Evaluation of the Medical Specialist Outreach Assistance Program and the Visiting Optometrists Scheme

5.5 Estimates of the program’s impact

Page last updated: 28 February 2012

To estimate the impact of MSOAP on access to specialist services, an analysis was undertaken of service supported through medical benefits under Medicare and the number of patients for whom a patient consultation was reported under the program.

Data were obtained from DoHA on the number of services for which a medical benefit was paid for the years 1999-2000 to 2009-10. Services were broken down into categories similar to those reported on in the recent AIHW publication which estimated health system expenditures by remoteness areas (AIHW Australian Institute of Health and Welfare 2011a). These categories are shown in Appendix H. Services were also grouped into the remoteness area of the Medicare beneficiary, jurisdiction and the sex and age group of the beneficiary. Summary data were obtained on the number of services, total benefits paid and total charges.

Table 48 shows the number of specialist consultations for which an MBS benefit was paid by the AGSC remoteness areas for 1999-2000 to 2009-10. Number of services per 1,000 population are also shown and these are also depicted in Figure 13. Overall, there were an estimated 24.8 million out of hospital consultations with specialists for which a Medicare benefits was paid in 2009-10, involving benefit payments of just over $2 billion. Together these consultations represent a consultation rate of around 1,122 per 1,000 persons per year. Using the rates of services per 1,000 persons in major cities as the reference point, access to specialist services are much lower for rural and remote areas. In inner regional areas, rates are around 89% of major cities, outer regional are 75%, remote 49% and very remote 36%. These estimates are very close to those described in the recent AIHW analysis (see Chapter 3).
Out of hospital specialist services supported by MBS per 1,000 persons, 2000-01 to 2009-10
Figure 13 – Out of hospital specialist services supported by MBS per 1,000 persons, 2000-01 to 2009-10

Source: Health Policy Analysis of Medicare Data Extract


Over the period analysed, the gap between major cities and inner regional areas has closed significantly (from 80% to 89%). It has narrowed for outer regional areas (69% to 75%), remained almost the same for remote areas (48% to 49%) and narrowed slightly for very remote areas (33% to 36%).

Table 48 Out of hospital specialist services for which an MBS payment was made and services per 1,000 population by remoteness areas, 1999-2000 to 2009-10
Remoteness Area: Financial year ended 30 June:
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Specialist services for which an MBS payment was made '000
Major Cities 15,858 15,974 16,154 16,258 16,369 16,771 16,987 17,126 17,333 17,913 18,082
Inner Regional 3,631 3,678 3,709 3,808 3,928 4,076 4,150 4,236 4,346 4,532 4,636
Outer Regional 1,558 1,563 1,578 1,595 1,623 1,667 1,695 1,709 1,757 1,828 1,857
Remote 182 179 176 178 177 179 180 180 181 189 189
Very Remote 67 67 67 67 65 66 66 65 70 74 75
Australia 21,296 21,462 21,685 21,905 22,161 22,760 23,078 23,316 23,686 24,536 24,839
 
Specialist services per 1000 persons
Major Cities 1,190 1,199 1,212 1,203 1,196 1,210 1,208 1,198 1,188 1,202 1,189
Inner Regional 948 961 969 982 1,000 1,022 1,024 1,028 1,035 1,058 1,062
Outer Regional 823 826 833 838 848 864 868 863 874 894 895
Remote 577 569 560 564 561 571 573 569 567 585 581
Very Remote 394 394 396 397 387 393 397 389 407 428 429
Australia 1,090 1,099 1,110 1,108 1,107 1,123 1,123 1,116 1,113 1,129 1,122
 
Specialist services per 1,000 relative to major cities (Major cities = 100)
Major Cities 100 100 100 100 100 100 100 100 100 100 100
Inner Regional 80 80 80 82 84 85 85 86 87 88 89
Outer Regional 69 69 69 70 71 71 72 72 74 74 75
Remote 48 47 46 47 47 47 47 47 48 49 49
Very Remote 33 33 33 33 32 33 33 32 34 36 36
Australia 92 92 92 92 93 93 93 93 94 94 94

An important question is to what extent has MSOAP contributed to the narrowing of these gaps or prevented their widening. Table 49 presents the estimates of patient consultations supported under MSOAP Core for 2005-06 to 2009-10. Data prior to these years was not available. MSOAP started to support services in 2001-02 so the impact of the program can be estimated by comparing 1999-2000 and 2000-01 to the later years where MSOAP data is available.

One factor in estimating the impact of MSOAP is that not all service providers supported under MSOAP will bill Medicare for their consultations. In the MSOAP survey reported below, 24% of MSOAP service providers indicated that they did not bill Medicare or charge their patients a fee. Based on stakeholder consultations we understand billing rates tend to be much lower in more remote areas. Estimates of the level of MBS billing for MSOAP supported services were made as follows: inner regional – 90%, outer regional – 80%, remote - 50%, very remote – 30%. Applying these assumptions, the difference relative to major cities is largely unchanged for most remoteness areas, but is significantly reduced for very remote areas (from 36% of the major cities rate to 46%) (Table 49 and Figure 14). These estimates do not include the impact of outreach services not supported under MSOAP, such as state/territory supported outreach services.Top of page

Table 49 MSOAP supported services and estimated total services per 1,000 population by remoteness areas, 1999-2000 to 2009-10
Remoteness Area: Financial year ended 30 June:
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Number of patient consultations supported under MSOAP '000
Major Cities - -         - - - - -
Inner Regional - -         33 38 42 47 46
Outer Regional - -         63 87 88 89 78
Remote - -         10 11 11 10 12
Very Remote - -         29 27 27 27 29
Australia - -         134 164 168 172 165
 
Specialist services per 1000 persons assuming only a proportion of MSOAP services are billed
Major Cities 1,190 1,199 1,212 1,203 1,196 1,210 1,208 1,198 1,188 1,202 1,189
Inner Regional 948 961 969 982 1,000 1,022 1,025 1,029 1,036 1,060 1,064
Outer Regional 823 826 833 838 848 864 874 872 883 902 903
Remote 577 569 560 564 561 571 589 587 583 601 599
Very Remote 394 394 396 397 387 393 516 503 518 536 544
Australia 1,090 1,099 1,110 1,108 1,107 1,123 1,130 1,124 1,121 1,137 1,129
 
Specialist services per 1,000 relative to major cities assuming only a proportion of MSOAP services are billed
Major Cities 100 100 100 100 100 100 100 100 100 100 100
Inner Regional 80 80 80 82 84 85 85 86 87 88 89
Outer Regional 69 69 69 70 71 71 72 73 74 75 76
Remote 48 47 46 47 47 47 49 49 49 50 50
Very Remote 33 33 33 33 32 33 43 42 44 45 46
Australia 92 92 92 92 93 93 94 94 94 95 95

Relative gap between in access to specialist services by remoteness areas under alternative assumptions (does not include outreach services outside of MSOAP), 2009-10
Figure 14 – Relative gap between in access to specialist services by remoteness areas under alternative assumptions (does not include outreach services outside of MSOAP), 2009-10
A text description of relative gap between in access to specialist services by remoteness areas under alternative assumptions, 2009-10 chart is available on a separate page.

Based on these two estimates, the relative impact of MSOAP on access to specialist services can be estimated (Table 50). The impact can be represented in two ways: the extent to which MSOAP services bridge the gap in access to services compared with major cities and the relative impact the program has on increasing access to specialist services within remoteness areas. Overall it is estimated that MSOAP reduces the gap between major cities and inner regional areas by 0.6 percentage points. For outer regional areas, the estimate is 2.2 percentage points, 2.1 percentage points for remote and 9.4 percentage points for very remote.

The relative importance of MSOAP varies across these areas. It represents 0.7% of services in inner regional, 3% in outer regional, 4.2% in remote and between 27.2 and 28.7% in very remote areas (Table 50, Figure 15, Figure 16). Top of page

Table 50 Estimated relative impact of MSOAP services, 2005-06 to 2009-10
Remoteness Area: Financial year ended 30 June:
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Approach A: Estimate of impact of MSOAP on specialist services per 1,000 relative to major cities - %
Major Cities - -         - - - - -
Inner Regional - -         0.5 0.5 0.6 0.6 0.6
Outer Regional - -         1.9 2.6 2.6 2.5 2.2
Remote - -         1.9 2.1 2.0 1.8 2.1
Very Remote - -         10.0 9.6 9.3 8.8 9.4
Australia - -         0.4 0.5 0.5 0.5 0.4
 
Approach A: Estimate of impact of MSOAP on specialist services per 1,000 relative to RA rate - %
Major Cities - -         - - - - -
Inner Regional - -         0.6 0.6 0.7 0.7 0.7
Outer Regional - -         2.7 3.7 3.6 3.4 3.0
Remote - -         4.0 4.4 4.1 3.6 4.2
Very Remote - -         30.7 30.2 28.0 25.7 27.2
Australia - -         0.4 0.5 0.5 0.5 0.5
 
Approach B: Estimate of impact of MSOAP on specialist services per 1,000 relative to major cities - %
Major Cities - -         - - - - -
Inner Regional - -         0.5 0.5 0.6 0.6 0.6
Outer Regional - -         1.9 2.6 2.6 2.5 2.2
Remote - -         1.9 2.1 2.0 1.8 2.1
Very Remote - -         10.0 9.6 9.3 8.8 9.4
Australia - -         0.4 0.5 0.5 0.5 0.4
 
Approach B: Estimate of impact of MSOAP on specialist services per 1,000 relative to RA rate - %
Major Cities - -         - - - - -
Inner Regional - -         0.6 0.6 0.7 0.7 0.7
Outer Regional - -         2.8 3.8 3.7 3.5 3.0
Remote - -         4.0 4.5 4.1 3.7 4.2
Very Remote - -         32.8 32.2 29.6 27.1 28.7
Australia - -         0.4 0.5 0.5 0.5 0.5

Estimated specialist services per 1,000 persons, with and without MSOAP supported patient consultations, 2000-01 to 2009-10
Figure 15 – Estimated specialist services per 1,000 persons, with and without MSOAP supported patient consultations, 2000-01 to 2009-10

Source: Health Policy Analysis of Medicare Data Extract


estimate 1 - Estimated relative impact of MSOAP Core on access to specialist services under alternative assumptions, 2009-10
estimate 2 - Estimated relative impact of MSOAP Core on access to specialist services under alternative assumptions, 2009-10
Figure 16 – Estimated relative impact of MSOAP Core on access to specialist services under alternative assumptions, 2009-10

Another way of considering these impacts is to convert services supported under MSOAP into equivalent full time specialist staff. There were a reported 24,290 medical specialists in 2009 (AIHW 2011b). There were 24.8 million out of hospital MBS services for specialists reported in 2009-10, which suggests roughly an average of 1,022 consultations per specialist per year. This suggested that MSOAP is delivering the equivalent of 161 full time specialists for rural and remote communities in Australia, 45 for inner regional, 77 for outer regional, 11 for remote and 28 for very remote regions.

The estimates presented above do not take into account a number of other features and benefits. These were highlighted in stakeholder consultations, community visits and through the service provider survey. The benefits include:
    • Outreach specialist services often strengthen the capacity of primary care. This is achieved through upskilling, the provision of a consultation and liaison service outside the actual visit and other shared care style arrangements. These can result in a more capable primary care service with the confidence to manage more complex patients on an ongoing basis.
    • The availability of specialist support potentially increases the attractiveness of primary care and can therefore have an impact on the primary care workforce.
    • In some regions, it is the specialist outreach service that has been the most stable service over an extended period of time providing continuity in managing patients on an ongoing basis.
    • The availability of outreach services means that patients and their families can avoid having to travel to regional or metropolitan centres which can entail out of pocket costs, health system costs and other social costs.Top of page