Web update: Medicare Benefits Schedule GP and specialist attendances and expenditure in 2015–16 - Technical Note - Indicator specifications

Web update: Medicare Benefits Schedule GP and specialist attendances and expenditure in 2015–16

Indicator specifications

When a health practitioner provides a 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 MBS Online website: www.mbsonline.gov.auExternal link, opens in a new window.

GP attendances and expenditure

This specification applies to the following indicators, presented as both crude and age-standardised rates:

  • Number of GP attendances per person
  • Medicare benefits expenditure on GP attendances per person
Data source
Data sources

Medicare Benefits Schedule (MBS) statistics 2010–11 to 2015–16

Australian Bureau of Statistics (ABS) Estimated Resident Population (ERP) at 30 June 2010–2015

Indicator description and calculation
Eligible claims A claim is classified as a GP attendance if the service is in any of the following broad type of service groups:
  • non-referred attendances – GP/VRGP (A/101)
  • non-referred attendances – Enhanced Primary Care (M/102)
  • non-referred attendances – Other (B/103).
Numerator

GP attendances: Sum of services from eligible claims by postcode for disaggregation by geography when item is not a bulk-billing incentive item or another top-up item.

GP expenditure: Sum of benefits paid for each eligible claim by postcode for disaggregation by geography.

Denominator ERP as at 30 June at the beginning of the reporting period
Calculation

Crude rates: Numerator ÷ denominator

Age-standardised rates: Numerator ÷ denominator (age-adjusted)

Method of adjustment Age-standardised rates: Direct age-standardisation. The standard population used was the ABS ERP at 30 June 2001.
Geographic disaggregation

Postcode of residence reported at the following levels:

  • PHN area
  • SA3.
Notes Data are reported by the financial year in which they were processed.

In-hours GP attendances

Number of in-hours GP attendances per person*.

Data source
Data sources

MBS statistics 2010–11 to 2015–16

ABS ERP at 30 June 2010–2015

Indicator description and calculation
Eligible claims A claim is classified as an in-hours GP attendance if the following conditions are true. The service is:
  • in any of the following broad type of service groups:
    • non-referred attendances - GP/VRGP (A/0101)
    • non-referred attendances - Enhanced Primary Care (M/0102)
    • non-referred attendances - Other (B/0103)
  • not in any of the following groups:
    • item urgent attendance after-hours (A11)
    • general practitioner after-hours attendances to which no other item applies (A22)
    • other non-referred after-hours attendances to which no other item applies (A23).
Numerator Sum of services for eligible claims by postcode for disaggregation by geography when item is not a bulk billing incentive item or another top-up item.
Denominator ERP as at 30 June at the beginning of the reporting period
Calculation Numerator ÷ denominator
Geographic disaggregation

Postcode of residence reported at the following levels:

  • PHN area
  • SA3.
Notes Data are reported by the financial year in which they were processed.

* Note this indicator is included in the Web update: Use of emergency department and GP services in 2015–16.

After-hours GP attendances and expenditure

This specification applies to the following indicators, presented as both crude and age-standardised rates:

  • Number of after-hours GP attendances per person*
  • Medicare benefits expenditure on after-hours GP attendances per person

Data source
Data sources

MBS statistics 2010–11 to 2015–16

ABS ERP at 30 June 2010–2015

Indicator description and calculation
Eligible claims A claim is classified as an after-hours GP attendance if the following conditions are true. The service is:
  • in any of the following broad type of service groups:
    • non-referred attendances - GP/VRGP (A/0101)
    • non-referred attendances - Enhanced Primary Care (M/0102)
    • non-referred attendances - Other (B/0103)
  • and in any of the following groups:
    • item urgent attendance after-hours (A11)
    • general practitioner after-hours attendances to which no other item applies (A22)
    • other non-referred after-hours attendances to which no other item applies (A23).

After-hours is defined as weekdays before 8am or on or after 8pm, Saturdays before 8am or on or after 1pm, or any time on Sundays and public holidays.

Numerator

GP attendances: Sum of services for eligible claims by postcode for disaggregation by geography when item is not a bulk-billing incentive item or another top-up item.

GP expenditure: Sum of benefits paid for each eligible claim by postcode for disaggregation by geography.

Denominator ERP as at 30 June at the beginning of the reporting period
Calculation

Crude rates: Numerator ÷ denominator

Age-standardised rates: Numerator ÷ denominator (age-adjusted)

Method of adjustment Age-standardised rates: Direct age-standardisation. The standard population used was the ABS ERP at 30 June 2001.
Geographic disaggregation

Postcode of residence reported at the following levels:

  • PHN area
  • SA3.
Notes Data are reported by the financial year in which they were processed.

* Note this indicator is included in the Web update: Use of emergency department and GP services in 2015–16, reported as a crude rate.

GP attendances bulk-billed

Percentage of GP attendances bulk-billed.

Data source
Data sources

MBS statistics 2010–11 to 2015–16

ABS ERP at 30 June 2010–2015

Indicator description and calculation
Eligible claims A claim is classified as a GP attendance if the service is in any of the following broad type of service groups:
  • non-referred attendances - GP/VRGP (A/0101)
  • non-referred attendances - Enhanced Primary Care (M/0102)
  • non-referred attendances - Other (B/0103).
Numerator Sum of services for eligible claims by postcode for disaggregation by geography where:
  • the type of Medicare billing issued for the provided service is direct billed “bulk billed”, and
  • the item is not a bulk billing incentive item or another top-up item.
Denominator Sum of services for eligible claims by postcode for disaggregation by geography.
Calculation Numerator ÷ denominator
Geographic disaggregation

Postcode of residence reported at the following levels:

  • PHN area
  • SA3.
Notes Data are reported by the financial year in which they were processed.

GP attendances in residential aged-care facilities

Number of GP attendances in residential aged-care facilities per patient who received at least one GP attendance in a facility.

Data source
Data sources

MBS statistics 2010–11 to 2015–16

ABS ERP at 30 June 2010–2015

Indicator description and calculation
Eligible claims A claim is classified as a GP attendance in a residential aged-care facility if the Medicare service is one of the following codes: 00020, 00035, 00043, 00051, 00092, 00093, 00095, 00096, 05010, 05028, 05049, 05067, 05260, 05263, 05265, 05267, 00731, 00903, 02125, 02138, 02179, 02220.
Numerator Sum of services for eligible claims by postcode for disaggregation by geography when item is not a bulk billing incentive item or another top-up item.
Denominator Count of patients where the sum of GP attendances in residential aged-care facilities is greater than or equal to 1.
Calculation Numerator ÷ denominator
Geographic disaggregation Postcode of residence reported at PHN area
Notes Data are reported by the financial year in which they were processed.

Specialist attendances and expenditure

This specification applies to the following indicators, presented as both crude and age-standardised rates:

  • Number of specialist attendances per person
  • Medicare benefits expenditure on specialist attendances per person

Data source
Data sources

MBS statistics 2010–11 to 2015–16

ABS ERP at 30 June 2010–2015

Indicator description and calculation
Eligible claims

A claim is classified as a specialist attendance if the following conditions are true:

  • the item is in the broad type of service group:
    • Specialist attendance (C/200)
  • the service is not conducted in a hospital.

These include consultant physician attendances, consultant psychiatrist attendances, other specialist attendances, specialist case conferences, and all anaesthesia consultations, whether provided by general practitioners or specialists.

Numerator

Specialist attendances: Sum of services for eligible claims by postcode for disaggregation by geography when item is not a bulk billing incentive item or another top-up item.

Specialist expenditure: Sum of benefits for each eligible claim by postcode for disaggregation by geography.

Denominator ERP as at 30 June at the beginning of the reporting period
Calculation

Crude rates: Numerator ÷ denominator

Age-standardised rates: Numerator ÷ denominator (age-adjusted)

Method of adjustment Age-standardised rates: Direct age-standardisation. The standard population used was the ABS ERP at 30 June 2001.
Geographic disaggregation Postcode of residence reported at the following levels:
  • PHN area
  • SA3.
Notes Data are reported by the financial year in which they were processed.