Monthly and Quarterly Standard Reports

Effective Enrolment
Table 2.2	Effective Enrolment Data
PBS & RPBS Services and Benefit
Table 5.1	Services by Patient Category and various periods
Table 5.2	Benefit by Patient Category various periods
Appendices
Appendix 2	Broad Type of Service Definitions
Appendix 3.1	PBS & RPBS - Services by Anatomical Therapeutic Chemical Classification (ATCC) and various periods by state.
Appendix 3.2	PBS & RPBS - Benefit by Anatomical Therapeutic Chemical Classification (ATCC) and various periods by state.
Appendix 4	Services Australia work days by state and month (July 1993 onwards)

Explanatory Notes

The statistics presented in the Monthly and Quarterly Standard Reports relate to the Medicare Program and the Pharmaceutical and Repatriation Pharmaceutical Benefits Schemes:

Medicare Program

The statistics are based on the items and groups in the Medicare Benefits Schedule.

The statistical tables include only those services which qualify for Medicare benefits. Any apparent discrepancies in addition in the tables are due to rounding.

Pharmaceutical and Repatriation Pharmaceutical Benefits Schemes

The statistics are based on the items and groups in the Pharmaceutical Benefits Schedule. The statistical tables relate to the value (benefits) and volumes (services) of Pharmaceutical and Repatriation Pharmaceutical Benefits scripts that were processed by Services Australia. The tables refer only to paid scripts processed from claims presented by approved pharmacies and do not include any adjustments made against pharmacists' claims, any manually paid claims or any benefits paid as a result of retrospective entitlement or refund of patient contributions. Any apparent discrepancies in addition in the tables are due to rounding.

These figures include both PBS Section 85 (Normal Arrangement) items and Private Hospital Section 100 (Special Arrangement) items. For a breakdown of these figures into PBS Section 85 items and Private Hospital Section 100 items, please visit the Pharmaceutical Benefits Schedule Group Statistics page on the Services Australia web site

Interested people and organisations may request further statistical information or clarification of the data in the accompanying tables by contacting Services Australia's Information Strategy and Delivery Section in the Canberra national office, email statistics@servicesaustralia.gov.au. Requests for additional information may incur a charge.

Any apparent discrepancies in addition in the tables are due to rounding.

Key Results - Summary of findings for the period

For the quarter selected these results summarise the value (benefits) and volumes (services) of

• Medicare services
• Pharmaceutical and Repatriation Benefits prescriptions

processed by Services Australia. A comparison is also made with the same quarter of the previous year. The various ways in which Medicare services are processed (ie. Bill Type) is shown along with a comparison of different time periods.

Medicare Services and Benefits

Table 1.1 - Services by Broad Type of Service and various periods

Table 1.1 shows the volume (services) for the period selected and a comparison with the same period of the previous year. The Year to Date and Financial Year figures are also given.

Table 1.2 - Benefit by Broad Type of Service and various periods

Table 1.2 shows the value (benefit) for the period selected and a comparison with the same period of the previous year. The Year to Date and Financial Year figures are also given.

For definition of Broad Type of Service please refer to Appendix 2.

For more information please refer to the Medicare Benefits Schedule

Processing Data and Effective Enrolment

Table 2.1 - Processing Data

Table 2.1 shows for the time period selected (and a number of comparison periods), the number of working days during which claims are processed, the number of Medicare and PBS services processed, value of Medicare and PBS services processed (as a value, count and rate per day) for each state as well as Australia as a whole.

Table 2.2 - Effective Enrolment Data

Table 2.2 shows for the time period selected, the number of active Medicare cards by number of persons enrolled on each card by State/Territory. A person must be enrolled with Medicare before a claim for Medicare benefits will be paid. Each eligible person may have his or her own card (eg a single person without dependants) or be on another person's card (eg a dependant child) or on two cards (eg a child of separated parents). The table also details the number of eligible persons, total persons on cards, persons on two or more cards and the average persons per card for each state.

Bill Type Data

Table 3 - % Bill Type by State and various periods

Table 3 shows for the time period selected (and a number of comparison periods), payment by bill type as a percentage of total services processed by state.

Table 4 - % Bill Type by Broad Type of Service and various periods

Table 4 shows for the time period selected (and a number of comparison periods), payment by bill type as a percentage of total services processed by Broad Type of Service.

PBS & RPBS Services and Benefit

Table 5.1 - Services by Patient Category and various periods
Table 5.2 - Benefit by Patient Category various periods

The patient category refers to the patient's eligibility status at the time of supply of the pharmaceutical item. The patient (or patient's family) may migrate to another category (Safety Net) after eligibility thresholds have been reached.

Tables 5.1 and 5.2 show for the time period selected and a comparison with the same period of previous year (plus the financial year and year to date figures) the services and benefits by patient category (and doctors' bag).

Medicare Non-Service Items

Table 6 - Medicare Non-Service Items

Table 6 shows for the time period selected, the total number of items processed and benefit paid for each Medicare Non-Service Item by State/Territory.

MBS Data by Electorates

Table 7 - % Bulk bill by Commonwealth Electorates
Maps - % Bulk bill by Commonwealth Electorates - Australia, State/Territory, Capital City

Bulk bill electorate statistics are only available for calendar years 2004 onwards.

Appendices

Appendix 1.1 - Medicare - Services by Broad Type of Service and various periods by state
Appendix 1.2 - Medicare - Benefit by Broad Type of Service and various periods by state

Appendices 1.1 and 1.2 show for the time period selected and four other comparative time periods the number of services or benefit by Broad Type of Service and State/Territory. A time series comparison across any requested period is available at Medicare Benefits Schedule (MBS) Group Statistics

Appendix 2 - Broad Type of Service Definitions

Appendix 2 lists the item numbers for each Broad Type of Service.

Appendix 3.1 - PBS & RPBS - Services by Anatomical Therapeutic Chemical Classification (ATCC) and various periods by state
Appendix 3.2 - PBS & RPBS - Benefit by Anatomical Therapeutic Chemical Classification (ATCC) and various periods by state

Appendices 3.1 and 3.2 show for the time period selected and four other comparative time periods the number of services or benefit split by ATC Classification across the State/Territory of supply for PBS and RPBS both as separate and or combined (PBS/RPBS) figures.

In the Anatomical Therapeutic Chemical (ATC) Classification, the drugs are divided into different groups according to their major site of action and their therapeutic and chemical characteristics. Please see the WHO Collaborating Centre for Drug Statistics Methodology website for more details.

Services Australia has prepared tables at the first level (anatomical level) of the ATC Classification for incorporation in to Appendices 3.1 and 3.2.

Appendix 4 - Services Australia work days by state and month (July 1993 onwards)

Work days exclude public holidays and weekends.

Definitions

Bill type

The method by which the Medicare benefit was paid

Bulk bill

The service provider claims Medicare benefits directly for the services rendered. In this case, the provider must accept the benefits as full payment. There is no cost to the patient.

Cheque to claimant

The person who incurred the expense (usually the cardholder) pays the account raised by the service provider, presents a claim and receives a cheque for the Medicare benefit.

Cheque to provider via claimant

The claimant does not pay the account raised by the service provider, presents a claim, and a cheque for the Medicare benefit, payable to the provider, is posted to the claimant. The claimant then sends this cheque, together with the balance of the account, if any, to the provider.

Cash

The claimant pays the account raised by the service provider, presents a claim and the Medicare benefit is paid in cash to the claimant.

Date of lodgement

The date on which Services Australia received the claim for Medicare benefit.

Date of processing

The date on which Services Australia processed the payment of a claim for Medicare benefit.

Date of service

The date on which the provider performed the service.

EFT

The claimant pays the account raised by the service provider, presents a claim and the Medicare benefit is paid by Electronic Funds Transfer to the claimants bank account.

EPC

Enhanced Primary Care.

GP

General Practitioner.

Simplified bill

Enables private hospital patients to be advised of their out-of-pocket expenses before treatment is received and to simplify the claiming process. At the conclusion of a hospital visit the accounts associated with the visit are collected and claimed from Medicare and health funds on behalf of the patient.

State/Territory

Determined according to the address (at the time of claiming) of the patient to whom the service was rendered unless otherwise indicated at the foot of the table.

VR GP

Vocationally Registered General Practitioner.