Palliative care services in Australia

Medicare Benefits Schedule data

Services Australia (formerly the Australian Government Department of Human Services) collects administrative data in processing claims for benefits under the Medicare Benefits Schedule (MBS) and provides this information to the Australian Government Department of Health and Aged Care. The item number and benefits paid by Services Australia are based on the Medicare Benefits Schedule Book (Department of Health and Aged Care 2023a).

The data presented in this report relate to services provided on a ‘fee-for-service’ basis for which MBS benefits were paid, and only for palliative medicine attendances and case conferencing services that are both provided by palliative medicine physicians or specialists, and are claimed under specialist palliative care MBS item numbers. 

Patients who are referred to specialists or physicians in palliative medicine usually have:

• intermediate and fluctuating needs that might result in unplanned use of hospital and other services, and/or
• complex and persistent needs (physical, social, emotional, or spiritual) that are not effectively managed through established protocols (PCA 2018).

Information is also provided on the settings where the attendances were provided – in hospital or consulting room, or in other settings, such as a person’s place of residence, including home, residential aged care or institution (see Table 1). For case conferencing, it refers to community case conference and discharge case conference (see Table 2).

* Items 3003 and 3015 ceased on 31 December 2021, with telehealth services now claimed against relevant item numbers in Group A40.

Note: Refer to Medicare Benefits Schedule Book July 2023 edition for full item descriptions (pages 308–309) and further information relating to MBS Palliative care (pages 118–119).

Note: Refer to Medicare Benefits Schedule Book July 2023 edition for full item descriptions (pages 309–311) and further information relating to MBS Palliative care (pages 118–119).

Palliative care physicians and specialists may at times use other MBS item numbers when attending to palliative care patients. These items are not included in the data on this report, as they are not claimed specifically as a palliative care-related service under the MBS. Further, other medical practitioners (general practitioners and medical specialists) and health professionals also attend to terminally ill patients and provide palliative care, without the service being eligible to be claimed specifically as a palliative care-related service under the MBS. In other words, the reported number of patients who receive a palliative care-related service under the MBS is a known underestimate of total palliative care activity. Further, the data does not include referred attendances by palliative medicine physicians or specialists to public in-patients or public outpatients of hospitals and services funded from the Department of Veterans’ Affairs National Treatment Account.

It should be noted that a patient may access more than one type of these specific MBS items provided by palliative medicine physicians or specialists during the reporting period and that each service is counted separately in this report. 

The MBS data presented in this report (2022–23 and trend data) are based on the date the service was provided rather than the date of service processing, as this more accurately reflects the date a service occurred. Note that in reports released prior to 2022, the data was based on the date the service was processed by Services Australia and as a result the data presented since 2022 releases are not comparable with previous releases.

Pharmaceutical Benefits Scheme and Repatriation Pharmaceutical Benefits Scheme data

Services Australia (formerly the Australian Government Department of Human Services) collects administrative data in processing prescriptions dispensed under the Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme data (RPBS) and provides these data to the Australian Government Department of Health and Aged Care.

Through the PBS and RPBS data, the Australian Government subsidises the cost of pharmaceutical products listed on the Schedule of Pharmaceutical Benefits (Department of Health and Aged Care 2023b). In 2004, the Australian Government introduced Pharmaceutical Benefits for Palliative Care, referred to as the PBS Palliative Care Schedule. The PBS Palliative Care Schedule, which lists medication items available for palliative care, was established as a separate schedule, complementing the General Schedule to improve access to essential and affordable medications for patients receiving palliative care.

Palliative care patients who are accessing medications listed in the PBS Palliative Care Schedule can also access medications listed on the General Schedules, for example morphine. The same medications may be listed on the PBS Palliative Care Schedule and the General Schedule, however, medications on the PBS Palliative Care Schedule may be listed with larger quantities and/or more script repeats, making them more suitable for use in palliative care (Department of Health 2016a). This may reduce patient co-payment costs and decrease the frequency of doctor consultations for ongoing symptom management. Given the overlap in medication items listed on the different schedules, and because the PBS Palliative Care Schedule is intended to complement the General Schedule, it is likely that some medicines prescribed for palliative care are prescribed from the General Schedule. These prescriptions are not included in the count of palliative care-related prescriptions in this report. In addition, medications prescribed for palliative care purposes in some other instances are not included in this report as well, since PBS and RPBS data do not capture over the counter medicines, medicines supplied to public hospital inpatients, and private prescriptions. For example, if a medicine is not listed under the PBS Schedule for a specific indication, but it has market authorisation by the Therapeutic Goods Administration for sale, it would not be included.

Palliative care prescriptions can also be identified through the prescriber. Palliative medicine specialists may prescribe medicines for a range of reasons, some of which may be for palliative care, and may prescribe from different schedules. This report includes information on medications prescribed by palliative medicine specialists from all schedules (Table 8 in Data tables for Palliative care-related medications) and are therefore likely to include prescriptions prescribed for both palliative care and non-palliative care reasons. 

In summary, only the medications listed on the PBS Palliative Care Schedule (referred to as palliative care-related prescriptions) and the medications prescribed by palliative medicine specialists are included in this report. 

The PBS and RPBS data presented in this report (2022–23 and trend data) are based on the date of supply, that is when the prescription was dispensed to the patient.

Types of palliative care-related prescriptions

Previously, this report has defined types of palliative care-related medicines by categories based on the Anatomical Therapeutic Chemical (ATC) classification system (WHO 2022). Since 2022, this report has used an updated method to report types of palliative care-related prescriptions, with the categories based on the Palliative Care publication of the Australian Therapeutic Guidelines (Therapeutic Guidelines Limited 2021). Therefore, the medication types (at the ATC level 2) in editions before 2022 are not directly comparable with the ‘medication group’ in this report. 

Table 3 lists the medication items from the PBS Palliative Care Schedule with their corresponding medication groups and ATC codes at levels 2, 3 and 5. Note that most of these medicines are listed in multiple areas in PBS and RPBS, and are not specific to the Palliative Care Schedule. In this report, data extracted using ATC codes for medication groups was filtered by program type (Palliative Care Schedule) to report on all palliative care-related prescriptions.

*Hyoscine Butylbromide can also be used to manage respiratory secretions.

**These PBS items are listed on the PBS as Restricted Benefit which can only be prescribed for specific therapeutic uses.

Relevant changes to the Pharmaceutical Benefits Scheme and Repatriation Pharmaceutical Benefits Scheme over time

Reporting of ‘subsidised’ and ‘under co-payment’ prescription data

Under the PBS and RPBS, the Australian Government sets a maximum ‘patient co-payment’ amount that people pay towards the cost of their medicines. 

• If a prescription is priced over the co-payment threshold, it is considered as ‘over co-payment’ or a 'subsidised prescription', the Australian Government pays pharmacies the difference between a consumer’s co‑payment and the PBS price of a medicine, as listed on the Schedule of Pharmaceutical Benefits.
• If a prescription is priced below the co-payment threshold, it is classified as an ‘under co-payment prescription’, the consumer pays the total cost, and the government does not contribute.

The maximum co-payment a patient pays depends on their level of entitlement, which is determined by the patient’s concessional status and whether they have qualified for the PBS safety net. Current and historical co‑payments can be found on the PBS website.

Until 1 April 2012, PBS and RPBS prescription data supplied to the AIHW by the Department of Health and Aged Care excluded prescriptions costing less than the patient co-payment amount (under co-payment). 

From 1 April 2012, changes to the National Health Act 1953 required pharmacies to supply data for prescriptions that are priced below the patient co-payment level to Services Australia (Department of Health and Ageing 2011). Under co-payment prescription data were then supplied in PBS and RPBS Palliative Care data sets and were incorporated in the same tables as subsidised prescription data but were often reported separately. 

Since 2022, this report combines under co-payment and subsidised data in most tables. An additional table by patient beneficiaries shows the palliative care data by co-payment type in a single table for 2022–23 (Table 4 in Data tables for Palliative care-related medications), rather than including this split in every table.

Changes to restriction levels on the Palliative Care Schedule

On 1 June 2016, as part of the Post-market Review of Authority Required PBS Listings, changes were made to items listed on the Palliative Care Schedule. The restrictions for a number of Palliative Care Schedule items were changed and some medications were added or deleted. The restriction level of certain Palliative Care Schedule items, specifically those in the ‘pain relief’ and ‘gastrointestinal symptoms’ categories, were changed, in many cases from ‘Authority Required (STREAMLINED)’ to ‘Restricted Benefit’, reducing the level of restriction. Certain versions of medications were delisted due to initial and continuing treatment restrictions being simplified and merged under a single item code. Prescriptions written prior to 1 June 2016 for deleted item codes remained valid for a 12-month transition period. Some pain relief items were also added, specifically Buprenorphine, resulting in an increase in prescriptions in this category.

It should also be noted that data from 2016–17 onwards are not comparable with previous years. This is due to significant changes to the PBS restriction level from June 2016, as well as new listings of medications in the PBS Palliative Care Schedule (Department of Health 2016b). These changes particularly affect medications in this report that come under the ‘pain relief’ and ‘gastrointestinal symptoms’ categories. 

National Hospital Cost Data Collection

The National Hospital Cost Data Collection (NHCDC) is an annual collection of public hospital cost data in Australia, managed by the Independent Health and Aged Care Pricing Authority (IHACPA), and is the primary data collection used to develop the National Efficient Price (NEP) and National Efficient Cost (NEC) Determinations for the funding of public hospitals services.

IHACPA uses classifications to categorise, cost and price hospital activity. Hospital activity relates to the management of (diagnostics and interventional) and the resources used by the patient in relation to their treatment. Classification systems are used to describe activity related to the following types of patient care: admitted acute care, subacute and non-acute care, non-admitted care, emergency care and mental health care. Palliative care belongs to subacute care, a specialised multidisciplinary care in which the primary need for care is optimisation of the patient’s functioning and quality of life. Note that not all hospitals submitted data to IHACPA has reported subacute data and palliative care data. The data presented in this report are related to records and costs that are linked and in scope for NHCDC reporting only, unless otherwise stated.

In this report:

• admitted patient palliative care includes either palliative care episodes or palliative care phases, which are identified by using the 'Care type' as 'Palliative care'
• non-admitted patient palliative care refers to palliative care service events, which are identified by using either 'Care type' as 'Palliative care', or ‘Tier 2 Non-Admitted Services classification’ as ‘Palliative care’ in Medical Consultation Classes or in Allied Health and/or Clinical Nurse Specialist Interventions Classes.

Note that expenditure for the non-admitted patient palliative care, where defined by 'Tier 2 Clinic Codes', does not specifically capture non-specialist care that are not mapped to these codes.

Also note, the expenditure data on admitted and non-admitted patient palliative care in this report may not match jurisdiction reported palliative care costs in other reports, as the definitions for palliative care between the AIHW and Budget Estimates differ.

The health departments of Australia’s states and territories submit their cost data to IHACPA. Taken together, the collection represents the primary source of information about the cost of treating patients in Australian hospitals. To support consistency in the costing process, IHACPA works with stakeholders to develop and implement national costing standards. The Standards prescribes the set of line items and cost centres used for mapping hospital costs. IHACPA then creates cost buckets as cost pools within the hospital, by combining line items and cost centres, which are made up of: 

• Line items: these represent types of costs (for example, salaries and wages or goods and services) incurred by hospitals which are reported on in the general ledgers of hospitals.
• Cost centres: these represent departmental cost, objects within a hospital that relate to a particular function of the hospital – for example, the hospital operating room (IHACPA 2023).

The current version of the standards is the Australian Hospital Patient Costing Standards Version 4.1. For more information about data specifications, see IHACPA's Data collection page.

References

Department of Health and Aged Care (2023a) Medicare Benefits Schedule Book, Operating from 1 July 2023, Department of Health and Aged Care, Australian Government, accessed 30 January 2024.

Department of Health and Aged Care (2023b) Schedule of Pharmaceutical Benefits: Summary of Changes. Effective 1 January 2023, Department of Health and Aged Care, Australian Government, accessed 10 January 2023.

Department of Health (2016a) Access to medicines for palliative care on the PBS, Department of Health, Australian Government, accessed 20 January 2023. 

Department of Health (2016b) Schedule of Pharmaceutical Benefits: Summary of Changes. Effective 1 January 2016, Department of Health, Australian Government, accessed 10 January 2023.

Department of Health and Ageing (2011) Pharmaceutical Benefits Scheme Collection of Under Co-payment Data, Department of Health and Ageing, Australian Government, accessed 10 January 2023.

IHACPA (Independent Health and Aged Care Pricing Authority) (2023) National Hospital Cost Data Collection (NHCDC) Public Sector Report 2020–21, IHACPA, Australian Government, accessed 19 October 2023.

PCA (Palliative Care Australia) (2018) Palliative Care Service Development Guidelines, PCA website, accessed 20 January 2024.

Therapeutic Guidelines Limited (2021) Therapeutic Guidelines: Palliative Care, Therapeutic Guidelines Limited website, accessed 10 March 2023.

WHO (World Health Organization) (2022) ATC Structure and principles, WHO website, accessed 18 January 2023.