Trends
The number of patients who had a Medicare-subsidised referred medical specialist consultation in a non-hospital setting increased from 7.5 million in 2015–16 to 8.3 million in 2020–21. However, the proportion of people who had a consultation with a specialist only increased slightly (31% and 32% 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 2020–21, from 96 to 101 consultations.
Patient characteristics
Older people received more Medicare-subsidised referred medical specialist consultations in non-hospital settings than younger people. In 2020–21, just under 2 in 3 Australians (63%) aged 65 and over had at least one Medicare-subsidised referred medical specialist consultation, whereas just over 1 in 4 (27%) aged under 65 had at least one consultation.
Among all patients regardless of age, a higher proportion of females (36%) had at least one specialist consultation in a non-hospital setting than males (29%). This difference is partly associated with pregnancy-related consultations. Without the pregnancy-related consultations, the proportion of females receiving a specialist consultation was only 2.9 percentage points higher than for males.
The proportion of Australians who received at least one referred medical specialist consultation in a non-hospital setting varied depending on where they lived. The proportion of people who had at least one referred medical specialist consultation was similar for residents of Inner regional and Major cities areas (34% and 33%, respectively), but decreased with increasing remoteness to 14% of people living in Very remote areas. The lower use of Medicare-subsidised referred medical specialist attendances in Remote and Very remote areas may be partly attributed to these populations relying more on General Practitioners (GPs) to provide health care services, due to less availability of local specialist services (AIHW 2019b).
Spending
In 2020–21, $4 billion was spent on Medicare-subsidised referred medical specialist consultations in non-hospital settings. By funding source:
- $2.5 billion in Medicare benefits was paid by the Australian Government
- $1.5 billion in out-of-pocket costs was paid by patients.
Nearly two-thirds (63%) or $1.6 billion of Australian Government spending on non-hospital referred medical specialist consultations was accounted for by 10 specialties:
- psychiatry ($370.1 million)
- cardiology ($207.3 million)
- obstetrics and gynaecology ($175.7 million)
- paediatric medicine ($160.9 million)
- ophthalmology ($131.6 million)
- gastroenterology and hepatology ($108.5 million)
- general medicine ($106.2 million)
- dermatology ($99.3 million)
- general surgery ($95.7 million)
- endocrinology ($95.1 million).
In 2020–21, 47% (13.1 million services) of non-hospital Medicare-subsidised referred medical 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 or 6 million people), the average cost per patient for non-hospital specialist attendances was $257 for all services received in the year (an average of $104 per service for those who incurred out-of-pocket costs).
Trends in spending
Overall, spending on Medicare-subsidised referred medical specialist consultations in non-hospital settings increased:
- Medicare benefits paid by the Australian Government increased in real terms (after adjusting for inflation), from $2.1 billion in 2015–16 to $2.5 billion in 2020–21. When accounting for changes in the number of patients (including through population growth), spending also increased on a per patient basis ($286 per patient in 2015–16 to $298 in 2020–21).
- Patient out-of-pocket costs increased, in real terms, from $1.2 billion in 2015–16 to $1.5 billion in 2020–21 (Figure 2). On a per patient basis, there was an increase in real terms from $233 per patient to $257 during this period.
In the 5 years to 2020–21, the average referred medical specialist fee per service increased 0.3% per year (on average) in real terms, from $140.4 in 2015–16 to $142.4 in 2020–21. The proportion of provider fees covered by Medicare for non-hospital specialist attendances decreased by 1.2 percentage points, from 63% in 2015–16 to 61.8% in 2020–21.