AIHW - Patients Spending on Medicare - Out-of-pocket Cost per Specialist and Obstetric Attendance (PHN) 2016-2017

This dataset presents the footprint of the percentage of patients with specialist and obstetric costs, and out-of-pocket cost per specialist and obstetric attendance at the 25th, 50th, 75th and 90th percentile. The data spans the financial year of 2016-2017 and is aggregated to 2015 Department of Health Primary Health Network (PHN) areas, based on the 2011 Australian Statistical Geography Standard (ASGS).

The data is sourced from the Medicare Benefits Schedule (MBS) claims data, which are administered by the Australian Government Department of Health. The 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 has been processed by the Department of Human Services. Data are reported for claims processed between 1 July 2016 and 30 June 2017. The data also contains the results from the ABS 2016-17 Patient Experience Survey, collected between 1 July 2016 and 30 June 2017. The Patient Experience Survey is conducted annually by the Australian Bureau of Statistics (ABS) and collects information from a representative sample of the Australian population. The Patient Experience Survey is one of several components of the Multipurpose Household Survey, as a supplement to the monthly Labour Force Survey.

The Patients' spending on Medicare Services data accompanies the Patients' out-of-pocket spending on Medicare services 2016-17 Report.

For further information about this dataset, visit the data source:Australian Institute of Health and Welfare - Patients' out-of-pocket spending on Medicare services Data Tables.

Please note:

• AURIN has spatially enabled the original data using the Department of Health - PHN Areas.

• 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.

• Obstetric attendances are Medicare-subsidised antenatal visits and attendances for the planning and management of pregnancy, as well as obstetric procedures involving non-admitted patients. These services can be provided by an obstetrician or GP. Selected services can also be provided by a midwife, nurse or Aboriginal and Torres Strait Islander health practitioner when the service is provided on behalf of, and under the supervision of, a medical practitioner.

• Out-of-pocket cost per service is the net cost to the patient of a health service, after deducting the Medicare benefit paid. The measure is calculated per patient (patients' annual out-of-pocket cost for eligible attendances, divided by the number of eligible attendances that the patient claimed in the year), for patients with out-of-pocket costs.

• The data is based on the patient's Medicare enrolment postcode, not where they received the health care service. Most peoples' Medicare enrolment postcode will be their residential postcode.

• If a service was flagged as bulk-billed, then the fee charged was set to equal the benefit paid (so there was no out-of-pocket cost for that service).

• Patients were excluded if the sum of eligible services in the year was less than one, or if their annual out-of-pocket expenditure on the eligible services was equal to or less than zero.

• Includes non-hospital Medicare-subsidised services only.

• NP - Not available for publication. The estimate is considered to be unreliable. Values assigned to NP in the original data have been set to null.