Medicare Benefits Schedule GP and specialist attendances and expenditure in 2015–16
This technical note accompanies Web update: Medicare Benefits Schedule GP and specialist attendances and expenditure in 2015–16.
The web update includes the following indicators:
- Number of general practitioner (GP) attendances per person
- Medicare benefits expenditure on GP attendances per person
- Number of after-hours GP attendances per person*
- Medicare benefits expenditure on after-hours GP attendances per person
- Number of specialist attendances per person
- Medicare benefits expenditure on specialist attendances per person
- Percentage of GP attendances bulk-billed
- Number of GP attendances in aged-care homes per person
- Number of in-hours GP attendances per person*.
Further details on these indicators are available in the indicator specification tables.
The web update provides insights into four Performance and Accountability Framework indicators:
- GP-type service use
- After-hours GP service utilisation
- GP service utilisation by residents of Residential Aged Care Facilities
- Specialist service utilisation.
About the data source
Data for the web update were sourced from the Medicare Benefits Schedule (MBS) statistics, which are administered by the Australian Government Department of Health. These statistics are derived from administrative information on services that qualify for a Medicare benefit under the Health Insurance Act 1973 and for which a claim is processed by the Department of Human Services (DHS). Data in the web update are reported by the financial year in which they were processed.
Under MBS arrangements, Medicare claims can be made by 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.
It is important to note that some Australian residents may access medical services through other arrangements, such as salaried doctor arrangements.
MBS statistics exclude services provided free of charge to public patients in hospitals, to Department of Veterans’ Affairs beneficiaries, some patients under compensation arrangements, and through other publicly funded programs including jurisdictional salaried GP services provided in remote outreach clinics. Services provided through Aboriginal Community Controlled Health Organisations may include those provided by doctors-in-training with lower associated Medicare fees.
As a result, MBS statistics may underestimate the rate of use of health services by some members of the community.
About the method
The web update includes measures expressed as age-standardised rates per person.
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. This adjustment is important because the rates of many health conditions and health service usage vary with age.
The direct method of age-standardisation was applied to the data.1 Age-standardised rates were derived by calculating crude rates by five year age groupings of 0–4 years to 85+ years. If a patient’s age was recorded as over 116, they were excluded. These crude rates were then given a weight that reflected the age composition of the standard population. The current standard population is the Australian Bureau of Statistics (ABS) Estimated Resident Population for Australia as at 30 June 2001.
Presentation of results
The web update presents information at the geography of:
- Primary Health Network (PHN) areas – 31 geographic areas covering Australia, with boundaries defined by the Australian Government Department of Health.2
- Statistical Areas Level 3 (SA3s) – 333 geographic areas covering Australia, with boundaries defined by the ABS.3
Results for PHN areas are available from 2013–14 to 2015–16 and results for SA3s are available from 2010–11 to 2015–16. National results are also included for context.
All results are based on where the person lived, not where they received the health care service.
Measures calculated at PHN area and SA3 were compiled by applying a geographic concordance to the unit record data. The concordance used the postcode of the residential address as recorded on the last date of service for the reporting year.
Where a postcode boundary overlapped more than one PHN area or SA3, records were attributed to an area based on the percentage of the postcode population that fell within each area. Figures were rounded at the end of the calculations to avoid truncation error.
All information about an area is suppressed (marked ‘NP – not available for publication’) if any of the following three conditions are met:
- there are less than six patients or less than six providers in the area (SA3/PHN). Note a patient/provider is only included if s/he provides or receives at least one service in the area
- one provider provides more than 85% of services or two providers provide more than 90% of services
- patient receives more than 85% of services or two patients receive more than 90% of services.
Crude rates are suppressed if:
- the number of attendances/services (numerator) was less than 20 for an area, or
- the population of an area (denominator) was less than 2,500.
Age-standardised rates are suppressed if either of the suppression conditions for crude rates were met.
For the remaining age-standardised rates, if the population of an area (denominator) was less than 30 in any of the standard 5-year age groupings used to calculate the rate, then the rate is marked ‘interpret with caution’, as these rates are considered potentially more volatile than other published rates. For each of these flagged rates, the effect of increasing the numerator by one on the rank of the area was examined. If the rank changed so much that the area was on the cusp of changing two deciles, then the rate is suppressed (marked ‘NP – Not available for publication’).
* Note these indicators are also included in the Web update: Use of emergency department and GP services in 2015–16.
1 Australian Institute of Health and Welfare (AIHW) 2005. Age-standardised rate. Canberra: AIHW. Viewed 19 June 2017, http://meteor.aihw.gov.au/content/index.phtml/itemId/327276External link, opens in a new window.
2 Department of Health 2016. Primary Health Networks (PHNs). Canberra: Department of Health. Viewed 19 June 2017, http://www.health.gov.au/internet/main/publishing.nsf/Content/PHN-HomeExternal link, opens in a new window.
3 ABS (Australian Bureau of Statistics) 2011. Australian Statistical Geography Standard (ASGS): Volume 1–Main structure and greater capital city statistical areas, ABS cat. no. 1270.0.55.001. Canberra: ABS.