Technical notes
Medicare Benefits Schedule (MBS) data
The MBS is a listing of Medicare services that are subsidised by the Australian Government. It is part of the Medicare Program that is managed by the Department of Health and Aged Care, and administered by Services Australia.
The statistics in this publication are based on AIHW analysis of the Medicare Benefits Schedule data, accessed through the Department of Health and Aged Care’s Enterprise Data Warehouse.
In this report, data are presented for Indigenous-specific health checks – listed as items 715, 228, 92004, 92011, 92016, 92023, 93470 and 93479 on the MBS.
The data presented on these items do not provide a complete picture of all health checks provided to Indigenous Australians. Some Indigenous Australians may be receiving similar primary health care through other MBS items (that is, items that are not specific to Indigenous Australians). A person may also be provided with equivalent care from a health care provider who is not eligible to bill Medicare – for example, through state- or territory-funded primary health care services and public hospitals, which are ordinarily not eligible to bill to Medicare.
MBS Indigenous-specific health checks
All Indigenous Australians, regardless of age, are eligible for an Indigenous-specific health check. There are 8 Indigenous-specific health check items listed on the MBS:
- MBS item 715 (available from 1 May 2010)
- MBS item 228 (available from 1 July 2018)
- MBS items 93470 and 93479 in Residential Aged Care Facilities (available from 10 October 2020 to 30 June 2022)
- Video-conference MBS items 92004 and 92011 (available from 30 March 2020)
- Telephone MBS items 92016 and 92023 (available from 30 March 2020 to 30 June 2021)
MBS items 715, 92004, 92016 and 93470 relate to health checks provided by a vocationally registered general practitioner (VR GP), while items 228, 92011, 92023 and 93479 relate to health checks provided by non-vocationally registered GPs (non-VR GPs). In all cases, suitably qualified health professions can assist under the supervision of the practitioner. The requirements of an Indigenous-specific health check, which are set out in the relevant sections of the MBS, include an assessment of the patient’s health, including their physical, psychological and social wellbeing. The check also assesses what preventive health care, education and other help should be offered to the patient to improve their health and wellbeing.
Indigenous Australians can receive an Indigenous-specific health check once in a 9-month period. If the GP or medical practitioner bulk-bills the item, there is no charge to the patient.
COVID-19 and temporary telehealth items
In March 2020, measures to reduce the risk of community transmission of COVID-19, including limiting public gatherings and reducing non-essential travel, were put in place across Australia. In response to these restrictions, a range of temporary telehealth MBS items were also made available to allow continuity of care for patients, as well as to provide protection for both patients and health care providers from the risk of COVID-19.
Temporary telehealth items for Indigenous-specific health checks have been made available from March 2020 (telephone items were discontinued after June 2021):
- Health checks provided via videoconference: MBS item 92004 (provided by VR GPs) and MBS item 92011 (provided by non-VR GPs)
- Health checks provided via telephone (when videoconferencing is not available): MBS item 92016 (provided by VR GPs) and MBS item 92023 (provided by non-VR GPs).
While many required aspects of an Indigenous-specific health check can be completed as a remote service via telehealth, some components can only be delivered through face-to-face consultation with the patient. This could include any necessary physical examinations such as a blood pressure check. Therefore, for an Indigenous health check undertaken by telehealth to be processed via Medicare all components of the health check, including both remotely delivered and face-to-face, must be completed.
Throughout most of the pandemic, telehealth items were restricted to medical practitioners with an existing clinical relationship with patients. Exemptions to this rule included patients of Indigenous-specific primary health care services, infants, persons experiencing homelessness, persons with COVID-19 and patients in declared COVID-19 hotspots.
Selected indicators of the COVID-19 pandemic
Included in this report, are data on 4 indicators related to the COVID-19 pandemic in Australia covering most of 2020 and 2021:
Relative COVID-19 case numbers
This metric compares reported new COVID-19 case numbers (for the total population) with the highest reported case numbers to-date.
Daily case numbers were downloaded from the COVID Live website on 17 January 2023, which sourced data from official jurisdictional reporting.
'New cases' were used, rather than 'Net cases', as new cases were reported more widely, while net cases were subject to retroactive changes, including significant downward adjustments (e.g. when duplicates and false positives were removed).
See 'Technical notes for the COVID-19 indicators' further on, for more information.
Relative COVID-19 hospitalisation numbers
This metric compares reported hospitalisation numbers (for the total population) with the highest reported hospitalisation numbers to-date.
Daily hospitalisation numbers were downloaded from the COVID Live website on 17 January 2023, which sourced data from official jurisdictional reporting.
See 'Technical notes for the COVID-19 indicators' further on, for more information.
Stay-at-home orders
This metric summarises the extent of 'lockdown' restrictions.
Stay-at-home orders' data were downloaded from the Oxford COVID-19 Government Response Tracker's Australian GitHub repository on 31 August 2022, based on analysis by Oxford University’s Blavatnik School of Government and the Australian National University's Centre for Social Research and Methods.
See 'Technical notes for the COVID-19 indicators' further on, for more information.
Relative time spent at residences
This metric reflects how much time people were spending at home, relative to a baseline period in January and February of 2020, based on anonymised mobile phone data and other devices using location services.
Data were downloaded from the COVID-19 Data website on 14 April 2022, which sourced data from Google Mobility reporting.
See 'Technical notes for the COVID-19 indicators' further on, for more information.
Counting services
This report presents data on the number of services – that is, the number of health checks provided in the specified period.
In any given period (for example, 12 months), the number of health check patients may be smaller than the number of services provided. This occurs when patients have received more than 1 health check in that period.
Dates and reference periods
The MBS data set includes information on the date the service was provided, as well as the date that the claim was processed by Medicare. These dates can differ due to a time lag between when a service is provided and when the claim for that service is processed by Medicare Australia.
The data in this report relate to services provided between 1 January 2012 and 31 December 2021, which were processed on or before 31 August 2022. Data are reported by date of service as this more accurately reflects when the service was provided. Due to lags between date of service and date of processing, there will be a small proportion of services provided during the reference period that are not captured in these data. For example, if a service was provided on 31 December 2021, but not processed until 1 September 2022, it will not be included in the data.
Location
Geographic correspondences (sometimes referred to as concordances or mapping files) can be used where the location information in an original data is not available at the geographic level required for analysis and reporting. Geographic correspondences are a mathematical method for reassigning data from one geographic classification (for example, a postcode) to a new geographic classification (for example, states and territories).
Geographic correspondences enable postcode data to be reported at various other geographic levels. However, there are limitations associated with the use of postcode data for this purposes. Key issues include:
- postcodes do not fit neatly into the boundaries of geographic areas typically used for statistical reporting
- defining geographic boundaries for postcodes is an imprecise process – postcodes can also change over time
- people may not keep their postcode information up-to-date with Medicare
- postcodes linked to patient records may belong to PO boxes, making correspondence to small geographic areas less accurate.
Due to these issues, various decisions need to be made about how best to allocate the postcode data to geographic regions. There will be some degree of inaccuracy in the resultant estimates, which will affect data in certain areas more than others.
For this report, postcodes were re-assigned to 2 different geographies (based on the 2016 Australian Statistical Geography Standard) – states/territories and Greater Capital City Statistical Areas (GCCSA). Where postcodes fell across the boundaries of multiple areas (for example, multiple states/territories), data were apportioned based on the population distribution of Indigenous Australians, according to AIHW analysis of Australian Bureau of Statistics (ABS) population estimates at 30 June 2016.
Postcode information is included in each MBS service record, allowing each service to be corresponded independently, even where a patient may have had more than one service within a given reference period.
Records with invalid postcode information could not be allocated to sub-national regions.
Comparisons with other reports
As described in the Dates and reference periods section, the data in this report are based on the date of service (rather than date of processing), as this more accurately reflects when the service was provided. Data in this report may differ to those published elsewhere based on date of processing. It may also differ to data published elsewhere based on date of service, where the date of processing cut-off is different. Location may be also determined in a slightly different way to some other reports (see Location, presented earlier).
Relative COVID-19 case numbers
This metric compares reported COVID-19 case numbers with the highest reported case numbers to-date.
Derivation steps:
- Daily case numbers were compiled for each jurisdiction.
- Rolling 7-day averages were calculated, based on each day and the previous 6 days (floored at zero).
- Proceeding forward one day at a time, the maximum rolling average was tracked, inclusive of the then 'current' date.
- Each day's rolling average was expressed as a percentage of the maximum rolling average to date, resulting in a measure ranging from 0% to 100%. Where the rolling average was 0, the percentage was hard-coded to 0%.
Note: Reported COVID-19 cases may have deviated substantially from the true number of cases, especially at times when testing rates were lower.
Relative COVID-19 hospitalisation numbers
This metric compares reported COVID-19 hospitalisation numbers with the highest reported hospitalisation numbers to-date.
Derivation steps:
- Daily hospitalisation numbers were compiled for each jurisdiction.
- Rolling 7-day averages were calculated, based on each day and the previous 6 days. Data gaps dating after the beginning of the series resulted in failed averages.
- Proceeding forward one day at a time, the maximum rolling average was tracked, inclusive of the then 'current' date.
- Each day's rolling average was expressed as a percentage of the maximum rolling average 'to date', resulting in a measure ranging from 0% to 100%. Where the rolling average was 0, the percentage was hard-coded to 0%.
Note: Data include hospitalisations principally for COVID-19 and included hospitalisations with (but not necessarily originally for) COVID-19, including asymptomatic cases.
Stay-at-home orders
This metric summarises the extent of 'lockdown' restrictions.
The metric is derived from 2 variables:
'C6_Stay at home requirements' - an ordinal scale
0 – no measures
1 – recommend not leaving house
2 – require not leaving house with exceptions for daily exercise, grocery shopping, and 'essential' trips
3 – require not leaving house with minimal exceptions (e.g. allowed to leave once a week, or only one person can leave at a time, etc.)
Blank – no data
'C6_Flag' - a binary flag for scope (geographic or specific to unvaccinated adults)
0 – targeted
1 – general
Blank – no data
To convert the 2 variables to an index ranging from 0 (no requirements) to 100 (a general requirement not to leave the house with minimal exceptions), following the Oxford COVID-19 Government Response Tracker's methodology:
= 100 × [ { C6_Stay at home requirements - 0.5 × ( 1 - C6_Flag ) } ÷ 3 ] , but with 0 as the lowest possible value.
The variables are recorded at eight different jurisdictional levels, describing the jurisdictional level at which the policies were applied. The levels are denoted by their jurisdictional level and a suffix. For the purposes of the calculation of the stay-at-home order metric used in this report, the values of the 'C6_Stay at home requirements' and 'C6_Flag' variables were taken for the data with the "TOTAL" suffix. The use of these jurisdictional levels imply the following application of policies across the different jurisdictions:
NAT_TOTAL – Describes the overall policy environment that applies to residents of the country, including policies set by sub-national governments, where those values are more stringent than country-wide action
STATE_TOTAL – Describes the overall policy environment that applies to residents of the state, including policies set by the national government, where those values are more stringent than state-level action
Note: The Stay-at-home orders metric does not necessarily scale with the degree of restrictions experienced by the general population or Indigenous population, since the main component of the indicator (C6_Stay at home requirements) is ordinal only, and also reflects the strictest settings issued within the jurisdiction. The binary flag pointing to scope (C6_Flag), which may have large importance in reality, has a relatively small influence over the scale of the indicator.
Relative time spent at residences
This metric reflects how much time people were spending at home, relative to a baseline period in January and February of 2020, based on anonymised mobile phone data and other devices using location services.
Specifically, the baseline was calculated using a median for each of the days of the week, based on a five-week period from 3 January to 6 February 2020 – before lockdown restrictions were introduced.
For some examples, a score of 0% means people were spending around the same amount of time at home as during the baseline period, while a score of 20% means people were spending around 20% more time at home than during the baseline period. Scores were reported as a rolling 7-day average.
Notes:
- The anonymised data on mobility were collected from the general population, not only from Indigenous Australians, and are therefore not a perfect reflection of variation in the mobility of Indigenous Australians specifically, especially for regions where the Indigenous population and total population have considerably different geographic distributions.
- The baseline period covered part of the summer holidays and wet season (in tropical zones), which may be atypical periods in terms of mobility.