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Australian Health Performance Framework: PI 2.5.1–Bulk-billing for non-referred (GP) attendances, 2020

Identifying and definitional attributes

Metadata item type:Help on this termIndicator
Indicator type:Help on this termIndicator
Short name:Help on this termAHPF PI 2.5.1–Bulk-billing for non-referred (GP) attendances, 2020
METeOR identifier:Help on this term728349
Registration status:Help on this termHealth, Standard 13/10/2021
Description:Help on this term

The number and rates of services for non-referred General Practitioner (GP) attendances bulk billed in a year.

Indicator set:Help on this termAustralian Health Performance Framework, 2020 Health, Standardisation pending 30/07/2021

Collection and usage attributes

Population group age to:Help on this term

All ages

Computation description:Help on this term

Bulk-billing is an arrangement in which a GP bills Medicare directly for any eligible medical or allied health service that the patient receives, and imposes no other 'gap payment' on the patient. In this arrangement the provider accepts the Medicare benefit as full payment for the service and the patient assigns their right to a Medicare benefit to the service provider.

GP attendances are Medicare benefit-funded patient/doctor encounters, such as visits and consultations, for which the patient has not been referred by another doctor. GP attendances exclude services provided by practice nurses and Aboriginal and Torres Strait Islander health practitioners on a GP’s behalf.

In terms of 'Broad Type of Service’ Groups, GP attendances comprise all items in Broad Type of Services Groups:

  • ‘A’ - GP/Vocationally Registered (VR)GP non-referred attendances  
  • ‘M’ - Enhanced Primary Care and
  • 'B’ - Non-referred other attendances as published in official Medicare Benefits Schedule statistics by the Department of Health.

In published bulk billing statistics from 2009-10, the patient’s geographic location is determined using their geocoded Medicare enrolment address at the date the claim was processed. There may be minor changes to the statistics in subsequent publications as geospatial information is updated.

Statistics are published by Modified Monash Model (MMM) and by state/territory of patient. The MMM is a geographical classification that categorises different areas in Australia into seven remoteness categories. The MMM classifies metropolitan, regional, rural and remote areas according to geographical remoteness, as defined by the Australian Bureau of Statistics (ABS), and town size.

The MMM is used to determine eligibility for a range of health programs.

Presented in numbers and percentages.

Modified Monash Category Description (including the Australian Standard Geographical Classification (ASGS) – Remoteness Area (2016)
MM 1

Metropolitan areas: Major cities accounting for 70% of Australia’s population. All areas categorised ASGS-RA1

MM 2 Regional centres: Inner (ASGS-RA 2) and Outer Regional (ASGS-RA 3) areas that are in, or within a 20km drive of a town with over 50,000 residents
MM 3 Large rural towns: Inner (ASGS-RA 2) and Outer Regional (ASGS-RA 3) areas that are not MM 2 and are in, or within a 15km drive of a town between 15,000 to 50,000 residents
MM 4 Medium rural towns: Inner (ASGS-RA 2) and Outer Regional (ASGS-RA 3) areas that are not MM 2 or MM 3, and are in, or within a 10km drive of a town with between 5,000 to 15,000 residents
MM 5 Small rural towns: All remaining Inner (ASGS-RA 2) and Outer Regional (ASGS-RA 3) areas. Islands that have an MM 5 classification with a population of less than 1,000 without bridges to the mainland are classified as MM 6
MM 6 Remote communities: Remote mainland areas (ASGS-RA 4) AND remote islands less than 5kms offshore. Islands that have an MM 5 classification with a population of less than 1,000 without bridges to the mainland are classified as MM 6
MM 7 Very remote communities: Very remote areas (ASGS-RA 5) and all other remote island areas more than 5kms offshore.
Computation:Help on this term

(Numerator ÷ Denominator) x 100

Bulk-billed GP attendances

Numerator:Help on this term

Number of bulk-billed GP attendances claimed through the Medicare Benefits Schedule (MBS)

Numerator data elements:Help on this term
Data Element / Data SetService event—bulk billed General Practitioner (GP) service, total number NN[N]
Data Source
Medicare (MBS) data
Guide for use

Data source type: Administrative by-product data


Data Element / Data SetAddress—Australian postcode, Australian postcode code (Postcode datafile) {NNNN}
Data Source
Medicare (MBS) data
Data Element / Data SetPerson—General Practitioner MBS health assessment indicator, yes/no code N
Data Source
Medicare (MBS) data
Denominator:Help on this term

Total GP attendances for year of processing

Denominator data elements:Help on this term
Data Element / Data SetPerson—General Practitioner MBS health assessment indicator, yes/no code N
Data Source
Medicare (MBS) data
Disaggregation:Help on this term

By state/territory and by Modified Monash Model (MMM) Category.

Disaggregation data elements:Help on this term
Data Element / Data SetData Element

Region of patient - geographic remoteness MMM remoteness classification


Data Source
Medicare (MBS) data
Data Element / Data SetService/care provider—Australian state/territory identifier, ACT-prioritised Australian state/territory code N
Data Source
Medicare (MBS) data

Representational attributes

Representation class:Help on this termCount
Data type:Help on this termReal
Unit of measure:Help on this termService event
Format:Help on this term

N[N8].N

N[NN].N

Data source attributes

Data sources:Help on this term
Data SourceMedicare (MBS) data
Frequency
Annually
Data custodian

Department of Health


Accountability attributes

Reporting requirements:Help on this term

Australian Health Performance Framework

Organisation responsible for providing data:Help on this term

Department of Health

Source and reference attributes

Submitting organisation:Help on this term

Australian Institute of Health and Welfare

Steward:Help on this termAustralian Institute of Health and Welfare
Origin:Help on this term

Department of Health

Relational attributes

Related metadata references:Help on this term

See also National Health Performance Authority, Healthy Communities: Bulk-billed GP attendances, 2013–14 National Health Performance Authority (retired), Retired 01/07/2016

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