Specialists provide diagnostic and treatment services in a specific area of medicine, generally for a particular disease or body system. They also support patients in managing health conditions. They can work in private clinics and in hospital admitted patient and outpatient settings, and usually require a patient referral from a medical practitioner or another health practitioner. 

Common referred specialties include: dermatology, cardiology, obstetrics, gynaecology, neurology, oncology, paediatrics and rheumatology. All specialists have completed advanced training, and must be registered with the Australian Health Practitioner Regulation Agency to practise in Australia.

Pathology, diagnostic imaging and other diagnostic services assist medical and other health practitioners to describe, screen, diagnose and monitor a patient’s illness or injury. Patients may receive such services in hospital, but for services provided in non-hospital settings, patients are typically referred to these services by a medical practitioner.

Pathology services include a wide range of tests on patient samples, such as blood or body tissue. Diagnostic imaging and other diagnostic services include: radiography (X-ray), ultrasound, computed tomography (CT scan), nuclear medicine and magnetic resonance imaging (MRI). These services are performed by qualified technical staff in conjunction with registered medical practitioners who are often specialists in diagnostic radiology.

Overall, 16.8 million Australians (68% of people) had more than 213.0 million Medicare-subsidised referred specialist attendances (consultations), pathology tests, imaging and other diagnostic services in 2017–18—a rate of 13 services per patient.

What are referred medical services?

These are medical services where the person has been referred by a general practitioner (GP) or medical specialist (AIHW 2019a). Australia’s national government-funded health care scheme, Medicare, subsidises access to referred specialist attendances (visits), pathology, imaging and other diagnostic services. This page describes the services that Australians receive under these arrangements.

Which referred medical services are included here?

This page focuses on referred medical services provided in non-hospital settings to non-admitted patients, which account for 87% of the total referred medical services subsidised under Medicare. The other 13% of services are provided to private patients in public or private hospitals as part of an episode of hospital treatment. For Medicare purposes, this can include some treatment in non-hospital settings for hospital-substitute treatment.

  • While services provided in-hospital are excluded, the data do include services provided in places like private outpatient clinics (which may or may not be located within the grounds of a hospital).
  • Data on specialist attendances provided here does not include information about therapeutic procedures covered by Medicare that may be performed in conjunction with a specialist attendance, which can be billed as a separate service. 
  • Specialist attendances, pathology, imaging and other diagnostic services provided to public patients treated in a public hospital are excluded as these services are funded under separate arrangements and data for these services are not collected in Medicare statistics.

Note that the expenditure data presented on this page will differ from similar data presented in Health expenditure Australia for ‘referred medical services’. This page presents benefits paid and out-of-pocket costs paid by patients only for non-hospital services attracting a Medicare rebate. Other expenditure data are not included here, such as for Medicare-subsidised in-hospital services and similar services provided under other arrangements (for example, services funded by the Department of Veterans' Affairs) either because data are not available or not complete.

Specialist attendances

In 2017–18, there were 33.5 million Medicare-subsidised referred specialist attendances (consultations) in a range of settings (Table 1). These attendances were provided to 8.2 million Australians (33% of people). Most people visited a referred specialist in non-hospital settings (75%), such as private consulting rooms and private outpatient clinics. In 2017–18, there were 25.2 million such referred specialist consultations, provided to 7.8 million patients in total.

Table 1: Medicare-subsidised specialist attendances(a) by setting, 2017–18

Service setting              

Proportion of people receiving a service (%)

Number of services (million)

Number of services per patient

Specialist attendances—non-hospital

31.9

25.2

3.2

Specialist attendances—in-hospital

8.6

8.3

3.9

Specialist attendances—total

33.3

33.5

4.1

  1. Specialist attendances are Medicare-subsidised referred patient/doctor encounters, such as visits, consultations, and attendances by video conference, involving medical practitioners who have been recognised as specialists or consultant physicians for Medicare benefits purposes. Specialist attendances include psychiatry and obstetric care, including antenatal and post-natal attendances.

Sources: AIHW analysis of MBS claims data; ABS 2018.

The data below relate to referred specialist consultations provided in non-hospital settings only.

In 2017–18, 32% of people had at least 1 Medicare-subsidised specialist consultation in a non-hospital setting. The most widely accessed specialties (in terms of the percentage of the population receiving a consultation) were: ophthalmology (5.3%), cardiology (4.0%), general surgery (3.9%) and dermatology (3.5%).

Across all specialties, there was an average of 3.2 specialist attendances per patient in 2017–18 (patients may have seen different types of specialists). The specialties for which patients received the most repeat services on average within the year included: psychiatry (4.9 services per patient), addiction medicine (3.6 services per patient) and medical oncology (3.4 services per patient).

In 2017–18, the specialties with the highest number of non-hospital consultations subsidised within the year were: ophthalmology (2.4 million), obstetrics and gynaecology (2.4 million), psychiatry (1.9 million), cardiology (1.7 million), general surgery (1.6 million), dermatology (1.5 million), and orthopaedic surgery (1.3 million) (Figure 1). These 7 specialties accounted for half of all non-hospital specialist consultations subsidised by Medicare (50%).
 

The following ten specialties had the highest number of Medicare-subsidised non-hospital specialist attendances in 2017–18: ophthalmology, obstetrics and gynaecology, psychiatry, cardiology, general surgery, dermatology, orthopaedic surgery, paediatric medicine, general medicine and medical oncology. In 2017–18, the number of specialist attendances claimed against these specialties ranged from 2.4 to 1.0 million and the proportion of population with at least one specialist attendance for these specialties ranged from 5.3% to 2.0%. 

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Trends  

The number of patients who had a Medicare-subsidised referred specialist consultation outside hospital increased from 7.0 million in 2013–14 to 7.8 million in 2017–18. However, the proportion of people who had a consultation with a specialist remained similar (30.4% and 31.9% of people respectively). 

After adjusting for differences in the age structure of the population, the number of specialist consultations per 100 people increased slightly in the 5 years to 2017–18, from 93 to 96 consultations.

Patient characteristics

Older people received more Medicare-subsidised specialist consultations outside hospital than younger people. In 2017–18, around 2 in 3 (64%) Australians aged 65 and over had at least 1 Medicare-subsidised referred specialist consultation outside hospital, whereas 1 in 4 (26%) aged under 65 had at least 1 consultation.

A higher proportion of females (35%) had at least 1 specialist consultation outside hospital than males (28%). This difference is partly associated with pregnancy-related consultations.    

The proportion of Australians who received at least 1 service varied depending on where they lived. The proportion of people who had at least 1 referred specialist consultation was similar for residents of Inner regional areas and Major cities (33.3% and 32.2% respectively), but decreased with increasing remoteness to 14% of people living in Very remote areas. The lower use of Medicare-subsidised specialist attendances in remote and very remote areas may be partly attributed to these populations relying more on GPs to provide health care services, due to less availability of local specialist services (AIHW 2019b).

Spending

In 2017–18, $3.4 billion was spent on Medicare-subsidised referred specialist consultations in non-hospital settings. By funding source:

  • $2.1 billion in Medicare benefits was paid by the Australian Government
  • $1.3 billion in out-of-pocket costs was paid by patients.

Two-thirds (66%) of spending on non-hospital consultations was accounted for by 10 specialties: obstetrics and gynaecology ($406.1 million), psychiatry ($401.3 million), ophthalmology ($257.4 million), cardiology ($217.1 million), dermatology ($211.0 million), paediatric medicine ($197.2 million), general surgery ($161.5 million), orthopaedic surgery ($154.2 million), general medicine ($124.8 million) and ear, nose and throat ($115.4 million).

In 2017–18, 43% (10.7 million services) of non-hospital Medicare-subsidised specialist consultations were bulk-billed (indicating that patients did not incur costs for these services). For those who did pay out-of-pocket costs (71% of patients—5.6 million people), the average cost per patient for non-hospital specialist attendances was $231 for all services received in the year.

See ‘What are referred medical services?’ above for further information on the in-scope Medicare services for the above and subsequent figures.

Trends in spending

Overall, spending on Medicare-subsidised specialist consultations in non-hospital settings increased:

  • Medicare benefits paid by the Australian Government increased in real terms (after adjusting for inflation), from $1.9 billion in 2013–14 to $2.1 billion in the 5 years to 2017–18. However, when we consider changes in the number of patients (including through population growth), spending remained the same on a per patient basis ($269 per patient in real terms in both 2013­–14 and 2017–18). 
  • Patient out-of-pocket costs increased, in real terms, from $1.0 billion in 2013–14 to $1.3 billion in 2017–18 (Figure 2). On a per patient basis, there was an increase in real terms from $197 per patient (for all services received in the year) to $231 during this period.

In the 5 years to 2017–18, the average specialist fee per service increased 1.0% per year (on average) in real terms. The proportion of provider fees covered by Medicare for non-hospital specialist attendances decreased by 3.0 percentage points, from 65.2% in 2013–14 to 62.2% in 2017–18.
 

Between 2013–14 and 2017–18, the average fee per service and provider fees for Medicare-subsidised non-hospital specialist attendances consistently increased in real terms—after adjustment for inflation ($129.2 to $134.4, $2.9 to $3.4 billion respectively). Medicare benefit paid and patient out-of-pocket costs also increased ($1.9 billion to $2.1 billion, $1,009.7 million to $1,281.2 million respectively). On the other hand, the percentage of fees covered by Medicare decreased from 65.2% to 62.2%.

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Patient experiences

The Patient Experiences in Australia survey for 2018–19 (ABS 2019) estimated that for people aged 15 and over who saw a medical specialist in the previous 12 months:

  • 17.4% of people who reported that they needed to see a medical specialist at some time in the last 12 months at least once delayed or did not see a specialist due to costs or other reasons
  • 23.5% waited longer than they felt acceptable to get an appointment with a medical specialist
  • a high proportion of people reported that the medical specialists they saw ‘always’ listened carefully, spent enough time with them and showed respect (80.1%, 80.4% and 84.0% respectively) (ABS 2019). Smaller proportions reported that the specialists they saw ‘often’ displayed these behaviours (12.8%, 11.7%, and 10.5% respectively) (ABS 2019).

See also Patient experience of health care.

Pathology, imaging and other diagnostic services

In 2017–18, 16.1 million (66%) Australians accessed 179.5 million Medicare-subsidised pathology tests, imaging scans and a range of diagnostic services.

Most (89%, or 160.7 million) Medicare-subsidised services included in this grouping were provided in non-hospital settings. The most common Medicare-subsidised services in this group were pathology (56% of people had at least 1 service) and diagnostic imaging services (38% of people had at least  service) (Table 2).

Table 2: Use of Medicare-subsidised pathology, imaging and other diagnostic services(a), 2017–18

Type of service

Proportion of people receiving a service (%)

Number of services (million)

Number of services per patient (average)

Pathology— non-hospital(b)

56.1

128.7

9.3

Diagnostic imaging—non-hospital(c)

38.2

24.9

2.7

Other diagnostic services—non-hospital(d)

15.6

7.0

1.8

Total

65.1

160.7

10.0

  1. This table includes non-hospital Medicare-subsidised services only.
  2. Pathology services include tests of patient samples, such as blood, urine, stools or body tissues. Note that one sample may result in multiple tests and therefore multiple MBS services.
  3. Diagnostic imaging services include X-rays, CT scans, ultrasound scans, MRI scans and nuclear medicine scans.
  4. Other diagnostic services include diagnostic procedures and investigations, such as electrocardiography, allergy testing, audiograms and sleep studies.

Sources: AIHW analysis of MBS claims data; ABS 2018.

Further data below relate to Medicare-subsidised services provided in non-hospital settings only.

Trends

Overall, there was a slight increase in the proportion of people who had a Medicare-subsidised service within this group over the 5 years to 2017–18. The proportion of people who had a pathology service increased from 53.9% to 56.1%, and the proportion who had diagnostic imaging services increased from 37.0% to 38.2%.

After adjusting for differences in the age structure of the population, the number of these services per 100 people increased in the 5 years to 2017–18, from 465 to 492 pathology services and from 88 to 96 diagnostic imaging services (Figure 3).
 

Between 2013–14 and 2017–18, the number of Medicare-subsidised non-hospital diagnostic services and percentage of population receiving a service has increased for all service types: pathology (113.0 to 128.7 million services, 53.9% to 56.1%), diagnostic imaging (21.1 to 24.9 million services, 36.9% to 38.2%), other diagnostic services (5.7 to 7.0 million services, 13.9% to 15.6%).

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Patient characteristics

Older people were more likely to have at least 1 of these Medicare-subsidised services. In 2017–18, 91% of people aged 65 and over had at least 1 pathology service, compared with 71% of people aged 45–64 and 41% of people aged 44 and under.

Females were more likely than males to have had 1 or more Medicare-subsidised pathology services (64% of females had at least 1 service, compared with 48% of males). This trend was also apparent for diagnostic imaging services, where 44% of females received a service compared with 33% of males.

In 2017–18, similar proportions of people living in Major cities, Inner regional areas and Outer regional areas received these types of services, compared with Remote and Very remote areas, where lower percentages of people received them. This was most apparent with diagnostic imaging, where 38% of people living in Major cities, Inner regional areas and Outer regional areas received a service, compared with 31% of people living in Remote areas and 24% of people living in Very remote areas.

Spending

In 2017–18, $7.0 billion was spent on Medicare-subsidised pathology, imaging and other diagnostic services in non-hospital settings. This comprised:

  • $6.5 billion in Medicare benefits paid by the Australian Government
  • $491.9 million in out-of-pocket costs paid by patients.

About $2.6 billion was spent on Medicare-subsidised pathology services in non-hospital settings, and $3.8 billion on diagnostic imaging services in 2017–18.

In 2017–18, 154 million (96%) of these services were bulk-billed (indicating that patients did not incur costs for these services). Pathology services contribute a large proportion of this figure as displayed in Figure 3. For those who did incur out-of-pocket costs, diagnostic imaging had the highest average cost per patient ($180) in 2017–18, whereas pathology had the lowest ($34) for all services received in the year. 

Trends in spending

In the 5 years to 2017–18, spending on Medicare-subsidised pathology, imaging and other diagnostic services outside of hospital increased:

  • Medicare benefits paid by the Australian Government increased in real terms (after adjusting for inflation), from $5.6 billion in 2013–14 to $6.5 billion in 2017–18 (Figure 4). Per patient, this was an increase in real terms from $379 per patient to $406 per patient.
  • Patient out-of-pocket costs increased in real terms (after adjusting for inflation), from $455.9 million in 2013–14 to $491.9 million in 2017–18. On a per patient basis there was an increase in real terms from $147 to $159 in this period.

For pathology services, the number of patients who had an out-of-pocket cost decreased—from 455,000 in 2013–14 to 219,000 in 2017–18. Over the same period, the average cost per patient (for those who had out-of-pocket costs) also decreased (from $55 to $34 per patient in real terms).

However, for diagnostic imaging services, the number of patients who had an out-of-pocket cost has been stable between 2013–14 and 2017–18—in the range of 2.1–2.2 million in each year. The average cost per patient (for those who had an out-of-pocket cost) increased in real terms from $167 in 2013–14 to $180 in 2017–18.
 

Between 2013–14 and 2017–18, provider fees for Medicare-subsidised non-hospital diagnostic services increased (pathology $2.3 to $2.6 billion, diagnostic imaging $3.2 to $3.8 billion and other diagnostic services $0.5 to $0.6 million). The trend over time was relatively flat for average fee per service for pathology ($20.7 to $20.4) and diagnostic imaging ($150.8 to $150.9), on the other hand, other diagnostic services decreased slightly ($87.5 to $86.0). The percentage of fees covered by Medicare increased for pathology (98.9% to 99.7%) and diagnostic imaging (88.8% to 89.7%), on the other hand fell one percentage point for other diagnostic services (85.1% to 84.1%). Medicare benefit paid increased for all service types: pathology ($2.3 to $2.6 billion), diagnostic imaging ($2.8 to $3.4 billion) and other diagnostic services ($0.4 to $0.5 billion). Out-of-pocket costs paid by patients reduced for pathology ($25.1 to $7.5 million), and increased for diagnostic imaging ($356.6 to $388.9 million) and other diagnostic services ($74.3 to $95.5 million).

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This page presents data for the most recently available 5 years of MBS claims data with a corresponding medical services price deflator—from 2013–14 to 2017–18. 

Where do I go for more information?

For more information and data on referred specialist, pathology, imaging and other diagnostic services see:

References

ABS (Australian Bureau of Statistics) 2011. Australian demographic statistics, Jun 2011. ABS cat. no. 3101.0. Canberra: ABS.

ABS 2018. Australian demographic statistics, Jun 2018. ABS cat. no. 3101.0. Canberra: ABS.

ABS 2019. Patient Experiences in Australia: summary of findings, 2018–19. ABS cat. no. 4839.0. Canberra: ABS. Viewed 12 November 2019.

AIHW (Australian Institute of Health and Welfare) 2019a. Health expenditure Australia 2017–18. Health and welfare expenditure series no. 65. Cat. no. HWE 77. Canberra: AIHW.

AIHW 2019b. Rural & remote health. Cat. no. PHE 255. Canberra: AIHW.