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

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


This new report shows variation in the total annual out-of-pocket costs for patients for their Medicare-subsidised health care delivered outside a hospital. It shines a spotlight on how much patients pay out-of-pocket for specialist, general practitioner (GP), diagnostic imaging and obstetric services (otherwise known as the ‘gap’). It also looks at where patients have reported delaying or not using health services because of cost.

Results are presented for the 31 Primary Health Network (PHN) areas and where possible for more than 300 smaller local areas (SA3s). Detailed results are also available in the Excel download and a new interactive web tool which allows you to see variation across similar local areas by remoteness and socioeconomic status.

Key findings

In 2016–17:

  • Half of all patients—10.9 million people—incurred out-of-pocket costs for non-hospital Medicare services
  • For these patients with costs, the median amount spent in the year was $142 per patient. This means that half of patients with costs spent more than $142, and half spent less. The median out-of-pocket cost per patient varied across Primary Health Network (PHN) areas, from $104 to $206 per patient
  • The 10% of patients with the highest costs spent at least $601 or more in the year. Across PHN areas, this ranged from $432 to $876 per patient
  • Patients were more likely to pay for specialist and obstetric services. These services also attracted the highest out-of-pocket costs per service
  • The percentage of patients with out-of-pocket costs for diagnostic imaging services was 5 times as high in Australian Capital Territory PHN area (44%) than South Western Sydney PHN area (8%). This ranged from 3% to 65% of patients across smaller local areas (SA3s)
  • 8% of people aged 15 years and over, or an estimated 1.3 million people, said the cost of services was the reason that they delayed or did not seek specialist, GP, imaging or pathology services when they needed them. This percentage ranged from 5% to 13% across PHN areas1.
Since publication in August 2018, data for this measure have been revised.

Infographic text

Out-of-pocket costs for non-hospital Medicare services 2016–17:

  • 72% of patients had costs for specialist services* (5.3 million people)
  • 44% of patients had costs for obstetric services* (159 000 people)
  • 34% of patients had costs for GP services* (7.1 million people)
  • 23% of patients had costs for diagnostic imaging services* (2.1 million people)

*Patients who claimed at least one eligible service. Includes non-hospital Medicare-subsidised services only.

Source: AIHW analysis of Medicare Benefits Schedule claims data, 2016–17.

Percentage of patients with any out-of-pocket costs for Medicare services outside hospital:

  • 31% in the Northern Territory
  • 50% Nationally
  • 69% in the Australia Capital Territory

Median out-of-pocket cost per specialist attendance (for patients with costs):

  • $47 in Country SA
  • $64 Nationally
  • $87 in Northern Sydney

Percentage of patients with out-of-pocket costs for diagnostic imaging services:

  • 8% in South Western Sydney
  • 23% Nationally
  • 44% in the Australian Capital Territory