Healthy Communities: Patients' out-of-pocket spending on Medicare services, 2016–17 - Report - Patients’ out-of-pocket costs per service

Healthy Communities: Patients' out-of-pocket spending on Medicare services, 2016–17

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Patients’ out-of-pocket costs per service

In 2016–17, Australians spent $3.0 billion out-of-pocket on non-hospital Medicare services—34% of which was spent on specialist services, 25% on GP services, 12% on diagnostic imaging services (including radiology) and 6.6% on obstetric services (Figure 6).

Figure 6: Total out-of-pocket expenditure on non-hospital Medicare services in 2016–17, by service group (per cent)

The following link expands the table data. Show tabular data Hide tabular data
Service group Total out-of-pocket expenditure
Specialist 33.7%
GP 24.6%
Diagnostic imaging 12.3%
Other 10.6%
Obstetrics 6.6%
Allied health 6.4%
Operations 5.7%
Source:
AIHW analysis of MBS claims data, 2016–17.

The relatively large share of spending on specialist services is set against the relatively fewer services provided to the Australian community. For example, 148.3 million GP services (subsidised by Medicare) were provided to 87% of the population in 2016–17, while around 23.0 million specialist services were provided to 31% of the population (7.4 million patients).

In addition, in the ABS Patient Experience Survey, a higher proportion of the population reported delaying or not getting specialist services due to cost than other health services (see How many people delayed or did not get care because of cost?).

This report looks in detail at specialist services. National and PHN area information on the out-of-pocket costs associated with GP, diagnostic imaging and obstetric visits are summarised below. Interactive displays of PHN and local area (SA3) level data are available here.

Specialist services

How many people had out-of-pocket costs for specialist services?

For patients who saw a specialist in 2016–17, more than 7 in 10 (72%, or 5.3 million) made some contribution to the cost of their appointment (Box 3).

Across PHN areas, this proportion ranged from 52% of patients in Northern Territory PHN area to 83% in Perth North and Northern Sydney (Figure 7).

Across all local areas, the percentage of patients who contributed to the cost of their specialist appointments was almost 6 times higher in some areas than in others, ranging from 15% to 87% of patients (Table 2).

Box 3: Specialist services

Non-hospital specialist visits accounted for 74% of all specialist services subsidised by Medicare. Costs incurred for these cannot be claimed through private health insurance. The remaining 26% of specialist services were provided to admitted hospital patients, so are not included in this report.

How much did patients spend per specialist service?

2.7 million people spent $64 or more per specialist service

Nationally, of patients with out-of-pocket costs for specialist services, the median out-of-pocket cost per service was $64 in 2016–17. The 10% of patients with the highest costs spent $137 or more out-of-pocket per service.

Variation across PHN areas

For patients with out-of-pocket costs for specialist services, the median cost per service ranged from $47 in Country SA PHN area to $87 in Northern Sydney (Figure 7). These two PHN areas also had the lowest ($97) and highest ($167) costs per specialist service at the 90th percentile.

Variation across local areas

Patients in some local areas spent 3 times as much as patients in other areas. For patients with out-of-pocket costs, the median amount spent per specialist service ranged from $36 in Mid North (SA) to $97 in Leichhardt (NSW) (Table 2).

For the 10% of patients with the highest costs, those living in Mid North (SA) spent $89 or more per service, while those in Sydney–Inner City spent $177 or more per visit (Table 2).

Variation by remoteness and socioeconomic status

Out-of-pocket costs per specialist service tended to be higher in the major city areas. Outside Major cities, the median out-of-pocket cost per service was higher in Remote local areas ($62) than in Inner regional and Outer regional ($57) local areas (Table 2, Figure 8).

There was particularly wide variation in out-of-pocket costs for specialist services within Outer regional local areas. Patients at the median in Central Highlands (Qld) spent more than twice as much per service ($81) as patients in Mid North (SA) ($36).

For local areas within Major cities, the median out-of-pocket cost per specialist service was generally greater in higher socioeconomic areas ($77) than in medium ($65) and lower ($60) socioeconomic areas. However, there was substantial variation in costs within all similar socioeconomic areas (Table 2, Figure 8).

Table 2: Out-of-pocket spending on specialist services, highest and lowest SA3s by socioeconomic status and remoteness, 2016–17

Major cities - by socioeconomic status Inner regional Outer regional Remote
Higher Medium Lower
Patients with costs (%) Highest SA3 87% 83% 79% 85% 81% 75%
Group result 79% 73% 65% 72% 67% 49%
Lowest SA3 70% 59% 46% 57% 51% 15%
Median cost ($) Highest SA3 $97 $84 $74 $75 $81 $89
Group result $77 $65 $60 $57 $57 $62
Lowest SA3 $50 $48 $41 $44 $36 $45
90th percentile cost ($) Highest SA3 $177 $167 $157 $152 $148 $172
Group result $155 $137 $127 $119 $122 $134
Lowest SA3 $101 $97 $92 $94 $89 $102
Patients with costs (%):
Percentage of patients with out-of-pocket costs for specialist services.
Median cost ($):
Median out-of-pocket cost per specialist service.
90th percentile cost ($):
90th percentile out-of-pocket cost per specialist service.
Note:
Includes non-hospital Medicare-subsidised services only. ‘Median cost’ and ‘90th percentile cost’ is calculated for patients with out-of-pocket costs. This includes patients who has some of their services bulk-billed.
Source:
AIHW analysis of MBS claims data, 2016–17.

Figure 7: Out-of-pocket cost per specialist service for patients with costs, 50th (median) and 90th percentile, by PHN area, 2016–17

Further information

Detailed local area data is available as an interactive display and Excel download.

The following link expands the table data. Show tabular data Hide tabular data
Primary Health Network area Out-of-pocket cost per specialist service Per cent of patients with specialist costs
50th Percentile (median) 90th Percentile
Metropolitan
Northern Sydney (NSW) $87 $167 82.7%
Central & Eastern Sydney (NSW) $81 $163 73.6%
Australian Capital Territory $87 $157 75.5%
Brisbane North (Qld) $76 $149 72.6%
Western Sydney (NSW) $70 $147 65.4%
Brisbane South (Qld) $71 $142 69.7%
Perth North (WA) $73 $142 82.8%
South Western Sydney (NSW) $65 $137 67.1%
South Eastern Melbourne (Vic) $64 $137 75.5%
Perth South (WA) $69 $137 80.0%
North Western Melbourne (Vic) $64 $134 63.9%
Eastern Melbourne (Vic) $63 $133 74.8%
Nepean Blue Mountains (NSW) $69 $132 72.0%
Gold Coast (Qld) $63 $130 70.0%
Adelaide (SA) $50 $100 68.4%
Regional
Western Queensland $72 $147 52.6%
Northern Territory $77 $147 52.2%
South Eastern NSW $63 $137 73.3%
Western NSW $59 $131 62.0%
Country WA $63 $130 75.3%
Central Qld, Wide Bay & Sunshine Coast $65 $129 68.5%
Northern Queensland $66 $127 64.0%
Murrumbidgee (NSW) $61 $126 78.7%
Hunter New England & Central Coast (NSW) $62 $126 74.1%
Darling Downs & West Moreton (Qld) $62 $126 68.3%
Western Victoria $51 $110 73.6%
North Coast (NSW) $55 $109 75.0%
Gippsland (Vic) $51 $107 64.4%
Murray (Vic & part NSW) $50 $107 72.2%
Tasmania $53 $102 68.3%
Country SA $47 $97 64.1%
All metropolitan PHN areas $68 $145 72.7%
All regional PHN areas $58 $122 70.4%
Australia $64 $137 71.9%
Patients with costs (%):
Percentage of patients with out-of-pocket costs for specialist services.
Note:
Includes non-hospital Medicare-subsidised services only. Measure is calculated per patient (patients’ out-of-pocket cost for specialist attendances, divided by the number of specialist attendances that patient claimed), for patients with out-of-pocket costs. This includes patients who had some of their services bulk-billed.
Source:
AIHW analysis of MBS claims data, 2016–17.

Figure 8: Out-of-pocket cost per specialist service for patients with costs, 50th (median) and 90th percentile, by local area (SA3), remoteness and socioeconomic status, 2016–17

The following link expands the table data. Show tabular data Hide tabular data
SA3 area name Remoteness/Socioeconomic status (SES) Out-of-pocket cost per specialist service Per cent of patients with specialist costs
50th percentile (Median) 90th percentile
National National $64 $137 71.9%
Leichhardt Major cities - higher SES $97 $171 78.0%
Sydney Inner City Major cities - higher SES $96 $177 71.8%
Eastern Suburbs - North Major cities - higher SES $96 $172 81.0%
North Sydney - Mosman Major cities - higher SES $95 $174 84.5%
Manly Major cities - higher SES $94 $168 85.4%
Gungahlin Major cities - higher SES $94 $163 74.7%
Chatswood - Lane Cove Major cities - higher SES $92 $170 81.6%
Ku-ring-gai Major cities - higher SES $92 $167 85.2%
South Canberra Major cities - higher SES $91 $162 79.4%
North Canberra Major cities - higher SES $90 $162 77.4%
Canada Bay Major cities - higher SES $86 $158 76.3%
Pittwater Major cities - higher SES $86 $157 87.0%
Brisbane Inner - West Major cities - higher SES $86 $159 83.3%
Queanbeyan Major cities - higher SES $85 $157 75.4%
Brisbane Inner - North Major cities - higher SES $85 $162 79.2%
Hornsby Major cities - higher SES $84 $161 81.9%
Warringah Major cities - higher SES $84 $162 83.0%
Belconnen Major cities - higher SES $84 $157 75.1%
Tuggeranong Major cities - higher SES $84 $157 72.4%
Woden Valley Major cities - higher SES $84 $157 77.1%
Pennant Hills - Epping Major cities - higher SES $83 $156 80.9%
Kenmore - Brookfield - Moggill Major cities - higher SES $83 $157 85.8%
Ryde - Hunters Hill Major cities - higher SES $82 $157 76.8%
Stonnington - West Major cities - higher SES $82 $157 80.2%
Sherwood - Indooroopilly Major cities - higher SES $82 $157 82.9%
Brisbane Inner - East Major cities - higher SES $82 $156 80.3%
Weston Creek Major cities - higher SES $82 $157 77.9%
Eastern Suburbs - South Major cities - higher SES $81 $163 71.7%
Molonglo Major cities - higher SES $81 $157 76.8%
Port Phillip Major cities - higher SES $80 $155 76.6%
Yarra Major cities - higher SES $80 $152 75.0%
Centenary Major cities - higher SES $80 $151 81.4%
The Gap - Enoggera Major cities - higher SES $80 $157 80.3%
Dural - Wisemans Ferry Major cities - higher SES $79 $148 83.6%
Stonnington - East Major cities - higher SES $79 $157 84.2%
The Hills District Major cities - higher SES $78 $152 77.2%
Baulkham Hills Major cities - higher SES $77 $148 79.6%
Melbourne City Major cities - higher SES $77 $147 69.5%
Boroondara Major cities - higher SES $77 $149 82.7%
Holland Park - Yeronga Major cities - higher SES $77 $151 76.0%
Perth City Major cities - higher SES $77 $147 83.2%
Rouse Hill - McGraths Hill Major cities - higher SES $76 $147 77.4%
Sutherland - Menai - Heathcote Major cities - higher SES $76 $149 83.1%
Bald Hills - Everton Park Major cities - higher SES $76 $151 74.7%
Cronulla - Miranda - Caringbah Major cities - higher SES $75 $153 82.6%
Blacktown - North Major cities - higher SES $74 $147 72.3%
Nathan Major cities - higher SES $74 $147 74.3%
Cottesloe - Claremont Major cities - higher SES $74 $142 82.8%
Bayside Major cities - higher SES $73 $141 84.0%
Carindale Major cities - higher SES $73 $147 80.3%
Joondalup Major cities - higher SES $73 $142 85.4%
South Perth Major cities - higher SES $73 $142 84.8%
Stirling Major cities - higher SES $72 $142 83.3%
Melville Major cities - higher SES $71 $140 84.9%
Essendon Major cities - higher SES $69 $137 74.8%
Nillumbik - Kinglake Major cities - higher SES $69 $128 79.0%
Manningham - East Major cities - higher SES $68 $137 82.7%
Cleveland - Stradbroke Major cities - higher SES $66 $127 73.3%
Banyule Major cities - higher SES $65 $130 74.7%
Maroondah Major cities - higher SES $60 $129 76.3%
Mornington Peninsula Major cities - higher SES $54 $122 78.6%
Burnside Major cities - higher SES $53 $101 77.4%
Mitcham Major cities - higher SES $50 $102 74.4%
Marrickville - Sydenham - Petersham Major cities - medium SES $84 $167 68.7%
Brisbane Inner Major cities - medium SES $83 $157 77.3%
Nundah Major cities - medium SES $77 $152 74.6%
Strathfield - Burwood - Ashfield Major cities - medium SES $76 $156 67.6%
Carlingford Major cities - medium SES $76 $147 72.6%
Chermside Major cities - medium SES $76 $147 74.4%
Mundaring Major cities - medium SES $76 $142 81.9%
Camden Major cities - medium SES $75 $137 78.3%
Swan Major cities - medium SES $75 $142 80.9%
Serpentine - Jarrahdale Major cities - medium SES $74 $142 82.0%
Cockburn Major cities - medium SES $74 $142 80.3%
Kogarah - Rockdale Major cities - medium SES $73 $155 70.7%
Darebin - South Major cities - medium SES $73 $142 74.1%
Belmont - Victoria Park Major cities - medium SES $73 $142 81.1%
Hurstville Major cities - medium SES $72 $152 70.9%
Glen Eira Major cities - medium SES $72 $147 80.1%
Sandgate Major cities - medium SES $72 $143 70.2%
Wanneroo Major cities - medium SES $72 $142 80.8%
Fremantle Major cities - medium SES $72 $141 81.1%
Penrith Major cities - medium SES $71 $132 70.7%
Parramatta Major cities - medium SES $71 $147 65.4%
Wynnum - Manly Major cities - medium SES $71 $145 75.6%
Strathpine Major cities - medium SES $71 $137 64.0%
Kalamunda Major cities - medium SES $71 $137 83.4%
Brunswick - Coburg Major cities - medium SES $70 $140 67.6%
Maribyrnong Major cities - medium SES $70 $139 63.4%
Bayswater - Bassendean Major cities - medium SES $70 $142 81.4%
Canning Major cities - medium SES $70 $139 81.0%
Richmond - Windsor Major cities - medium SES $69 $130 76.8%
Mt Gravatt Major cities - medium SES $69 $142 73.9%
Rocklea - Acacia Ridge Major cities - medium SES $69 $137 65.8%
Blue Mountains Major cities - medium SES $68 $132 74.8%
Capalaba Major cities - medium SES $68 $136 72.2%
North Lakes Major cities - medium SES $68 $137 65.0%
Rockingham Major cities - medium SES $68 $132 78.8%
St Marys Major cities - medium SES $67 $132 62.8%
Sunnybank Major cities - medium SES $67 $137 71.1%
Ormeau - Oxenford Major cities - medium SES $67 $137 67.3%
Narangba - Burpengary Major cities - medium SES $67 $133 60.0%
Mudgeeraba - Tallebudgera Major cities - medium SES $66 $137 72.5%
Jimboomba Major cities - medium SES $66 $134 59.5%
Surfers Paradise Major cities - medium SES $65 $137 75.0%
Gosford Major cities - medium SES $64 $131 78.6%
Whitehorse - West Major cities - medium SES $64 $137 78.0%
Kingston Major cities - medium SES $64 $135 77.7%
Broadbeach - Burleigh Major cities - medium SES $64 $132 74.6%
Manningham - West Major cities - medium SES $63 $133 78.9%
Coolangatta Major cities - medium SES $63 $127 73.6%
Nerang Major cities - medium SES $63 $129 67.2%
Robina Major cities - medium SES $63 $127 72.6%
Buderim Major cities - medium SES $63 $132 77.6%
Kiama - Shellharbour Major cities - medium SES $62 $136 74.3%
Lake Macquarie - East Major cities - medium SES $62 $122 72.2%
Sunbury Major cities - medium SES $62 $130 70.7%
Cardinia Major cities - medium SES $62 $125 73.5%
Nambour Major cities - medium SES $62 $127 69.7%
Whitehorse - East Major cities - medium SES $61 $129 77.5%
Casey - North Major cities - medium SES $61 $125 73.1%
Southport Major cities - medium SES $61 $128 64.0%
Caloundra Major cities - medium SES $61 $126 75.9%
Noosa Major cities - medium SES $61 $127 69.3%
Yarra Ranges Major cities - medium SES $60 $127 73.5%
Wyndham Major cities - medium SES $60 $127 60.3%
Knox Major cities - medium SES $59 $124 76.0%
Monash Major cities - medium SES $59 $128 78.2%
Keilor Major cities - medium SES $58 $127 75.5%
Mandurah Major cities - medium SES $58 $122 74.8%
Melton - Bacchus Marsh Major cities - medium SES $57 $123 60.1%
Adelaide City Major cities - medium SES $55 $105 70.0%
Prospect - Walkerville Major cities - medium SES $55 $105 73.4%
Norwood - Payneham - St Peters Major cities - medium SES $53 $100 76.6%
Unley Major cities - medium SES $53 $105 77.3%
Campbelltown (SA) Major cities - medium SES $50 $99 76.6%
Holdfast Bay Major cities - medium SES $49 $100 75.6%
Tea Tree Gully Major cities - medium SES $48 $97 74.9%
Marion Major cities - medium SES $48 $100 69.6%
Botany Major cities - lower SES $74 $157 67.7%
Forest Lake - Oxley Major cities - lower SES $74 $147 60.0%
Kwinana Major cities - lower SES $73 $142 74.8%
Bringelly - Green Valley Major cities - lower SES $71 $138 69.4%
Maitland Major cities - lower SES $69 $127 76.0%
Liverpool Major cities - lower SES $69 $142 68.4%
Hobsons Bay Major cities - lower SES $68 $137 70.1%
Springfield - Redbank Major cities - lower SES $68 $139 60.6%
Armadale Major cities - lower SES $68 $137 77.7%
Gosnells Major cities - lower SES $68 $137 78.9%
Springwood - Kingston Major cities - lower SES $67 $137 57.4%
Wollongong Major cities - lower SES $66 $142 74.9%
Newcastle Major cities - lower SES $66 $127 71.1%
Auburn Major cities - lower SES $66 $147 58.8%
Loganlea - Carbrook Major cities - lower SES $66 $133 61.5%
Caboolture Major cities - lower SES $65 $127 53.1%
Redcliffe Major cities - lower SES $65 $127 64.9%
Canterbury Major cities - lower SES $64 $149 62.1%
Campbelltown (NSW) Major cities - lower SES $64 $131 66.3%
Browns Plains Major cities - lower SES $64 $136 51.7%
Bankstown Major cities - lower SES $63 $147 65.4%
Merrylands - Guildford Major cities - lower SES $63 $142 58.2%
Beenleigh Major cities - lower SES $63 $127 56.0%
Maroochy Major cities - lower SES $63 $129 73.1%
Wyong Major cities - lower SES $62 $127 75.3%
Blacktown Major cities - lower SES $62 $137 60.0%
Dapto - Port Kembla Major cities - lower SES $61 $128 69.9%
Lake Macquarie - West Major cities - lower SES $61 $122 72.2%
Fairfield Major cities - lower SES $61 $130 62.1%
Darebin - North Major cities - lower SES $61 $127 59.6%
Whittlesea - Wallan Major cities - lower SES $61 $127 56.1%
Casey - South Major cities - lower SES $61 $127 69.6%
Mount Druitt Major cities - lower SES $60 $129 49.2%
Gold Coast - North Major cities - lower SES $60 $126 67.7%
Moreland - North Major cities - lower SES $57 $127 62.1%
Brimbank Major cities - lower SES $57 $125 56.8%
Frankston Major cities - lower SES $57 $125 71.6%
Ipswich Inner Major cities - lower SES $57 $118 65.8%
Tweed Valley Major cities - lower SES $56 $117 71.4%
Tullamarine - Broadmeadows Major cities - lower SES $56 $123 50.3%
Dandenong Major cities - lower SES $52 $122 64.4%
Geelong Major cities - lower SES $50 $117 73.1%
Port Adelaide - East Major cities - lower SES $50 $100 65.5%
Onkaparinga Major cities - lower SES $50 $107 65.1%
Charles Sturt Major cities - lower SES $49 $98 71.1%
West Torrens Major cities - lower SES $49 $100 72.9%
Port Adelaide - West Major cities - lower SES $47 $99 62.2%
Salisbury Major cities - lower SES $45 $97 56.4%
Gawler - Two Wells Major cities - lower SES $43 $93 65.8%
Playford Major cities - lower SES $41 $92 46.2%
Young - Yass Inner regional $75 $152 75.4%
Gladstone Inner regional $73 $136 66.4%
Bundaberg Inner regional $72 $138 68.4%
Burnett Inner regional $72 $136 62.6%
Wheat Belt - North Inner regional $72 $142 82.7%
Hawkesbury Inner regional $71 $135 78.8%
Goulburn - Mulwaree Inner regional $70 $147 71.0%
Southern Highlands Inner regional $70 $152 71.7%
Wollondilly Inner regional $70 $139 75.6%
Lower Hunter Inner regional $68 $125 74.5%
Macedon Ranges Inner regional $67 $132 75.8%
Rockhampton Inner regional $67 $129 64.3%
Mackay Inner regional $67 $122 62.5%
Bathurst Inner regional $66 $127 67.8%
Upper Hunter Inner regional $66 $127 71.9%
Tumut - Tumbarumba Inner regional $66 $135 84.6%
Caboolture Hinterland Inner regional $66 $127 61.6%
Hervey Bay Inner regional $66 $127 60.3%
Maryborough Inner regional $66 $127 59.7%
Wagga Wagga Inner regional $65 $127 81.8%
Port Stephens Inner regional $64 $121 71.7%
Darling Downs - East Inner regional $64 $127 71.6%
Lithgow - Mudgee Inner regional $63 $127 69.7%
Orange Inner regional $63 $132 71.8%
Gold Coast Hinterland Inner regional $63 $127 68.9%
Beaudesert Inner regional $63 $127 59.5%
Sunshine Coast Hinterland Inner regional $63 $127 72.5%
Toowoomba Inner regional $62 $123 74.3%
Bribie - Beachmere Inner regional $61 $117 62.2%
Noosa Hinterland Inner regional $61 $125 64.8%
Coffs Harbour Inner regional $60 $122 76.4%
Heathcote - Castlemaine - Kyneton Inner regional $60 $123 76.4%
Granite Belt Inner regional $60 $118 68.6%
Augusta - Margaret River - Busselton Inner regional $60 $122 81.3%
Tamworth - Gunnedah Inner regional $59 $127 72.1%
Ipswich Hinterland Inner regional $59 $120 67.5%
Richmond Valley - Coastal Inner regional $58 $117 76.9%
Armidale Inner regional $57 $122 70.8%
Bunbury Inner regional $57 $122 77.1%
Shoalhaven Inner regional $56 $126 70.2%
Creswick - Daylesford - Ballan Inner regional $56 $107 71.3%
Bendigo Inner regional $56 $112 75.3%
Loddon - Elmore Inner regional $55 $107 76.3%
Barwon - West Inner regional $55 $125 75.7%
Gympie - Cooloola Inner regional $55 $120 62.3%
Launceston Inner regional $55 $109 74.2%
Surf Coast - Bellarine Peninsula Inner regional $54 $123 78.2%
Adelaide Hills Inner regional $54 $106 78.0%
Hobart - South and West Inner regional $54 $97 76.6%
Hobart Inner Inner regional $54 $102 76.7%
Dubbo Inner regional $53 $133 58.5%
Port Macquarie Inner regional $53 $102 79.6%
Albury Inner regional $53 $111 77.5%
Upper Murray exc. Albury Inner regional $53 $109 80.9%
Richmond Valley - Hinterland Inner regional $53 $107 71.5%
Ballarat Inner regional $53 $102 69.9%
Maryborough - Pyrenees Inner regional $53 $102 69.9%
Baw Baw Inner regional $53 $112 64.8%
Gippsland - South West Inner regional $53 $114 72.7%
Campaspe Inner regional $53 $109 79.2%
Sorell - Dodges Ferry Inner regional $53 $97 68.8%
Upper Goulburn Valley Inner regional $52 $117 69.1%
Wodonga - Alpine Inner regional $52 $108 77.3%
Brighton Inner regional $52 $97 62.3%
Hobart - North East Inner regional $52 $97 73.3%
Hobart - North West Inner regional $51 $94 63.6%
Clarence Valley Inner regional $50 $107 75.0%
Wangaratta - Benalla Inner regional $49 $100 76.0%
Wellington Inner regional $49 $102 67.2%
Lower North Inner regional $49 $97 71.3%
Devonport Inner regional $49 $106 58.1%
Taree - Gloucester Inner regional $48 $97 78.1%
Latrobe Valley Inner regional $48 $107 56.5%
Great Lakes Inner regional $47 $97 79.8%
Shepparton Inner regional $47 $112 61.5%
Colac - Corangamite Inner regional $47 $107 78.5%
Barossa Inner regional $47 $97 72.2%
Moira Inner regional $45 $103 71.6%
Warrnambool Inner regional $44 $97 78.2%
Fleurieu - Kangaroo Island Inner regional $44 $94 71.5%
Central Highlands (Qld) Outer regional $81 $143 67.0%
Biloela Outer regional $78 $145 70.8%
Bowen Basin - North Outer regional $77 $132 65.5%
Whitsunday Outer regional $77 $135 54.6%
Darwin City Outer regional $77 $148 71.6%
Darwin Suburbs Outer regional $77 $147 63.1%
Palmerston Outer regional $77 $148 64.0%
Snowy Mountains Outer regional $76 $147 75.4%
Litchfield Outer regional $76 $147 62.6%
Wheat Belt - South Outer regional $71 $142 80.6%
Darling Downs (West) - Maranoa Outer regional $68 $137 64.9%
Townsville Outer regional $68 $137 65.2%
Charters Towers - Ayr - Ingham Outer regional $67 $137 71.2%
Port Douglas - Daintree Outer regional $66 $130 68.1%
Moree - Narrabri Outer regional $64 $137 65.6%
Griffith - Murrumbidgee (West) Outer regional $64 $122 71.0%
Cairns - North Outer regional $63 $125 66.4%
Cairns - South Outer regional $63 $125 63.6%
Innisfail - Cassowary Coast Outer regional $62 $125 62.2%
Tablelands (East) - Kuranda Outer regional $62 $125 69.3%
Lachlan Valley Outer regional $61 $132 72.2%
South Coast Outer regional $59 $129 76.3%
Manjimup Outer regional $57 $122 78.1%
Inverell - Tenterfield Outer regional $56 $117 72.5%
Murray River - Swan Hill Outer regional $55 $107 76.8%
Albany Outer regional $55 $127 66.0%
Meander Valley - West Tamar Outer regional $55 $107 74.0%
North East Outer regional $54 $104 72.3%
Huon - Bruny Island Outer regional $53 $97 66.9%
South East Coast Outer regional $53 $102 66.4%
Kempsey - Nambucca Outer regional $52 $104 73.2%
West Coast Outer regional $52 $107 50.9%
Gippsland - East Outer regional $51 $107 63.6%
Grampians Outer regional $51 $102 69.4%
Central Highlands (Tas.) Outer regional $51 $93 57.8%
Burnie - Ulverstone Outer regional $49 $102 56.3%
Lower Murray Outer regional $46 $97 65.6%
Glenelg - Southern Grampians Outer regional $45 $97 75.6%
Limestone Coast Outer regional $45 $93 61.8%
Murray and Mallee Outer regional $45 $97 64.4%
Yorke Peninsula Outer regional $42 $94 70.7%
Mildura Outer regional $39 $92 60.5%
Mid North Outer regional $36 $89 54.8%
West Pilbara Remote (incl. very remote) $89 $172 72.7%
East Pilbara Remote (incl. very remote) $87 $157 65.5%
Kimberley Remote (incl. very remote) $85 $149 46.3%
East Arnhem Remote (incl. very remote) $84 $147 21.8%
Katherine Remote (incl. very remote) $83 $150 36.3%
Outback - North Remote (incl. very remote) $77 $152 46.3%
Gascoyne Remote (incl. very remote) $77 $147 70.7%
Barkly Remote (incl. very remote) $77 $152 15.2%
Goldfields Remote (incl. very remote) $74 $151 72.8%
Daly - Tiwi - West Arnhem Remote (incl. very remote) $74 $137 40.1%
Esperance Remote (incl. very remote) $73 $147 67.3%
Alice Springs Remote (incl. very remote) $71 $148 19.4%
Outback - South Remote (incl. very remote) $69 $143 54.5%
Bourke - Cobar - Coonamble Remote (incl. very remote) $63 $140 47.5%
Far North Remote (incl. very remote) $63 $127 36.9%
Mid West Remote (incl. very remote) $57 $117 75.4%
Outback - North and East Remote (incl. very remote) $50 $103 37.3%
Broken Hill and Far West Remote (incl. very remote) $46 $107 25.6%
Eyre Peninsula and South West Remote (incl. very remote) $45 $102 42.4%
OOP:
Out-of-pocket
Note:
Includes non-hospital Medicare-subsidised services only. Measure is calculated per patient (patients’ out-of-pocket cost for specialist attendances, divided by the number of specialist attendances that patient claimed), for patients with out-of-pocket costs. This includes patients who had some of their services bulk-billed.
Source:
AIHW analysis of MBS claims data, 2016–17.

GP services

Nationally, 21.1 million people had at least one Medicare-subsidised GP visit in 2016–17, and 34% of these patients paid something in the year toward the cost of their services. This proportion ranged from 10% of patients living in South Western Sydney and Western Sydney PHN areas to 64% of patients in ACT (Figure 9).

For patients with out-of-pocket costs, the median cost per GP service ranged from $12 in Western Sydney PHN area to $32 in ACT. Ten per cent of patients with costs across Australia spent an average of $42 or more per service. This ranged from $33 in Nepean Blue Mountains PHN area to $51 in ACT (Figure 10).

Diagnostic imaging

In 2016–17, 9.1 million patients claimed 23.7 million diagnostic imaging services through Medicare, and 23% of these patients paid something toward the cost of their services. The percentage of patients with out-of-pocket costs for diagnostic imaging services ranged from 8% of patients living in South Western Sydney PHN area to 44% of patients in ACT (Figure 9).

For patients with out-of-pocket costs, the median cost per service ranged from $25 in Western NSW to $90 in ACT PHN area. There was also considerable variation for patients at the 90th percentile—those in Country WA PHN area spent nearly 3 times as much ($199) as those in Western NSW ($70).

Figure 9: Percentage of patients with out-of-pocket costs, by PHN area and service type, 2016–17

Further information

Detailed local area data is available as an interactive display and Excel download.

The following link expands the table data. Show tabular data Hide tabular data
PHN area name Per cent of patients with costs Median out-of-pocket cost per service
Specialist
National 71.9% $64
Perth North 82.8% $73
Northern Sydney 82.7% $87
Perth South 80.0% $69
Murrumbidgee 78.7% $61
South Eastern Melbourne 75.5% $64
Australian Capital Territory 75.5% $87
Country WA 75.3% $63
North Coast 75.0% $55
Eastern Melbourne 74.8% $63
Hunter New England and Central Coast 74.1% $62
Central and Eastern Sydney 73.6% $81
Western Victoria 73.6% $51
South Eastern NSW 73.3% $63
Brisbane North 72.6% $76
Murray 72.2% $50
Nepean Blue Mountains 72.0% $69
Gold Coast 70.0% $63
Brisbane South 69.7% $71
Central Queensland, Wide Bay and Sunshine Coast 68.5% $65
Adelaide 68.4% $50
Darling Downs and West Moreton 68.3% $62
Tasmania 68.3% $53
South Western Sydney 67.1% $65
Western Sydney 65.4% $70
Gippsland 64.4% $51
Country SA 64.1% $47
Northern Queensland 64.0% $66
North Western Melbourne 63.9% $64
Western NSW 62.0% $59
Western Queensland 52.6% $72
Northern Territory 52.2% $77
GP
National 33.8% $20
Australian Capital Territory 63.7% $32
Tasmania 49.5% $23
Northern Sydney 45.6% $24
Country SA 44.4% $17
Country WA 43.9% $25
Brisbane North 43.2% $21
Western Victoria 42.3% $19
Perth North 42.0% $23
Murray 41.3% $17
Murrumbidgee 40.1% $17
Hunter New England and Central Coast 38.6% $18
Northern Queensland 37.8% $20
South Eastern Melbourne 37.6% $23
Eastern Melbourne 36.6% $21
Central Queensland, Wide Bay and Sunshine Coast 36.3% $17
Western Queensland 36.2% $17
North Coast 34.4% $15
Gippsland 34.3% $18
South Eastern NSW 33.5% $18
Adelaide 33.4% $17
Perth South 33.1% $22
Brisbane South 32.1% $21
Darling Downs and West Moreton 29.7% $18
Western NSW 28.2% $16
Central and Eastern Sydney 27.8% $19
Gold Coast 27.0% $14
Northern Territory 25.7% $25
North Western Melbourne 25.0% $19
Nepean Blue Mountains 16.4% $13
Western Sydney 10.3% $12
South Western Sydney 9.6% $13
Diagnostic Imaging
National 23.5% $60
Australian Capital Territory 43.7% $90
Northern Sydney 40.1% $55
Perth North 36.7% $78
Murrumbidgee 35.4% $60
Country WA 34.9% $82
Country SA 33.3% $76
Perth South 32.5% $78
Western Victoria 31.1% $64
Western NSW 30.9% $25
Western Queensland 29.4% $83
Gippsland 27.2% $60
North Coast 27.1% $33
Tasmania 26.6% $68
South Eastern Melbourne 25.8% $70
Hunter New England and Central Coast 24.2% $41
Eastern Melbourne 24.1% $65
South Eastern NSW 23.7% $52
Adelaide 23.6% $70
Murray 23.3% $38
Brisbane North 23.3% $50
Central and Eastern Sydney 21.3% $50
Brisbane South 21.2% $59
Gold Coast 20.3% $50
Darling Downs and West Moreton 20.3% $53
Northern Territory 18.3% $75
North Western Melbourne 15.9% $65
Northern Queensland 14.5% $45
Central Queensland, Wide Bay and Sunshine Coast 13.8% $37
Western Sydney 10.8% $41
Nepean Blue Mountains 9.6% $38
South Western Sydney 8.5% $38
Obstetric
National 44.2% $78
Northern Sydney 66.6% $227
Country WA 57.8% $35
Perth North 56.1% $132
Central and Eastern Sydney 54.3% $205
Murray 52.3% $30
Adelaide 52.2% $157
Country SA 51.8% $29
Eastern Melbourne 51.3% $172
Tasmania 50.9% $64
Brisbane North 50.0% $80
Murrumbidgee 48.7% $30
Australian Capital Territory 46.7% $64
Western Queensland 46.4% $31
Gippsland 44.8% $21
South Eastern Melbourne 44.3% $125
Perth South 44.2% $71
Western Victoria 43.3% $41
Nepean Blue Mountains 40.5% $81
Brisbane South 39.6% $87
South Eastern NSW 39.4% $38
Central Queensland, Wide Bay and Sunshine Coast 38.9% $63
Hunter New England and Central Coast 37.2% $49
Western NSW 35.7% $26
Gold Coast 35.4% $60
Western Sydney 35.3% $210
North Western Melbourne 34.8% $191
North Coast 34.3% $30
Darling Downs and West Moreton 34.3% $55
Northern Queensland 33.9% $39
South Western Sydney 32.3% $190
Northern Territory 27.5% $144
Note:
Includes non-hospital Medicare-subsidised services only.
Source:
AIHW analysis of MBS claims data, 2016–17.

Obstetric services

Nationally, 361,000 people claimed 1.8 million non-hospital obstetric services in 2016–17, and 44% of these patients paid something toward the cost of their services. This proportion ranged from 27% in Northern Territory PHN area to 67% in Northern Sydney (Figure 9).

Of all the services examined, obstetrics showed the largest variation in out-of-pocket costs per service across PHN areas (Figure 10). The median out-of-pocket cost per service was more than 10 times as high in Northern Sydney PHN area ($227) than in Gippsland ($21). Patients at the 90th percentile in Northern Territory PHN area spent 13 times as much per service ($887) as those in Gippsland ($66).

Figure 10: Out-of-pocket cost per service for patients with costs, 50th (median) and 90th percentile, by PHN area and service type, 2016–17

Further information

Detailed local area data is available as an interactive display and Excel download.

The following link expands the table data. Show tabular data Hide tabular data
PHN area name Out-of-pocket cost per service Per cent of patients with costs
Median 90th Percentile
Specialist
Northern Sydney $87 $167 82.7%
Australian Capital Territory $87 $157 75.5%
Central and Eastern Sydney $81 $163 73.6%
Northern Territory $77 $147 52.2%
Brisbane North $76 $149 72.6%
Perth North $73 $142 82.8%
Western Queensland $72 $147 52.6%
Brisbane South $71 $142 69.7%
Western Sydney $70 $147 65.4%
Nepean Blue Mountains $69 $132 72.0%
Perth South $69 $137 80.0%
Northern Queensland $66 $127 64.0%
South Western Sydney $65 $137 67.1%
Central Queensland, Wide Bay and Sunshine Coast $65 $129 68.5%
North Western Melbourne $64 $134 63.9%
South Eastern Melbourne $64 $137 75.5%
South Eastern NSW $63 $137 73.3%
Eastern Melbourne $63 $133 74.8%
Gold Coast $63 $130 70.0%
Country WA $63 $130 75.3%
Hunter New England and Central Coast $62 $126 74.1%
Darling Downs and West Moreton $62 $126 68.3%
Murrumbidgee $61 $126 78.7%
Western NSW $59 $131 62.0%
North Coast $55 $109 75.0%
Tasmania $53 $102 68.3%
Gippsland $51 $107 64.4%
Western Victoria $51 $110 73.6%
Murray $50 $107 72.2%
Adelaide $50 $100 68.4%
Country SA $47 $97 64.1%
GP
Australian Capital Territory $32 $51 63.7%
Country WA $25 $45 43.9%
Northern Territory $25 $48 25.7%
Northern Sydney $24 $48 45.6%
South Eastern Melbourne $23 $47 37.6%
Perth North $23 $44 42.0%
Tasmania $23 $43 49.5%
Perth South $22 $44 33.1%
Eastern Melbourne $21 $42 36.6%
Brisbane North $21 $41 43.2%
Brisbane South $21 $42 32.1%
Northern Queensland $20 $40 37.8%
Central and Eastern Sydney $19 $48 27.8%
North Western Melbourne $19 $43 25.0%
Western Victoria $19 $38 42.3%
South Eastern NSW $18 $40 33.5%
Hunter New England and Central Coast $18 $38 38.6%
Gippsland $18 $38 34.3%
Darling Downs and West Moreton $18 $35 29.7%
Murrumbidgee $17 $36 40.1%
Murray $17 $35 41.3%
Western Queensland $17 $38 36.2%
Central Queensland, Wide Bay and Sunshine Coast $17 $38 36.3%
Adelaide $17 $38 33.4%
Country SA $17 $37 44.4%
Western NSW $16 $35 28.2%
North Coast $15 $35 34.4%
Gold Coast $14 $38 27.0%
Nepean Blue Mountains $13 $33 16.4%
South Western Sydney $13 $35 9.6%
Western Sydney $12 $38 10.3%
Diagnostic Imaging
Australian Capital Territory $90 $178 43.7%
Western Queensland $83 $168 29.4%
Country WA $82 $199 34.9%
Perth North $78 $188 36.7%
Perth South $78 $183 32.5%
Country SA $76 $145 33.3%
Northern Territory $75 $150 18.3%
South Eastern Melbourne $70 $165 25.8%
Adelaide $70 $145 23.6%
Tasmania $68 $135 26.6%
North Western Melbourne $65 $178 15.9%
Eastern Melbourne $65 $164 24.1%
Western Victoria $64 $155 31.1%
Murrumbidgee $60 $142 35.4%
Gippsland $60 $135 27.2%
Brisbane South $59 $144 21.2%
Northern Sydney $55 $145 40.1%
Darling Downs and West Moreton $53 $125 20.3%
South Eastern NSW $52 $135 23.7%
Central and Eastern Sydney $50 $164 21.3%
Brisbane North $50 $155 23.3%
Gold Coast $50 $105 20.3%
Northern Queensland $45 $125 14.5%
Western Sydney $41 $130 10.8%
Hunter New England and Central Coast $41 $124 24.2%
Nepean Blue Mountains $38 $105 9.6%
South Western Sydney $38 $128 8.5%
Murray $38 $106 23.3%
Central Queensland, Wide Bay and Sunshine Coast $37 $110 13.8%
North Coast $33 $99 27.1%
Western NSW $25 $70 30.9%
Obstetric
Northern Sydney $227 $694 66.6%
Western Sydney $210 $483 35.3%
Central and Eastern Sydney $205 $566 54.3%
North Western Melbourne $191 $563 34.8%
South Western Sydney $190 $445 32.3%
Eastern Melbourne $172 $501 51.3%
Adelaide $157 $349 52.2%
Northern Territory $144 $887 27.5%
Perth North $132 $387 56.1%
South Eastern Melbourne $125 $440 44.3%
Brisbane South $87 $287 39.6%
Nepean Blue Mountains $81 $301 40.5%
Brisbane North $80 $297 50.0%
Perth South $71 $346 44.2%
Tasmania $64 $212 50.9%
Australian Capital Territory $64 $423 46.7%
Central Queensland, Wide Bay and Sunshine Coast $63 $263 38.9%
Gold Coast $60 $217 35.4%
Darling Downs and West Moreton $55 $209 34.3%
Hunter New England and Central Coast $49 $284 37.2%
Western Victoria $41 $313 43.3%
Northern Queensland $39 $214 33.9%
South Eastern NSW $38 $378 39.4%
Country WA $35 $92 57.8%
Western Queensland $31 $244 46.4%
North Coast $30 $183 34.3%
Murrumbidgee $30 $264 48.7%
Murray $30 $193 52.3%
Country SA $29 $188 51.8%
Western NSW $26 $71 35.7%
Gippsland $21 $66 44.8%
Note:
Includes non-hospital Medicare-subsidised services only. Measure is calculated per patient (patients’ annual out-of-pocket cost for the service type, divided by the number of relevant services that patient claimed), for patients with out-of-pocket costs. This includes patients who had some of their services bulk-billed.
Source:
AIHW analysis of MBS claims data, 2016–17.

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