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COVID’s impact on health service usage, rebates and scripts

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Latest data from the Australian Institute of Health and Welfare (AIHW) tracks the impact of COVID-19 on health and services used.
 
Comparing Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) service use in 2020 with the same period in 2019, the AIHW reports that bulk-billing incentives increased from $55.6 million in March 2020, to an average of $130.4 million per month from April to August.
 
Between March – when COVID-19 measures were first implemented – and December 2020, there were 166,752,498 Medicare services processed and over $9 billion in benefits paid for COVID-related items.
 
Overall use of COVID-related items and benefits paid peaked in July 2020, with 17,638,456 services provided and $969 million in benefits paid. The start of Victoria’s second wave in July contributed to services peaking in Greater Melbourne.
 
Following the introduction of temporary MBS telehealth video and phone items in March 2020, there was a drop in face-to-face GP consultations, dipping to a low of 7,068,108 across Australia in August.
 
This was particularly evident in Victoria during the state’s second wave of COVID-19 from July to September 2020.
 
Compared to the previous year, when there were 12,674,048 face-to-face GP attendances in May 2019 – the highest of any month – there were just 7,628,886 face-to-face attendances in May 2020.
 
April 2020 saw the most GP attendances overall, comprising:
 

• 7,895,745 face-to-face services
• 4,175,507 phone services
• 154,722 video services.

 
The same month also saw a large spike in brief (Level A) GP attendances, marking the beginning of flu season and people being urged to get their flu vaccination.
 
From April to September 2020, there was an increase in benefits paid for incentive items, coinciding with the doubling of rebates associated with the temporary COVID-19 bulk-billing incentives items.

In September there were 2,112,868 services for COVID-19 bulk-billing incentive items – the highest for 2020. A total of $30,128,125 in benefits were paid for COVID-related items during this month.
 
Although the AIHW analysis indicates that COVID-19 had little impact on overall PBS script volumes for 2020 compared to 2019, there was a surge early on in the pandemic.
 
In March 2020, the volume of scripts dispensed nationally (31,034,515) was 23% higher compared to March 2019.
 
This coincided with the introduction of COVID-19 restrictions and was followed by a decrease in April 2020 – a pattern occurring in every state and territory and most areas within each jurisdiction.
 
But there was some regional variation across the nation, with the most noticeable increases in PBS scripts in greater metropolitan areas. The Northern Territory was the exception, seeing the biggest surge territory-wide, with scripts increasing by more than 30% in all areas compared to the previous March.
 
The Department of Health warned GPs in early 2020 to stop filling out Regulation 49 scripts, after thousands were being filled each week under the PBS Regulation 49 hardship measures, due to GPs wanting to help vulnerable patients to self-isolate.
 
Then-RACGP President Dr Harry Nespolon agreed that it could lead to a shortage of medication, but backed GPs wanting to support their patients to only go to the pharmacy when necessary.
 
The surge in PBS prescriptions included a high number for respiratory medicines – particularly asthma and chronic obstructive pulmonary disease – up by 87.5% in March compared to the previous year.
 
Notably, there was a decrease for antibiotics and antivirals throughout 2020 compared to the previous year, from 2.5 million in March to 1.5 million in April.
 
The AIHW notes this could be associated with COVID-19 measures such as physical distancing, hand hygiene and lockdowns, corresponding with reports of lower numbers of influenza cases in Australia compared to previous years.
 
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AIHW COVID-19 MBS benefits PBS telehealth

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