting LGA statistics in the Northern Territory. These statistics are under-represented because of a high proportion of Northern Territory residents enrolled in the MBS using Post Office box addresses. Unless the Post Office box postcodes are the same as residential postcodes, the non-residential postcodes are not assigned to an LGA, but have been included in the Northern Territory and Australian totals.

Suppression has been applied to protect individual confidentiality in areas, where services are rendered by a few providers or rendered to a few patients; or services are heavily dominated by a few providers.

The month of interest for an area is suppressed for volatility if there are fewer than 50 services, or the relevant ERP is fewer than 100. In these cases, the chart is displayed with gaps.

The entire chart is not shown if 30% or more months are suppressed. If the “age group comparison” option is selected, age groups where 30% or more of the months are suppressed will be omitted from chart, so in some cases only one or two age groups will be present on the chart when this option is selected.