Healthy Communities: Australians' experiences with primary health care in 2010–11 - Technical Supplement - Medicare Benefits Schedule statistics

Healthy Communities: Australians' experiences with primary health care in 2010–11

Medicare Benefits Schedule statistics

This section summarises methods used to calculate descriptive statistics on performance indicators using data from the Medicare Benefits Schedule (MBS). These statistics are derived from administrative information on services that qualified for a Medicare benefit under the Health Insurance Act 1973 and for which a claim was processed by the Department of Human Services. Under MBS arrangements, ‘eligible persons’ are persons who reside permanently in Australia. This includes 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. MBS data do not include services provided free of charge to public patients in hospitals, to Department of Veterans’ Affairs beneficiaries, to some patients under compensation arrangements and through other publicly funded programs.

This report contains MBS statistics on GP attendances, after-hours attendances and GP care planning for the 12 months of processing ending 30 June 2010–11 and 2011–12. These statistics exclude MBS rebatable investigations, tests and procedures which might occur during an attendance or consultation. It is important to note that some Australian residents may access medical services through other arrangements, such as salaried doctor arrangements. As a result, MBS statistics may underestimate the rate of use of health services by some members of the community.

GP attendances

‘GP attendances’ are based on the performance indicator for GP-type services in the National Healthcare Agreement (NHA). GP attendances are MBS non-referred attendances provided by medical practitioners, but deviates from the NHA performance indicator by excluding services provided by practice nurses and Aboriginal and Torres Strait Islander health practitioners on behalf of medical practitioners.

GP attendances represent non-referred attendances between patients and medical practitioners for the purposes of primary health care, which include:

  • GP and other non-referred attendances
  • Prolonged attendances
  • Group therapy
  • Acupuncture
  • Urgent attendance after hours
  • Health assessments
  • GP management plans, team care arrangements and case conferences
  • Domiciliary and residential management reviews
  • Attendances associated with Practice Incentives Program (PIP) payments
  • GP mental health treatment
  • After-hours attendances
  • Pregnancy support counselling
  • Telehealth attendances.

These services correspond with the non-referred attendance broad type of services groups used in MBS statistics published by the Department of Human Services2 and the Department of Health and Ageing.3

After-hours attendances

This subcategory of GP attendances includes urgent items in Group A11 and non-urgent items in Groups A22 and A23 of the MBS. Essentially, these services represent after-hours non-referred ‘attendances’ between patients and medical practitioners (including general practitioners) for the purposes of primary health care.

GP care planning

This sub-category of GP attendances includes GP management plans, team-care arrangements, multidisciplinary care plans, and case conferences involving a general practitioner.

Medicare services and benefits

Each MBS non-referred attendance, including after-hours attendances and care planning items, processed by the Department of Human Services (Medicare) in 2010–11 and 2011–12, is counted as a service in summary statistics. Bulk-billing incentive services are excluded from service counts, since they are ‘top-up’ items. MBS statistics only include benefits paid by the Department of Human Services and do not include patient copayments. While MBS benefits associated with bulk-billing incentives are included in MBS statistics published elsewhere, they are not included in this report since they cannot be precisely attributed to associated items in the MBS. In 2010–11 and 2011–12, total MBS expenditure for GP bulk-billing incentives other than pathology and diagnostic imaging was $482.2M and $493.6M, respectively. Services and benefits per person for 2010–11 and 2011–12 (based on date of processing) were computed having regard to ABS population estimates at 30 June 2011.

Geography levels

MBS statistics are presented in this report by Medicare Local and by ABS Statistical Area Level 3 (SA3), based on the patient’s enrolment address postcode in the Department of Human Services (Medicare) program as opposed to the service provider. Statistics in this report have been compiled by applying geographic concordances to MBS aggregate statistics at the patient enrolment postcode level. This has led to several technical methodological decisions which were required to produce results for this report.

Where postcodes overlapped Medicare Local or SA3 boundaries, services and benefits paid were attributed to a Medicare Local or SA3 based on the percentage of the population of each postcode in each Medicare Local or SA3.

Further, in the postcode to SA3 geographical correspondence file (see Glossary) obtained from the ABS, the factors for a number of postcodes either did not equal or sum to one. This was due to boundary misalignment between the original postcode and other maps. In some instances, service counts have been apportioned between multiple Medicare Locals or SA3s. National totals may not correspond to the sums of lower-level statistics due to rounding.

In the Medicare Local statistics that summarise service use by postcodes, a small number of postcodes which did not map to a Medicare Local have been assigned to a single “Other” row. Those individual numbers were generally low.

In the SA3 tables and maps, postcodes which did not map to SA3s have been separately tabulated under their respective states or territories. This includes Post Office Boxes, delivery centres, etc. For the Northern Territory, data for all SA3s and unallocated postcodes have been combined.

ABS Statistical Areas Level 3 (SA3s) have been excluded from the reported range of results where the population is less than 1000, as they may identify individual providers and their patients. Additionally, Christmas Island and the Cocos (Keeling) Islands were excluded as the majority of primary health care services are provided by the Indian Ocean Territories Health Service.

Region

Statistics are presented at Medicare Local level and SA3 level. Since many patients change mailing address through a year, the postcode used in compiling statistics was based on the latest processed MBS record (of any type, not just GP attendances) for each patient during each processing year (financial years 2010–11 and 2011–12, by date of processing).

Confidential results

Data rows containing information which could lead to the identification of individuals have been suppressed and their cell values marked as not available for publication (NP). The rules that were applied in ensuring confidential results of data are defined for the number of MBS services and benefits per person. The definition of confidential data for a number of MBS services is as follows:

  • If number of services is less than six, or;
  • If the number of services is equal to or greater than six but:
    1. two patients receive more than 90% of services, or;
    2. one patient receives more than 85% of services.

Due to confidentiality processes that were applied to the MBS data, some cells have been suppressed at the age group by sex by Medicare Local level on provision to the Authority. This suppression, together with not attributing some postcodes to SA3 regions, has led to some MBS data by Medicare Local, SA3 and higher aggregates possibly not agreeing with statistics published elsewhere. The impact on estimates presented in this report is relatively small.

Interpretation of MBS statistics

Several factors should be considered in interpreting MBS statistics by region and in making comparisons in service utilisation, including services per person, between regions. As noted above, these statistics relate to the Medicare enrolment region of the patient as opposed to the region in which the services were provided. Many patients receive services in a region other than the region recorded as their Medicare enrolment address postcode.

In the Northern Territory, approximately 30 per cent of GP attendances involve persons with Post Office Box or similar enrolment postcodes. Since these postcodes are not on SA3 concordance files, it was not possible to publish statistics for the Northern Territory at SA3 level.

Differences in utilisation of MBS services by region can be due to:

  • Services in some regions of Australia being provided by salaried practitioners outside Medicare ‘fee-for-service’ arrangements. These services are not captured in MBS statistics

  • Significant differences in the supply of practitioners
  • Rates of bulk-billing, or;
  • The age and gender profile of persons in the region.

Future work

The Authority has commenced statistical analysis comparing MBS statistics compiled using different “per person” denominators including:

  • The ABS Estimated Resident Population presented in this report as at 30 June 2011
  • An approximate mid-financial year estimate for 31 December 2010 and 31 December 2011
  • The number of clients who obtained an MBS benefit in the financial year, and;
  • If accessible, the number of people who held a Medicare entitlement in the financial year (that is, including those who did not obtain an MBS benefit during the year)

Results of this analysis will be presented in a future report by the Authority.