Medicare Benefits Scheme Utilisation in Australians with Congenital Heart Disease (CHD): A Population-Based Analysis

Introduction Patients with congenital heart disease (CHD) require coordinated, lifelong multidisciplinary care. We examined Medicare Benefits Scheme (MBS) utilisation in this growing population. Method We analysed linked MBS claims data (2017–2022) of 1,492 individuals with CHD in New South Wales and Victoria from a multicentre study. Cross-sectional utilisation in 2022 was examined. Age- and sex-adjusted service utilisation rates per 100,000 population were compared with corresponding general population rates using Poisson regression. The ≥85-year age band was excluded due to absence of CHD participants, obstetric services in the 0–4 band due to absence of claims in either population, and dental Broad Type of Service (BTOS) categories due to no CHD claims in the study period. Results The CHD cohort (median age 24 years [IQR 11–41]; 50% female) Rate Ratios (RR; Figure ) demonstrated significantly higher utilisation across multiple BTOS compared with the general population including Other Medical (4.02), Anaesthetics (2.44), Specialist Attendances (1.98), Diagnostic Imaging (1.75), and Pathology Tests (1.45). Conversely, General Practitioner (GP) Attendances and Obstetric services RRs were lower, 0.89 and 0.63 respectively (p<0.001). Discussion Adults with CHD show higher MBS service utilisation but lower primary care engagement than the general population. These concerning data warrant further investigation.