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Web update: Medicare Benefits Schedule GP and specialist attendances and expenditure in 2016–17 - Technical Note - Indicator specifications

Web update: Medicare Benefits Schedule GP and specialist attendances and expenditure in 2016–17

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

Medicare Benefits Schedule (MBS) claims data 2010–11 to 2016–17

Australian Bureau of Statistics (ABS) Estimated Resident Population (ERP) at 30 June 2001; 2010–2016

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: Total services from eligible claims. This does not include any bulk-billed incentive items or other top-up items.

GP expenditure: Total benefit paid for eligible claims.

Denominator ERP as at 30 June at the previous end of financial year
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

Enrolment postcode reported at the following levels:

  • PHN area
  • SA3.
Age-group disaggregation PHN level analysis by age group (<15, 15–24, 25–44, 45–64, 65+) and sex
Notes Data are reported by the financial year in which they were processed.

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

MBS claims data 2010–11 to 2016–17

ABS Estimated Resident Population (ERP) at 30 June 2001; 2010–2016

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/101)
    • non-referred attendances – Enhanced Primary Care (M/102)
    • non-referred attendances – Other (B/103).
  • and in any of the following groups:
    • 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: Total services from eligible claims. This does not include any bulk-billed incentive items or other top-up items.

GP expenditure: Total benefit paid for eligible claims.

Denominator ERP as at 30 June at the previous end of financial year
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 Enrolment postcode reported at the following levels:
  • PHN area
  • SA3.
Age-group disaggregation

PHN level analysis by age group (<15, 15–24, 25–44, 45–64, 65+) and sex

Notes Data are reported by the financial year in which they were processed.

GP attendances bulk-billed

Percentage of GP attendances bulk-billed.

Data source
MBS claims data 2010–11 to 2016–17
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 Total services from eligible claims 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 Total services from eligible claims.
Calculation (Numerator ÷ denominator) x 100
Geographic disaggregation Enrolment postcode 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
MBS claims data 2010–11 to 2016–17
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 Total services from eligible claims. This does not include any bulk-billed incentive items or other top-up items.
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 Enrolment postcode 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

MBS claims data 2010–11 to 2016–17

ABS Estimated Resident Population (ERP) at 30 June 2001; 2010–2016

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.

Specialist attendances exclude obstetrics attendances, which are included in the ‘Obstretrics’ Broad Type of Service group in official MBS claims data.

Numerator

Specialist attendances: Total services from eligible claims. This does not include any bulk-billed incentive items or other top-up items.

Specialist expenditure: Total benefit paid for eligible claims.

Denominator ERP as at 30 June at the previous end of financial year
Calculation

Crude rates: Numerator ÷ denominator

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

Geographic disaggregation Enrolment postcode reported at the following levels:
  • PHN area
  • SA3.
Age-group disaggregation PHN level analysis by age group (<15, 15–24, 25–44, 45–64, 65+) and sex
Notes Data are reported by the financial year in which they were processed.

Did not see a GP

Percentage of people who did not claim a GP attendance.

Data source

MBS claims data 2016–17

ABS Estimated Resident Population (ERP) at 30 June 2016

Indicator description and calculation
Eligible claims

A claim is classified as a GP attendance if the service is in any of the 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 The number of people who did not claim a GP attendance was derived by subtracting the number of patients who claimed at least one GP attendance in 2016–17 from the ABS ERP (30 June 2016) for the patient region in question. Unique GP patients were identified through the Patient Identification Numbers (PINs) in the Medicare claim records.
Denominator ERP as at 30 June 2016
Calculation (Numerator ÷ denominator) x 100
Geographic disaggregation Enrolment postcode reported at the following levels:
  • PHN area
  • SA3.
Notes Data are reported by the financial year in which they were processed.