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

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

Geography

The report 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 (2016).
  • Statistical Areas Level 3 (SA3s) - 340 geographic areas covering Australia, with boundaries defined by the Australian Bureau of Statistics (ABS) (2016).

National results are also included.

All results are based on the patient’s Medicare enrolment postcode, not where they received the health care service. Most peoples’ Medicare enrolment postcode will be their residential postcode.

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 in the reference year. Where 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.

Where a postcode boundary overlapped more than one PHN area or SA3, the percentage of patients attributed to each area was the same as the percentage of the postcode population that fell within each area. Patients were attributed to an area based on the cumulative ratio of the postcode to PHN area/SA3 and the corresponding last 3 digits of the patient’s Personal Identifier Number (PIN). For example, if 30% of a postcode overlapped with PHN A and 70% with PHN B, then 30% of patients (PINs ending in 000 to 299) were allocated to PHN A, while the remaining 70% of patients (PINs ending in 300 to 999) were allocated to PHN B. The last 3 digits of patients’ PINs are for the most part evenly distributed across Australia, so when postcodes are split across different PHN areas/SA3s there is a similar chance of being allocated to an area based on the estimated postcode population in that area.

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 areas

Some information is presented by metropolitan and regional PHN areas to illuminate apparent differences in the out-of-pocket costs by populations in these areas. Metropolitan PHN areas have 85% or more of the population in major cities, as defined by the ABS. All other PHN areas are classified as regional PHN areas. See Table 1 for the metropolitan or regional classification of each PHN area.

Local areas (SA3s)

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. 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). IRSD is one of the Socio-Economic Indexes for Area (SEIFA) produced by the ABS (2018b). 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. Across all SA3s, the population percentage in the chosen socioeconomic group ranged from 39% to 92%. 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 areas 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, which 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).

Results for SA3s, including for each SA3 by its remoteness and/or socioeconomic category, are available to download from: http://www.myhealthycommunities.gov.au/explore-the-data.

Table 1: Metropolitan and regional Primary Health Network areas

Primary Health Network areas
Metropolitan
Name Proportion of the population* in Major Cities**
PHN101 Central and Eastern Sydney 100%
PHN801 Australian Capital Territory 100%
PHN102 Northern Sydney 99%
PHN103 Western Sydney 99%
PHN401 Adelaide 99%
PHN201 North Western Melbourne 98%
PHN203 South Eastern Melbourne 98%
PHN303 Gold Coast (Qld) 98%
PHN501 Perth North 98%
PHN502 Perth South 98%
PHN202 Eastern Melbourne 96%
PHN302 Brisbane South 96%
PHN301 Brisbane North 95%
PHN105 South Western Sydney 90%
PHN104 Nepean Blue Mountains 86%
Regional
Name Proportion of the population* in Major Cities**
PHN108 Hunter New England and Central Coast (NSW) 64%
PHN106 South Eastern NSW 52%
PHN304 Darling Downs and West Moreton (Qld) 35%
PHN306 Central Queensland, Wide Bay, Sunshine Coast 34%
PHN206 Western Victoria 30%
PHN109 North Coast (NSW) 16%
PHN402 Country SA 10%
PHN107 Western NSW 0%
PHN110 Murrumbidgee (NSW) 0%
PHN204 Gippsland (Vic) 0%
PHN205 Murray (Vic & part NSW) 0%
PHN305 Western Queensland 0%
PHN307 Northern Queensland 0%
PHN503 Country WA 0%
PHN601 Tasmania 0%
PHN701 Northern Territory 0%
*
population = ABS ERP 30 June 2016.
**
Major Cities = as defined by the Australian Statistical Geography Standard 2016 Remoteness Areas (ABS 2016).
Source:
ABS Estimated Resident Population at 30 June 2016

Suppression of results

Results for an area were suppressed (marked ‘NP – not available for publication’) if any of the following conditions were met:

  • there were fewer than six patients or fewer than six providers of services in the PHN area or SA3 (note a patient/provider is only included if they received or provided at least one service in the area)
  • one provider provided more than 85% of services or two providers provided more than 90% of services to patients in an area
  • one patient received more than 85% of services or two patients received more than 90% of services provided in an area
  • one provider charged more than 85% of out-of-pocket costs or two providers charged more than 90% of out-of-pocket costs in an area
  • one patient was charged more than 85% of out-of-pocket costs or two patients were charged more than 90% of out-of-pocket costs in an area
  • less than 20 services were provided in an area, or
  • the population of an area was less than 2,500.

For further information about the MBS measures, see Figure 1 and the indicator specification tables.

Figure 1: Flowchart of populations included in the MBS measures of the Patients’ out-of-pocket spending on Medicare services, 2016–17 report

The following is a textual flow chart, select this link to skip to a textual description

Population excluded
Measure
*
This flowchart section can also be applied to the corresponding GP, diagnostic imaging and obstetric measures
The following link expands the infographic text. Show infographic text Hide infographic text

This flowchart displays the populations included and excluded in the MBS measures in Patients’ out-of-pocket spending on Medicare services, 2016–17.

People who did not claim any non-hospital Medicare-subsidised services in 2016–17 were excluded from all analyses.

The cohort for the measure ‘Percentage of patients with out-of-pocket costs for non-hospital Medicare services’ was all patients with an annual out-of-pocket cost equal to or greater than $0. Patients were excluded if the annual number of non-hospital services they claimed was less than 1.

The cohort for the measure ‘Total out-of-pocket cost per patient (50th and 90th percentile)’ was patients with an annual out-of-pocket cost greater than $0, in addition to the above exclusions.

The cohorts for the specialist measures included patients who claimed at least 1 non-hospital Medicare-subsidised specialist service in 2016–17, and whose annual out-of-pocket cost for these specialist services was equal to or greater than $0. Patients were excluded if the total number of non-hospital specialist services they claimed was less than 1.

The ‘Out-of-pocket cost per specialist attendance (50th and 90th percentile)’ measure was calculated for patients with out-of-pocket costs for specialist services in the year (excluding patients with no costs, in addition to the above exclusions for specialist services).

The GP, diagnostic imaging and obstetric measures are calculated in the same way as the specialist measures, except with the corresponding service type.