4102.0 - Australian Social Trends, 1996  
ARCHIVED ISSUE Released at 11:30 AM (CANBERRA TIME) 24/06/1996   
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Contents >> Health >> Health Services: Medicare: the first ten years

Health Services: Medicare: the first ten years

Use of Medicare services increased between 1984-85 and 1993-94 from an average of 7 per person per year to 10.

The federal government introduced Medicare, Australia's national health insurance scheme, in February 1984. Medicare provides free access to hospital services for all Australian residents, and benefits to help meet the cost of a range of medical services. Medicare is partly funded by a tax levy. Benefits payable under the scheme are administered by the Health Insurance Commission (HIC). In 1993-94 the HIC processed 180 million services and paid out $5.4 billion in benefits1.

Since the introduction of Medicare, private health insurance funds have mainly concentrated on providing benefits for hospital and medical practitioner services received by private patients in private and public hospitals2.


Medicare benefits

Medicare determines a scheduled fee for each service that comes under the scheme. Medicare refunds 85% of the scheduled fee for out-of- hospital services (medical and optometrical) and 75% of the scheduled fee for professional services provided to private patients in public or private hospitals. Some service providers bill the patient direct while others bulk bill Medicare and the patient has no out-of-pocket expense.

Exclusions

Medical treatment of public patients in public hospitals is not included in this review since these services are not billed to the Health Insurance Commission (HIC) but are paid by hospitals which are funded by states with the aid of federal government grants. This covers both in and out-patient care. Other exclusions from HIC Medicare data include services to eligible military service veterans and their dependants, services covered by motor vehicle third party insurance, workers' compensation schemes, public authorities and most government-funded community health services2.

Rates of use per person have been calculated using the 31 December estimated resident population figures for the relevant financial year.


Increasing use of Medicare
There has been increasing use of Medicare services since its inception. The average number of Medicare services used per person in a year increased by 41%, from 7 services in 1984-85 to 10 in 1993-94.

Rates are higher for females than males. In 1993-94 females used on average 12 services each while males used 8. The difference between the average number of services used by males and females has slowly increased over the past ten years. In 1984-85 females used on average 3 more services per year than males.

The increase in use of services per person is due mainly to real increases with an additional effect of population ageing (older people make greater use of medical services). The 41% increase (from 7.2 to 10.2) reduces by 4 percentage points, to 37%, when adjusted to compensate for the change in age structure of the population over that period (age standardisation).

AVERAGE NUMBER OF MEDICARE SERVICES USED PER PERSON
Males
Females
Persons
Age standardised(a)
Year
rate
rate
rate
rate
1984-85
5.6
8.8
7.2
7.4
1985-86
5.9
9.3
7.6
7.8
1986-87
6.2
9.7
8.0
8.1
1987-88
6.4
10.0
8.2
8.3
1988-89
6.7
10.4
8.6
8.6
1989-90
6.8
10.4
8.6
8.6
1990-91
6.8
10.3
8.5
8.6
1991-92
7.2
10.9
9.0
9.0
1992-93
7.8
11.8
9.8
9.8
1993-94
8.1
12.2
10.2
10.1
(a) Standardised to the 1991 age structure.

Source: Health Insurance Commission Annual Reports; Australian Demographic Statistics (cat. no. 3101.0).


Service use and age
The average use of services under Medicare varies with age and sex. Up to the age of 14 boys and girls have similar patterns of use. In 1993-94, infants (0-4 years) used about 10 services per year while older children (10-14 years) had the lowest use for all ages at 5 services per year. From 15 years of age onwards the average number of services per year gradually increased for men while that for women increased rapidly and remained higher than that for men at all ages. Between the ages of 25 and 34, the age range in which many women have children, the average use by women was 13 services per year while that for men was 6. The greatest use of Medicare services was made by people aged 75 or over. They averaged 20 services for men and 23 for women during 1993-94.

AVERAGE NUMBER OF MEDICARE SERVICES USED PER PERSON, 1993-94



Source: Health Insurance Commission Annual Report 1993-94


State differences
There are distinct differences in the average use of Medicare services per person between the states and territories. These differences remain even when the rates are standardised to remove the effect of different age structures. In 1993-94, New South Wales had the highest average standardised rates with 9 services per year for males and 13 for females. The Northern Territory had the lowest standardised rates with 5 services per year for males and 9 for females. These differences may reflect different state usage rates of hospital out-patient services, the mix of public and private hospital usage in the states, regional variation in clinical practises and varying access and availability of medical services between states. Studies have shown that as the number of general practitioners per person increases the number of services used per person increases3.

AGE STANDARDISED(a) AVERAGE NUMBER OF MEDICARE SERVICES USED PER PERSON, 1993-94



(a) The average Medicare usage rate if the states/territories had the same population age and sex structure as Australia. Real age-specific usage rates are used for each state/territory.

Source: Health Insurance Commission Annual Report 1993-94


Types of service used
The three most common types of service used in 1993-94 under the Medicare system were general practitioners (45%), pathology (24%) and specialists attendances (9%).

Between 1984-85 and 1993-94 the use per person per year of most types of service increased. Radiology and pathology services increased by the greatest proportions. Radiology services increased from 0.3 services per person to 0.5 (a 78% increase) and pathology services increased from 1.4 to 2.4 services per person (a 71% increase). Specialist services increased from 0.7 to 0.9 services per person (a 42% increase) and general practitioner services increased from 4.1 to 5.4 (a 33% increase).

THE FIVE MOST COMMON SERVICES USED UNDER MEDICARE, 1993-94



Source: Health Insurance Commission Annual Report 1993-94

AVERAGE USE OF SELECTED MEDICARE SERVICES(a) PER PERSON
No. of services per person
% increase
Broad type of service
1984-85
1993-94
Total
Annual average
rate
rate
%
%
Consultations
4.8
6.4
34.4
3.0
    General practitioner
4.1
5.4
33.2
2.9
    Specialist
0.7
0.9
41.7
3.5
Pathology
1.4
2.4
70.9
5.5
Radiology
0.3
0.5
78.2
5.9
Operations
0.2
0.3
36.1
3.1
Other services(b)
0.5
0.5
0.6
0.1
All services
7.2
10.2
40.9
3.5
(a) Some amendments to the items included in the broad type of service have been made through the period of this comparison.
(b) Comprises obstetrics, anaesthetics, assistance at operations, optometry, dental and miscellaneous services.

Source: Health Insurance Commission Annual Reports; Australian Demographic Statistics (cat. no. 3101.0)


Use of general practitioners
The number of general practitioner (GP) services used varied by age and between males and females. These variations were similar in both 1984-85 and 1993-94. In general, females had more services from GPs than males except among children. Among children aged 5-14 the average number of services per year for boys and girls were similar, while among children aged 0-4 boys had an average of 0.5 services more than girls (7.6 services for boys and 7.1 services for girls in 1993-94). A similar difference was observed in 1984-85.

Although the patterns of use were similar in 1984-85 and 1993-94, the average number of times a person used a GP service in the year increased. The increase was greatest among boys and girls aged 0-4 who had on average two more services a year in 1993-94 than in 1984-85.

AVERAGE NUMBER OF GENERAL PRACTITIONER SERVICES USED PER PERSON
1984-85
1993-94
Age group (years)
Males
Females
Males
Females
rate
rate
rate
rate
0-4
5.3
4.9
7.6
7.1
5-9
2.9
3.0
4.0
4.0
10-14
2.2
2.3
3.1
3.2
15-19
2.1
3.6
3.0
4.9
20-24
2.3
4.8
3.2
6.1
25-34
2.5
4.6
3.4
6.0
35-44
2.7
4.3
3.7
5.6
45-54
3.4
5.0
4.3
6.3
55-64
4.2
6.0
6.0
7.5
65-74
5.6
8.2
6.8
9.0
75+
8.8
11.4
9.5
12.4
Total
3.3
5.0
4.5
6.4
Source: Health Insurance Commission unpublished data; Australian Demographic Statistics (cat. no. 3101.0)


People not using services
Although the average number of Medicare services per person is a simple and convenient measure of service use, it understates the actual use per person because people who did not use a Medicare service are included.

The proportion of people who did not make a claim for a Medicare service varied with age and sex. Among males aged 25-34, 30% did not make a Medicare claim during 1993-94. Among females under 55 years the highest rate of not using any Medicare services occurred among girls aged 10-14, 20% of whom made no claims in 1993-94.

The data for men and women aged 55 and over indicate that high proportions used no Medicare services. This must be interpreted carefully. As previously discussed, older people who use health services under the Medicare scheme have the highest average use of Medicare per person. However, older people are also the most likely to be using public hospital in-patient care without charge and therefore not using the Medicare system. The medical services of the Department of Veterans Affairs programs also provide medical service outside of the Medicare system.

PEOPLE WHO DID NOT USE A MEDICARE SERVICE, 1993-94


Source: Health Insurance Commission Annual Report 1993-94


Endnotes

1 Health Insurance Commission Annual Report 1993-94.

2 Australian Institute of Health and Welfare (1994) Australia's Health 1994, the 4th biennial report of the Australian Institute of Health and Welfare.

3 Australian Institute of Health and Welfare (1992) Australia's Health 1992, the 3rd biennial report of the Australian Institute of Health and Welfare.




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