Remote Aboriginal primary health care classification and cost estimation: a casemix and Medical Benefit Groups approach from Australia’s Northern Territory

Abstract Background Service classifications and costings are important for measuring the effectiveness and efficiency of health service delivery. This study aimed to develop and test a new classification of primary health care (PHC) by care type and stage of condition, and to pilot this classification by estimating average costs per visit and annual cycle of care for the Northern Territory (NT) Government managed remote clinics in Australia. Methods Patient and service data were gathered from the NT Department of Health Primary Care Information System that uses the International Classification of Primary Care version 2 plus (ICPC) for data collection. PHC financial data were extracted from the NT Government Accounting System. We defined a new framework, the Medical Benefit Groups (MBGs), to classify PHC encounters using spectrum (illness) and continuum (stage of illness and type of care) categories for each visit and annual cycle of care, and calculated the average costs associated with the spectrum and continuum by activity-based costing. Results Seven continuum categories consolidated ICPC codes: Prevention, Symptoms, Diagnostics, Results, Conditions, Therapeutics and Referrals. Twenty spectrum categories used ICPC alpha codes for chapters and multi-system categories (cancer, injury and infectious disease). Between 2017/18 and 2021/22, a total of 2.2 million visits and 801,000 cycles of care were recorded for 51 remote clinics serving a predominantly Aboriginal population (86%). After adjusting for inflation, the average costs were estimated at $386-$455 per visit, with average costs per annual cycle of care ranging from $1080 to $1175 in 2020 Australian dollars. The average cost by MBG continuum was $1126 per cycle of care, ranging from Symptoms $1008 to Referrals $1318 annually. For MBG spectrum categories, Urology (including chronic kidney disease) was the most costly condition ($1388 per cycle of care), followed by Pregnancy ($1290) and Blood ($1171, including iron deficiency anaemia). The total annual funding averaged $4685 per person. Conclusions MBGs can be used to better understand PHC expenditure by type and stage of illness and thereby provide useful insights into remote Aboriginal PHC utilisation and health outcomes. This research serves as a necessary first step towards better financial management, sustainability and adequacy of health care resources for remote PHC delivery.