Medicare Benefits Schedule GP and specialist attendances and expenditure
This technical note accompanies Medicare Benefits Schedule GP and specialist attendances and expenditure.
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
- Percentage of people who did not claim a GP attendance.
The web update provides insights into the following Performance and Accountability Framework indicators:
- 126.96.36.199 GP-type service use
- 188.8.131.52 Specialist service utilisation
- 184.108.40.206 GP service utilisation by residents of Residential Aged Care Facilities
- 220.127.116.11 After-hours GP service utilisation.
Further details on these indicators are available in the indicator specification tables.
About the data sources
Data for the web update were sourced from the Medicare Benefits Schedule (MBS) claims data, which are administered by the Australian Government Department of Health. These claims data 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. 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. MBS claims data do not include services that were provided free of charge to public patients in hospitals, or were subsidised by the Department of Veterans’ Affairs, compensation arrangements or through other publicly funded programs including jurisdictional salaried GP services provided in remote outreach clinics. As a result, MBS claims data may underestimate the rate of use of health services in some areas and by some members of the community. Some areas have a higher proportion of services that are not Medicare funded than other areas and this may affect comparability.
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 and changes over time within an area. This adjustment is important because the prevalence of health conditions and rates of health service use 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. These crude rates were then given a weight that reflected the age composition of the standard population. If a patient’s age was recorded as over 116, their records were excluded from the age-standardised rates. The current standard population is the Australian Bureau of Statistics (ABS) Estimated Resident Population (ERP) for Australia as at 30 June 2001.
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
PHNs were established on 1 July 2015. The My Healthy Communities website includes results for PHN areas from 2013–14 to 2016–17 and results for SA3s from 2010–11 to 2016–17. National results are also included for context.
All results are based on the patient’s Medicare enrolment postcode, not where they received the health care service. In most cases a patient’s Medicare enrolment postcode is the same as 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. If 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 records attributed to each area was the same as the percentage of the postcode population that fell within each area. Figures were rounded at the end of the calculations to avoid truncation error.
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:
- Higher socioeconomic areas
- Medium socioeconomic areas
- Lower socioeconomic areas
- Inner regional
- Outer regional
- Remote (includes very remote).
SA3s by remoteness
SA3 boundaries align well with the ABS remoteness classification for major cities, inner regional areas and outer regional areas.4 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 47% to 100%. However, if 95% or more 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).
SA3s in major cities
The majority of SA3s (188 of 333) 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 2011 ABS Index of Relative Socioeconomic Disadvantage (IRSD). IRSD is one of the Socio-economic Indexes for Areas (SEIFA) produced by the ABS.5 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 percentage of the population in each of these groups, which ranged from 39% to 95%. This indicates a diverse population in some SA3s.
An exception to this rule was developed for SA3s with an average IRSD score above 1050. These SA3s were allocated to the higher socioeconomic category on the basis of their average IRSD score, rather than the percentage of population in a particular IRSD quintile. This affected eight SA3s—Canada Bay (NSW), Camden (NSW), Manningham-West (Vic), Glen Eira (Vic), Kingston (Vic), Whitehorse-East (Vic), Unley (SA) and Kalamunda (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
Disaggregation by age group and sex
Measures that were disaggregated by age group and sex used the patient’s date of birth and sex as recorded at the last claim processed in the reference year. Where multiple claims were processed on the same day, age and sex was taken from the last date of service on that date of processing.
All information about an area is suppressed (marked ‘NP – not available for publication’) if any of the following conditions are met:
- there are fewer than six patients or fewer than six providers in the area (SA3/PHN)—note a patient/provider is only included if they provide or receive at least one service in the area
- one provider provides more than 85% of services or two providers provide more than 90% of services
- one 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’).
1 AIHW (Australian Institute of Health and Welfare) 2005. Age-standardised rate. Canberra: AIHW. Viewed 1 March 2018, 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 1 March 2018, 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.
4 ABS 2013. Australian Statistical Geography Standard: Volume 5 – Remoteness Structure, July 2011. ABS Cat. no. 1270.0.55.005. Canberra: ABS. Viewed 11 April 2018, http://www.abs.gov.au/ausstats/abs@.nsf/mf/1270.0.55.005External link, opens in a new window..
5 ABS 2013. Census of Population and Housing: Socio-Economic Indexes for Areas (SEIFA), Australia, 2011. ABS Cat. no. 2033.0.55.001. Canberra: ABS. Viewed 11 April 2018, http://www.abs.gov.au/ausstats/abs@.nsf/mf/2033.0.55.001External link, opens in a new window..