Medicare-subsidised GP, allied health and specialist health care across local areas: 2019–20 to 2020–21

Summary

The release uses two data sources:

• Medicare Benefits Schedule
• Australian Bureau of Statistics (ABS) Estimated Resident Population (ERP) at 30 June 2001 (see Age standardised rates) and 2021.

The release presents data on the following non-hospital Medicare-subsidised services:

• General Practitioner (GP) attendances
• Diagnostic imaging services
• Allied health attendances
• Specialist attendances
• Attendances provided by Practice Nurses, Aboriginal Health Workers, Midwives and Nurse Practitioners.

About the data source

Data for the report were sourced from the Medicare Benefits Schedule (MBS) claims data, which are managed by the Australian Government Department of Health and Aged Care. The claims data are derived from administrative information on services that qualify for a Medicare benefit under the Health Insurance Act 1973 and for which a claim has been processed by Services Australia.

When a health practitioner provides a clinically relevant service to a Medicare-eligible person, the practitioner or patient can make a claim with Medicare. Medicare will then provide a rebate, or benefit, to cover all or part of the cost of the service. For more detailed information on the MBS services and item types, see the Australian Government Department of Health and Aged Care: MBS online.  

Scope of the MBS claims data

Under MBS arrangements, Medicare claims can be made by eligible persons, this includes Australian and New Zealand citizens and holders of permanent residence visas. Applicants for permanent residence may also be eligible depending on circumstances. In addition, persons from countries with which Australia has reciprocal health care agreements might also be entitled to benefits under MBS arrangements.

It is important to note that some Australian residents may obtain similar medical services through other arrangements. MBS claims data do not include:

• services provided to patients where no MBS benefit has been processed (even if the service is eligible for a rebate)
• services provided to public patients in hospitals
• services subsidised by the Department of Veterans’ Affairs
• services delivered in public outpatient departments, or public accident and emergency departments
• services for a compensable injury or illness for which the patient’s insurer or compensation agency has accepted liability
• non-hospital services subsidised by private health insurance
• services provided through other publicly funded programs including jurisdictional salaried GP services provided in remote outreach clinics
• health screening services.

Some areas and service types have a higher proportion of services that are not Medicare‑subsidised than others and this may affect comparability when estimating total health care use in Australia. In particular, caution should be taken when interpreting use of Medicare-subsidised allied health services, which with the exception of optometry are generally only available to patients with chronic, developmental or mental health conditions with a referral from a GP or specialist medical practitioner. Some Australians also access subsidised allied health services through their general (‘ancillary’ or ‘extras’) private health insurance, or pay for services entirely out‑of‑pocket. At present, there is no national data on allied health service use outside of Medicare or private health insurance (AIHW 2018).

Scope and measures of the data

This data provides non-hospital Medicare-subsidised services data based on year of processing. Non-hospital Medicare-subsidised services refers to services provided in non-inpatient settings. This excludes services delivered to patients admitted to hospital at the time of receiving the service or where the care was provided as part of an episode of hospital-substitute treatment where the patient received a benefit from a private health insurer. While services provided in-hospital are excluded, the data do include services provided in places like private outpatient clinics (which may or may not be located within the grounds of a hospital).

The geography is based on a person’s Medicare enrolment postcode and not the location or availability of health care services in these areas.

The report includes information about use of the following non-hospital Medicare‑subsidised services from 2021–22:

• GP attendances, broken down into 27 sub-groups
• Allied health attendances, broken down into 18 sub-groups
• Specialist attendances, including Psychiatry and Early Intervention Services for children with autism, pervasive developmental disorder or disability
• Attendances provided by Practice Nurses, Aboriginal Health Workers, Midwives and Nurse Practitioners
• Diagnostic Imaging services.

See Technical information, a separate section containing details on the service groups, including descriptions of how MBS items are allocated to each group, reported in this publication.

Medicare service groups are defined by the MBS item billed for the service, not the health care providers’ specialty.

Data are reported by the financial year in which they are processed (see ‘Reporting year’).

These analyses exclude services delivered to patients admitted to hospital at the time of receiving the service or where the care was provided as part of an episode of hospital-substitute treatment where the patient received a benefit from a private health insurer. Further information about out-of-hospital Medicare-subsidised services, by broad type of service, are available in the Department of Health and Aged Care’s Annual Medicare Statistics.

The following information is reported for each Medicare service group:

• Percentage of the population who claimed the service
• Services per 100 people
• Medicare benefits per 100 people
• Number of patients
• Number of services
• Total Medicare benefits paid
• Total provider fees
• Estimated population of the area.

See Table A for how each measure is defined.

All Medicare service groups listed in the Technical information are reported by Primary Health Network (PHN) areas and by smaller geographic areas known as Statistical Areas Level 3 (SA3s, or ’local areas’) (ABS 2016). Note, GP aged care attendances are only reported by PHN area.

To support comparisons between similar areas, PHN areas are grouped into metropolitan and regional PHN areas. Results for SA3s are grouped by similar socioeconomic status (higher, medium and lower) for SA3s in Major cities, and by remoteness areas for SA3s in Inner regional, Outer regional, and Remote areas. See Geography – metropolitan and regional PHN areas and Local areas (SA3) groups for more information.

Where possible, measures are disaggregated by sex and age (PHN age groups: 0–14, 15–24, 25–44, 45–64, 65–79, 80+ years, and SA3 age groups 0-24, 25-44, 45-64 and 65+).

What are the limitations of the data?

The MBS is managed by the Department of Health and Aged Care, and over time MBS items are introduced, amended, deleted or replaced (see Australian Government Department of Health and Aged Care: MBS online for the latest MBS). This may affect comparability over time, for instance changes to patient eligibility or provider incentives to claim the item. In some cases, providers may bill a ‘general’ item (for example, items in ‘GP Standard (Level B)’) for a service that could have qualified as a health-specific item (for example, GP Health Assessment). This may underestimate the true use of more specific service types.

MBS claims data are an administrative by-product of Services Australia’s administration of the Medicare fee-for-service payment system. There may be some administrative errors in the recording of the MBS item billed, and patients’ location, age, and sex. Discrepancies may also occur as a result of negative adjustments made after the service was first processed (for example, due to cancelled cheques).

For some results that are disaggregated by age, the number of patients is higher than the ERP. Affected results have been annotated with a footnote to interpret these with caution. This may be due to several factors (including the above MBS data limitations):

• This release uses the ERP at the beginning of the financial year. As the population changes, some people may be included in the numerator (MBS data), but not the denominator (ERP), for instance a person who migrated to Australia after 30 June 2019 but who claimed a service in 2021–22.
• The ERP includes people who usually live in Australia, that is, people who have been residing in Australia for a period of 12 months or more over the last 16 months. Some temporary visitors who are not included in the ERP are able to claim Medicare services, for instance through reciprocal health care agreements. However, some residents who usually live in Australia (e.g. international students or those on working visas) are not eligible for Medicare.

The ERP, the official estimate of the Australian population, is produced by the ABS using a range of data sources, including the Census of Population and Housing, and births, deaths, and migration administrative data. ERP data sources are subject to non‑sampling error, which may arise from inaccuracies in collecting, recording and processing data (ABS 2022).

Table A: List of measures included in the report and their calculation

Measure	Calculation
Percentage of population who claimed the service (%)	Numerator: Number of patients who had at least one eligible service processed in the reporting year for the specified service type. The unique number of patients were identified through the Patient Identification Numbers (PINs) in the Medicare claim records. Denominator: ABS ERP as at 30 June at the end of the previous financial year Calculation: (Numerator ÷ denominator) x 100
Services per 100 people	Numerator: Sum of services from eligible claims for the specified service type. This does not include any bulk billed incentive items or other top-up items. Denominator: ABS ERP as at 30 June at the end of the previous financial year Calculation: (Numerator ÷ denominator) x 100
Services per 100 people (age standardised)	Numerator: Sum of services from eligible claims for the specified service type. This does not include any bulk billed incentive items or other top-up items. Denominator: ABS ERP as at 30 June at the end of the previous financial year Standard population: ABS ERP at 30 June 2001 Method: Direct age standardisation method (see ‘Age standardised rates’). Note: this measure is reported for the following service groups (as defined in the Technical Information) by PHN area: GP attendances (total) GP subtotal - After-hours GP attendances Allied Health attendances (total) Diagnostic imaging services (total) Specialist attendances (total).
Medicare benefits per 100 people ($)	Numerator: Sum of benefits paid for eligible claims for the specified service type. Results are rounded to the whole dollar. This does not include any payments associated with bulk billed incentive items or other top-up items. Denominator: ABS ERP as at 30 June at the end of the previous financial year Calculation: (Numerator ÷ denominator) x 100 Note: Expenditure results are not adjusted for inflation.
No. patients	Number of patients who had at least one eligible service in total processed in the reporting year for the specified service type. The unique number of patients were identified through the PINs in the Medicare claim records. Totals and subtotals of patients may be less than the sum of each service group as a patient may receive more than one type of service but will be counted only once in the relevant total
No. services	Sum of services from eligible claims for the specified service type. This does not include any bulk billed incentive items or other top-up items
Total Medicare benefits paid ($)	Sum of benefits paid by Medicare for eligible claims for the specified service type. Results are rounded to the whole dollar. This does not include any payments associated with bulk billed incentive items or other top-up items. Note: Expenditure results are not adjusted for inflation.
Total provider fees ($)	Sum of fees charged by the health care provider for eligible claims for the specified service type, comprising the benefits paid by Medicare and patients' out-of-pocket costs. Results are rounded to the whole dollar. Note: Expenditure results are not adjusted for inflation.
Estimated Population	ABS Estimated Resident Population (ERP) as at 30 June at the end of the previous financial year (e.g. 30 June 2018 for 2018–19 results).
GP attendances per residential aged care patient	Numerator: Sum of services from eligible claims for the specified service type. This does not include any bulk billed incentive items or other top-up items. Denominator: Number of patients who had at least one GP attendance in a residential aged care facility processed in the reporting year. Calculation: (Numerator ÷ denominator) x 100

About the method 

Reporting year

Data are reported by the financial year in which the service is rendered, not the date the service occurred. Most non-hospital Medicare services (approximately 98%) occurred within the same year as the year of processing. Approximately 2% occurred in the previous year, and less than 0.1% occurred more than 2 years before the processing date. The gap between date of processing and date of service varies across Australia and across provider groups.

Number of patients

‘Number of patients’ refers to patients who claimed at least one eligible service in total (for the respective service type) in the reporting year, as identified through the Patient Identification Numbers (PINs) in the Medicare claim records. Totals and subtotals of patients may be less than the sum of each service group as a patient may receive more than one type of service but will be counted only once in the relevant total.

Percentage of people or proportion of population

The terms ‘people’ or ‘population’ refer to the Australian Bureau of Statistics (ABS) Estimated Resident Population (ERP) at 30 June at the end of the previous financial year (e.g. 30 June 2013 for 2013–14 results). This release used the preliminary ERP at 30 June 2021.

Disaggregation by age and sex

In addition to results for the total population in an area, results by PHN area and SA3 are reported by sex and by the following age groups:

• PHN area level analysis by six age groups (0–14, 15–24, 25–44, 45–64, 65–79, 80+)
• SA3 analysis by four age groups (0–24, 25–44, 45–64, 65+). Due to smaller populations, SA3 results by age and sex are reported for the ‘total’ Medicare service groups only.

Where the group was too small to report, age groups were combined where possible (e.g. 0–24 and 25–44 becomes 0–44 years) for 2013–14 to 2017–18. This method was revised for 2018−19 and later years, with data presented for six age groups by PHN and four age groups by SA3, where possible. Data were not published if it met any of the suppression rules (see Suppression).

Measures that are disaggregated by age group and sex use the patient’s date of birth and sex as recorded at the last service rendered (for any MBS service) in the reporting year. Where multiple services were rendered on the last date of service, age and sex was taken from the last date of processing on that date of service.

If a patient’s age was recorded as unknown or over 116, their records were excluded from the age group results. Similarly, if a patient’s sex was missing, their records were excluded from the sex group results.

Age standardised rates

Age standardised rates are hypothetical rates that would have been observed if the populations studied had the same age distribution as the standard population. This facilitates comparisons between populations with different age structures and changes over time within an area. This adjustment is important because the prevalence of health conditions and rates of health service use vary with age.

The direct method of age standardisation was applied to the data (AIHW 2005). Age standardised rates were derived by calculating crude rates by five-year age groupings of 0–4 years to 85+ years. These crude rates were then given a weight that reflected the age composition of the standard population (ABS ERP for Australia as at 30 June 2001). If a patient’s age was recorded as unknown or over 116, their records were excluded from the age standardised rates.

Suppression

Information about an area was suppressed (marked ‘n.p. – not published’) if any of the following conditions were met:

• There were fewer than six patients or fewer than six health service providers in the area (SA3/PHN) – note a patient/provider was only included if they provided or received at least one service in the area.
• One provider provided more than 85% of services or two providers provided more than 90% of services.
• One patient received more than 85% of services or two patients received more than 90% of services.
• The number of attendances/services was fewer than 20 for an area.
• The total population of an area was fewer than 1,000.
• The population of the reported age group or sex group in an area was fewer than 300.

Consequential suppression was applied to manage confidentiality. This is the process of suppressing information which, whilst not necessarily confidential, may be used to derive confidential data.

For age standardised rates, if the population of an area (denominator) was fewer than 30 in any of the standard age groupings, then the rate was marked ‘interpret with caution’, as these rates are considered potentially volatile. For each of these interpret with caution rates, the effect of increasing the numerator by one on the rank of the area was examined. If the rank changed considerably so that the area was on the cusp of changing two deciles, the rate was suppressed.

Geography

All results are based on the patient’s Medicare enrolment postcode, not where they received the health care service. Patients may use services outside of their Medicare enrolment postcode. The accuracy of the patient’s Medicare enrolment postcode cannot be determined, and may not reflect the primary residence (e.g. the Medicare enrolment postcode may be a PO box postcode).

The report presents information nationally and at the geography of:

• Primary Health Network (PHN) areas – 31 geographic areas covering Australia, with boundaries defined by the Australian Government Department of Health and Aged Care (2018).
• Metropolitan and regional PHN groups – PHN areas have been assigned into 2 groups: metropolitan and regional
• Statistical Areas Level 3 (SA3s) – 340 geographic areas covering Australia, with boundaries defined by the ABS (2016).
• SA3 groups – SA3s have been assigned into 6 groups: Major cities (Higher socioeconomic), Major cities (Medium socioeconomic), Major cities (Lower socioeconomic), Inner regional, Outer regional and Remote (ABS 2018a, 2018b).

Measures calculated at PHN area and SA3 were compiled by applying a geographic concordance to the unit record data. The concordance used the patient’s Medicare enrolment postcode as recorded on the last claim processed (for any MBS service) in the reporting year. If a patient had more than one postcode listed on their last date of processing in the year, then the postcode was taken from the last date of service on that date of processing. Records with invalid or missing postcodes were included in the national total but not allocated to a PHN area or SA3.

Where a postcode boundary overlapped more than one PHN area or SA3, the percentage of records attributed to each area was the same as the percentage of the postcode population that fell within each area. Postcodes are updated (introduced, retired or changed) over time, which can affect the comparability of how patients are allocated to regions over time.

Figures were rounded at the end of the calculations to avoid truncation error. Individual area results may not add to national totals due to rounding and missing location data.

Metropolitan and regional PHN groups

PHN areas with at least 85% of the population residing in Major cities are classified as metropolitan, as defined by the ABS (2018a), using the population distribution as of 30 June 2016. All other PHN areas are classified as regional PHN areas. See Table C for the metropolitan or regional classification of each PHN area.

Local area (SA3) groups

Identification of SA3s with similar socioeconomic or remoteness characteristics can help when making comparisons between areas. Results for local areas (SA3s) are presented by ABS categories of remoteness and, in Major cities, also by socioeconomic status. Results are grouped into the following categories:

• Major cities
• Higher socioeconomic areas
• Medium socioeconomic areas
• Lower socioeconomic areas
• Inner regional
• Outer regional
• Remote (includes Very remote).

SA3s in major cities

The majority of SA3s (190 of 340) across Australia are in the Major cities category (based on the Australian Statistical Geography Standard (ASGS) 2016, ABS 2018a). SA3 populations can be diverse in terms of socioeconomic status. To better enable fair comparisons within city areas, SA3s were divided into three socioeconomic groups: higher, medium and lower using the 2016 ABS Index of Relative Socioeconomic Disadvantage (IRSD) and the population as of 30 June 2016. IRSD is one of the Socio-Economic Indexes for Area (SEIFA) produced by the ABS (2018b). It ranks Statistical Area Level 1s (SA1s) from the most disadvantaged area (lowest quantile) to the least disadvantaged area (highest quantile), based on the relative socioeconomic conditions at an overall area level, not at an individual level.

The socioeconomic groups were defined as follows to produce three groups:

• Lower: IRSD quintiles 1 and 2
• Medium: IRSD quintiles 3 and 4
• Higher: IRSD quintile 5.

SA3s in Major cities were allocated to a socioeconomic group based on the largest number of SA1s in each group. In this report, across all SA3s, the percentage of the population that lived in the socioeconomic group allocated to that area ranged from 26% to 100%. This indicates that some SA3s have a broad diversity in socioeconomic status.

SA3s by remoteness

SA3 boundaries align well with the ABS remoteness classification for Major cities, Inner regional and Outer regional areas (ABS 2018a). SA3s are not as well defined between Remote and Very remote areas, so these categories were combined into a single category (Remote) for this analysis.

SA3s were allocated to one remoteness category based on the largest percentage of the population in each of the categories, using the population distribution as of 30 June 2016. This ranged from 48% to 100%. However, if 95% of the geographic area in an SA3 was Remote or Very remote, it was categorised on the basis of geographic area rather than population. This affected four SA3s – Broken Hill and Far West (NSW), Outback-North and East (SA), Goldfields (WA) and Mid West (WA).

Table C: Metropolitan and regional Primary Health Network areas

Primary Health Network (PHN) area	Proportion of population(a) in Major cities(b)
Metropolitan PHN areas
Central and Eastern Sydney	100%
Australian Capital Territory	100%
Western Sydney	99%
Northern Sydney	99%
Adelaide	99%
South Eastern Melbourne	98%
Gold Coast (Qld)	98%
Perth South	98%
Perth North	98%
North Western Melbourne	98%
Eastern Melbourne	96%
Brisbane South	96%
Brisbane North	95%
South Western Sydney	90%
Nepean Blue Mountains (NSW)	86%
Regional PHN areas
Hunter New England and Central Coast (NSW)	64%
South Eastern NSW	52%
Darling Downs and West Moreton (Qld)	35%
Central Queensland, Wide Bay, Sunshine Coast	34%
Western Victoria	30%
North Coast (NSW)	16%
Country SA	10%
Western NSW	0%
Murrumbidgee (NSW)	0%
Gippsland (Vic)	0%
Murray (Vic & part NSW)	0%
Western Queensland	0%
Northern Queensland	0%
Country WA	0%
Tasmania	0%
Northern Territory	0%

Notes:

1. Population = ABS ERP at 30 June 2016.

2. Major cities – as defined by the Australian Statistical Geography Standard 2016 Remoteness Areas (ABS 2018a).

Source: ABS Estimated Resident Population at 30 June 2016.