{"ok":true,"summary":"For 45M (AUS), clinical categories ranked by MBS service-utilisation RATE (services per 1,000 population — NOT a probability of needing care). Highest-utilisation category: Skin. These are population rates for the cohort, not predictions about these individuals. Gold-tier categories are listed separately under 'needs_confirmation' — ASK the person the clarifying question before suggesting them.","caveat":"Service-utilisation RATE (MBS services per 1,000 population), NOT a unique-patient probability; a cohort can exceed 1000/1,000.","geo":"AUS","n_people":1,"people":[{"label":"Person 1","age":45,"age_range":"45-54","gender":"M","mapping_coverage_pct":92.40867764382976,"rateable_pct":99.99993945247783}],"period_start":"2016-07-01","period_end":"2016-07-31","n_months":1,"build_id":1,"combine_rule":"average services_per_1000 across all people (missing category = 0)","ranking":[{"clinical_category":"Skin","services_per_1000":10.514448249769806,"definition":"Hospital treatment for the investigation and treatment of skin, skin-related conditions and nails. The removal of foreign bodies is also included. Plastic surgery that is medically necessary and relating to the treatment of a skin-related condition is also included.\nFor example: melanoma, minor wound repair and abscesses.\nRemoval of excess skin due to weight loss is listed separately under Weight loss surgery.\nChemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.","min_tier":"Bronze","min_tier_rank":2,"is_phi_category":true,"model_flags":"TEMPORAL_MISMATCH","model_warning":"Service-utilisation RATE (MBS services per 1,000 population), NOT a unique-patient probability; a cohort can exceed 1000/1,000. MBS services are from 2016; ABS population is from 2025 — the rate spans mismatched periods and is directional, not headline-accurate.","mapping_coverage_pct":92.40867764382976,"rateable_pct":99.99993945247783,"per_person":[{"label":"Person 1","services_per_1000":10.514448249769806}],"rank":6},{"clinical_category":"Hospital Psychiatric Services","services_per_1000":5.328941170750386,"definition":"Hospital treatment for the treatment and care of patients with psychiatric, mental, addiction or behavioural disorders.\nFor example: psychoses such as schizophrenia, mood disorders such as depression, eating disorders and addiction therapy.","min_tier":"Basic","min_tier_rank":1,"is_phi_category":true,"model_flags":"TEMPORAL_MISMATCH","model_warning":"Service-utilisation RATE (MBS services per 1,000 population), NOT a unique-patient probability; a cohort can exceed 1000/1,000. MBS services are from 2016; ABS population is from 2025 — the rate spans mismatched periods and is directional, not headline-accurate.","mapping_coverage_pct":92.40867764382976,"rateable_pct":99.99993945247783,"per_person":[{"label":"Person 1","services_per_1000":5.328941170750386}],"rank":7},{"clinical_category":"Gastrointestinal Endoscopy","services_per_1000":1.6829194915383003,"definition":"Hospital treatment for the diagnosis, investigation and treatment of the internal parts of the gastrointestinal system using an endoscope.\nFor example: colonoscopy, gastroscopy, endoscopic retrograde cholangiopancreatography (ERCP).\nNon-endoscopic procedures for the digestive system are listed separately under Digestive system.","min_tier":"Bronze","min_tier_rank":2,"is_phi_category":true,"model_flags":"TEMPORAL_MISMATCH","model_warning":"Service-utilisation RATE (MBS services per 1,000 population), NOT a unique-patient probability; a cohort can exceed 1000/1,000. MBS services are from 2016; ABS population is from 2025 — the rate spans mismatched periods and is directional, not headline-accurate.","mapping_coverage_pct":92.40867764382976,"rateable_pct":99.99993945247783,"per_person":[{"label":"Person 1","services_per_1000":1.6829194915383003}],"rank":8},{"clinical_category":"Ear, Nose and Throat","services_per_1000":1.5577185470612724,"definition":"Hospital treatment for the investigation and treatment of the ear, nose, throat, middle ear, thyroid, parathyroid, larynx, lymph nodes and related areas of the head and neck.\nFor example: damaged ear drum, sinus surgery, removal of foreign bodies, stapedectomy and throat cancer.\nTonsils, adenoids and grommets are listed separately under Tonsils, adenoids and grommets. \nThe implantation of a hearing device is listed separately under Implantation of hearing devices. \nOrthopaedic neck conditions are listed separately under Back, neck and spine.\nSleep studies are listed separately under Sleep studies.\nChemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.","min_tier":"Bronze","min_tier_rank":2,"is_phi_category":true,"model_flags":"TEMPORAL_MISMATCH","model_warning":"Service-utilisation RATE (MBS services per 1,000 population), NOT a unique-patient probability; a cohort can exceed 1000/1,000. MBS services are from 2016; ABS population is from 2025 — the rate spans mismatched periods and is directional, not headline-accurate.","mapping_coverage_pct":92.40867764382976,"rateable_pct":99.99993945247783,"per_person":[{"label":"Person 1","services_per_1000":1.5577185470612724}],"rank":9},{"clinical_category":"Brain and Nervous System","services_per_1000":1.0654235712049982,"definition":"Hospital treatment for the investigation and treatment of the brain, brain-related conditions, spinal cord and peripheral nervous system.\nFor example: stroke, brain or spinal cord tumours, head injuries, epilepsy and Parkinson’s disease.\nTreatment of spinal column (back bone) conditions is listed separately under Back, neck and spine.\nChemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.","min_tier":"Bronze","min_tier_rank":2,"is_phi_category":true,"model_flags":"TEMPORAL_MISMATCH","model_warning":"Service-utilisation RATE (MBS services per 1,000 population), NOT a unique-patient probability; a cohort can exceed 1000/1,000. MBS services are from 2016; ABS population is from 2025 — the rate spans mismatched periods and is directional, not headline-accurate.","mapping_coverage_pct":92.40867764382976,"rateable_pct":99.99993945247783,"per_person":[{"label":"Person 1","services_per_1000":1.0654235712049982}],"rank":11},{"clinical_category":"Kidney and Bladder","services_per_1000":0.9858054948628109,"definition":"Hospital treatment for the investigation and treatment of the kidney, adrenal gland and bladder.\nFor example: kidney stones, adrenal gland tumour and incontinence.\nDialysis is listed separately under Dialysis for chronic kidney failure.\nChemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.","min_tier":"Bronze","min_tier_rank":2,"is_phi_category":true,"model_flags":"TEMPORAL_MISMATCH","model_warning":"Service-utilisation RATE (MBS services per 1,000 population), NOT a unique-patient probability; a cohort can exceed 1000/1,000. MBS services are from 2016; ABS population is from 2025 — the rate spans mismatched periods and is directional, not headline-accurate.","mapping_coverage_pct":92.40867764382976,"rateable_pct":99.99993945247783,"per_person":[{"label":"Person 1","services_per_1000":0.9858054948628109}],"rank":12},{"clinical_category":"Eye (not Cataracts)","services_per_1000":0.7439124079605921,"definition":"Hospital treatment for the investigation and treatment of the eye and the contents of the eye socket.\nFor example: retinal detachment, tear duct conditions, eye infections and medically managed trauma to the eye.\nCataract procedures are listed separately under Cataracts.\nEyelid procedures are listed separately under Plastic and reconstructive surgery.\nChemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.","min_tier":"Bronze","min_tier_rank":2,"is_phi_category":true,"model_flags":"TEMPORAL_MISMATCH","model_warning":"Service-utilisation RATE (MBS services per 1,000 population), NOT a unique-patient probability; a cohort can exceed 1000/1,000. MBS services are from 2016; ABS population is from 2025 — the rate spans mismatched periods and is directional, not headline-accurate.","mapping_coverage_pct":92.40867764382976,"rateable_pct":99.99993945247783,"per_person":[{"label":"Person 1","services_per_1000":0.7439124079605921}],"rank":13},{"clinical_category":"Plastic and Reconstructive Surgery (medically Necessary)","services_per_1000":0.6460611843644685,"definition":"Hospital treatment which is medically necessary for the investigation and treatment of any physical deformity, whether acquired as a result of illness or accident, or congenital.\nFor example: burns requiring a graft, cleft palate, club foot and angioma.\nPlastic surgery that is medically necessary relating to the treatment of a skin-related condition is listed separately under Skin.\nChemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.","min_tier":"Silver","min_tier_rank":3,"is_phi_category":true,"model_flags":"TEMPORAL_MISMATCH","model_warning":"Service-utilisation RATE (MBS services per 1,000 population), NOT a unique-patient probability; a cohort can exceed 1000/1,000. MBS services are from 2016; ABS population is from 2025 — the rate spans mismatched periods and is directional, not headline-accurate.","mapping_coverage_pct":92.40867764382976,"rateable_pct":99.99993945247783,"per_person":[{"label":"Person 1","services_per_1000":0.6460611843644685}],"rank":14},{"clinical_category":"Digestive System","services_per_1000":0.6442378696390748,"definition":"Hospital treatment for the investigation and treatment of the digestive system, including the oesophagus, stomach, gall bladder, pancreas, spleen, liver and bowel.\nFor example: oesophageal cancer, irritable bowel syndrome, gall stones and haemorrhoids.\nEndoscopy is listed separately under Gastrointestinal endoscopy. \nHernia and appendicectomy procedures are listed separately under Hernia and appendix. \nBariatric surgery is listed separately under Weight loss surgery.\nChemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.","min_tier":"Bronze","min_tier_rank":2,"is_phi_category":true,"model_flags":"TEMPORAL_MISMATCH","model_warning":"Service-utilisation RATE (MBS services per 1,000 population), NOT a unique-patient probability; a cohort can exceed 1000/1,000. MBS services are from 2016; ABS population is from 2025 — the rate spans mismatched periods and is directional, not headline-accurate.","mapping_coverage_pct":92.40867764382976,"rateable_pct":99.99993945247783,"per_person":[{"label":"Person 1","services_per_1000":0.6442378696390748}],"rank":15},{"clinical_category":"Bone, Joint and Muscle","services_per_1000":0.6241814076597452,"definition":"Hospital treatment for the investigation and treatment of diseases, disorders and injuries of the musculoskeletal system.\nFor example: carpal tunnel, fractures, hand surgery, joint fusion, bone spurs, osteomyelitis and bone cancer.\nChest surgery is listed separately under Lung and chest. \nSpinal cord conditions are listed separately under Brain and nervous system. \nSpinal column conditions are listed separately under Back, neck and spine. \nJoint reconstructions are listed separately under Joint reconstructions. \nJoint replacements are listed separately under Joint replacements. \nPodiatric surgery performed by a registered podiatric surgeon is listed separately under Podiatric surgery (provided by a registered podiatric surgeon).\nManagement of back pain is listed separately under Pain management. Pain management that requires a device is listed separately under Pain management with device.\nChemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.","min_tier":"Bronze","min_tier_rank":2,"is_phi_category":true,"model_flags":"TEMPORAL_MISMATCH","model_warning":"Service-utilisation RATE (MBS services per 1,000 population), NOT a unique-patient probability; a cohort can exceed 1000/1,000. MBS services are from 2016; ABS population is from 2025 — the rate spans mismatched periods and is directional, not headline-accurate.","mapping_coverage_pct":92.40867764382976,"rateable_pct":99.99993945247783,"per_person":[{"label":"Person 1","services_per_1000":0.6241814076597452}],"rank":16},{"clinical_category":"Heart and Vascular System","services_per_1000":0.41997015841566104,"definition":"Hospital treatment for the investigation and treatment of the heart, heart-related conditions and vascular system.\nFor example: heart failure and heart attack, monitoring of heart conditions, varicose veins and removal of plaque from arterial walls.\nChemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.","min_tier":"Silver","min_tier_rank":3,"is_phi_category":true,"model_flags":"TEMPORAL_MISMATCH","model_warning":"Service-utilisation RATE (MBS services per 1,000 population), NOT a unique-patient probability; a cohort can exceed 1000/1,000. MBS services are from 2016; ABS population is from 2025 — the rate spans mismatched periods and is directional, not headline-accurate.","mapping_coverage_pct":92.40867764382976,"rateable_pct":99.99993945247783,"per_person":[{"label":"Person 1","services_per_1000":0.41997015841566104}],"rank":17},{"clinical_category":"Chemotherapy, Radiotherapy and Immunotherapy for Cancer","services_per_1000":0.41814684369026744,"definition":"Hospital treatment for chemotherapy, radiotherapy and immunotherapy for the treatment of cancer or benign tumours. \nSurgical treatment of cancer is listed separately under each body system.","min_tier":"Bronze","min_tier_rank":2,"is_phi_category":true,"model_flags":"TEMPORAL_MISMATCH","model_warning":"Service-utilisation RATE (MBS services per 1,000 population), NOT a unique-patient probability; a cohort can exceed 1000/1,000. MBS services are from 2016; ABS population is from 2025 — the rate spans mismatched periods and is directional, not headline-accurate.","mapping_coverage_pct":92.40867764382976,"rateable_pct":99.99993945247783,"per_person":[{"label":"Person 1","services_per_1000":0.41814684369026744}],"rank":18},{"clinical_category":"Pain Management","services_per_1000":0.3865427217834449,"definition":"Hospital treatment for pain management that does not require the insertion or surgical management of a device.\nFor example: treatment of nerve pain and chest pain due to cancer by injection of a nerve block.\nPain management using a device (for example an infusion pump or neurostimulator) is listed separately under Pain management with device.","min_tier":"Bronze","min_tier_rank":2,"is_phi_category":true,"model_flags":"TEMPORAL_MISMATCH","model_warning":"Service-utilisation RATE (MBS services per 1,000 population), NOT a unique-patient probability; a cohort can exceed 1000/1,000. MBS services are from 2016; ABS population is from 2025 — the rate spans mismatched periods and is directional, not headline-accurate.","mapping_coverage_pct":92.40867764382976,"rateable_pct":99.99993945247783,"per_person":[{"label":"Person 1","services_per_1000":0.3865427217834449}],"rank":19},{"clinical_category":"Male Reproductive System","services_per_1000":0.3427831683739983,"definition":"Hospital treatment for the investigation and treatment of the male reproductive system including the prostate.\nFor example: male sterilisation, circumcision and prostate cancer.\nChemotherapy and radiotherapy for cancer is listed separately under Chemotherapy, radiotherapy and immunotherapy for cancer.","min_tier":"Bronze","min_tier_rank":2,"is_phi_category":true,"model_flags":"TEMPORAL_MISMATCH","model_warning":"Service-utilisation RATE (MBS services per 1,000 population), NOT a unique-patient probability; a cohort can exceed 1000/1,000. MBS services are from 2016; ABS population is from 2025 — the rate spans mismatched periods and is directional, not headline-accurate.","mapping_coverage_pct":92.40867764382976,"rateable_pct":99.99993945247783,"per_person":[{"label":"Person 1","services_per_1000":0.3427831683739983}],"rank":20},{"clinical_category":"Joint Reconstructions","services_per_1000":0.2522252036794491,"definition":"Hospital treatment for surgery for joint reconstructions.\nFor example: torn tendons, rotator cuff tears and damaged ligaments.\nJoint replacements are listed separately under Joint replacements. \nBone fractures are listed separately under Bone, joint and muscle.\nProcedures to the spinal column are listed separately under Back, neck and spine.\nPodiatric surgery performed by a registered podiatric surgeon is listed separately under Podiatric surgery (provided by a registered podiatric surgeon).","min_tier":"Bronze","min_tier_rank":2,"is_phi_category":true,"model_flags":"TEMPORAL_MISMATCH","model_warning":"Service-utilisation RATE (MBS services per 1,000 population), NOT a unique-patient probability; a cohort can exceed 1000/1,000. MBS services are from 2016; ABS population is from 2025 — the rate spans mismatched periods and is directional, not headline-accurate.","mapping_coverage_pct":92.40867764382976,"rateable_pct":99.99993945247783,"per_person":[{"label":"Person 1","services_per_1000":0.2522252036794491}],"rank":22}],"ranking_truncated":true,"empty":false,"tier_coverage":{"Basic":{"covered_services_per_1000":5.4480643994761015,"total_phi_services_per_1000":27.955669141309937,"coverage_pct":19.488227493097373},"Bronze":{"covered_services_per_1000":24.73691087941508,"total_phi_services_per_1000":27.955669141309937,"coverage_pct":88.48620562210577},"Silver":{"covered_services_per_1000":25.816920968423233,"total_phi_services_per_1000":27.955669141309937,"coverage_pct":92.34950105441659},"Gold":{"covered_services_per_1000":27.955669141309937,"total_phi_services_per_1000":27.955669141309937,"coverage_pct":100.0}},"tier_caveat":"Product-tier coverage is category-level ELIGIBILITY under the legislated minimum, NOT payment of every item and NOT a probability of needing care. Coverage % is a share of expected PHI service volume.","needs_confirmation":[{"clinical_category":"Sleep Studies","min_tier":"Gold","services_per_1000":1.2866524245527562,"definition":"Hospital treatment for the investigation of sleep patterns and anomalies. \nFor example: sleep apnoea and snoring.","clarifying_question":"Have you been advised you may need an in-hospital sleep study (e.g. for sleep apnoea)? Sleep studies are only covered at the Gold tier."},{"clinical_category":"Dialysis for Chronic Kidney Failure","min_tier":"Gold","services_per_1000":0.2990236149645517,"definition":"Hospital treatment for dialysis treatment for chronic kidney failure.\nFor example: peritoneal dialysis and haemodialysis.","clarifying_question":"Do you have, or are you at risk of, chronic kidney failure that could require dialysis? Dialysis is only covered at the Gold tier."},{"clinical_category":"Weight Loss Surgery","min_tier":"Gold","services_per_1000":0.22062108177262657,"definition":"Hospital treatment for surgery that is designed to reduce a person’s weight, remove excess skin due to weight loss and reversal of a bariatric procedure.\nFor example: gastric banding, gastric bypass, sleeve gastrectomy.","clarifying_question":"Are you considering weight-loss (bariatric) surgery, or has a clinician raised it with you? It is only covered at the Gold tier."},{"clinical_category":"Cataracts","min_tier":"Gold","services_per_1000":0.134925289679127,"definition":"Hospital treatment for surgery to remove a cataract and replace with an artificial lens.","clarifying_question":"Do you have, or have you been told you may develop, cataracts needing surgery? Cataract surgery is only covered at the Gold tier."},{"clinical_category":"Joint Replacements","min_tier":"Gold","services_per_1000":0.09845899517125484,"definition":"Hospital treatment for surgery for joint replacements, including revisions, resurfacing, partial replacements and removal of prostheses.\nFor example: replacement of shoulder, wrist, finger, hip, knee, ankle, or toe joint.\nJoint fusions are listed separately under Bone, joint and muscle.\nSpinal fusions are listed separately under Back, neck and spine.\nJoint reconstructions are listed separately under Joint reconstructions.\nPodiatric surgery performed by a registered podiatric surgeon is listed separately under Podiatric surgery (provided by a registered podiatric surgeon).","clarifying_question":"Do you have a joint condition (e.g. hip or knee) that may need a replacement? Joint replacements are only covered at the Gold tier."},{"clinical_category":"Pain Management with Device","min_tier":"Gold","services_per_1000":0.051052812311021024,"definition":"Hospital treatment for the implantation, replacement or other surgical management of a device required for the treatment of pain.\nFor example: treatment of nerve pain, back pain, and pain caused by coronary heart disease with a device (for example an infusion pump or neurostimulator).\nTreatment of pain that does not require a device is listed separately under Pain management.","clarifying_question":"Do you have a chronic pain condition that may need an implanted pain-management device? This is only covered at the Gold tier."},{"clinical_category":"Assisted Reproductive Services","min_tier":"Gold","services_per_1000":0.04558286813484021,"definition":"Hospital treatment for fertility treatments or procedures.\nFor example: retrieval of eggs or sperm, In vitro Fertilisation (IVF), and Gamete Intra-fallopian Transfer (GIFT).\nTreatment of the female reproductive system is listed separately under Gynaecology. \nPregnancy and birth-related services are listed separately under Pregnancy and birth.","clarifying_question":"Are you considering IVF or other assisted-reproduction treatment? These services are only covered at the Gold tier."},{"clinical_category":"Pregnancy and Birth","min_tier":"Gold","services_per_1000":0.0024310863005248106,"definition":null,"clarifying_question":"Are you planning to have children (or expecting) in the period this cover would apply? Pregnancy & Birth is only covered at the Gold tier."}],"needs_confirmation_note":"Gold-tier categories tied to a specific individual health need. ASK the person each clarifying_question before recommending these — do not recommend them based on the cohort rate alone.","non_phi_categories":[{"clinical_category":"Common List","services_per_1000":419.61157318633366,"definition":null,"min_tier":null,"min_tier_rank":null,"is_phi_category":false,"model_flags":"TEMPORAL_MISMATCH","model_warning":"Service-utilisation RATE (MBS services per 1,000 population), NOT a unique-patient probability; a cohort can exceed 1000/1,000. MBS services are from 2016; ABS population is from 2025 — the rate spans mismatched periods and is directional, not headline-accurate.","mapping_coverage_pct":92.40867764382976,"rateable_pct":99.99993945247783,"per_person":[{"label":"Person 1","services_per_1000":419.61157318633366}],"rank":1},{"clinical_category":"Support List (pathology)","services_per_1000":324.4953216783004,"definition":null,"min_tier":null,"min_tier_rank":null,"is_phi_category":false,"model_flags":"TEMPORAL_MISMATCH","model_warning":"Service-utilisation RATE (MBS services per 1,000 population), NOT a unique-patient probability; a cohort can exceed 1000/1,000. MBS services are from 2016; ABS population is from 2025 — the rate spans mismatched periods and is directional, not headline-accurate.","mapping_coverage_pct":92.40867764382976,"rateable_pct":99.99993945247783,"per_person":[{"label":"Person 1","services_per_1000":324.4953216783004}],"rank":2},{"clinical_category":"N/a (not Hospital Treatment)","services_per_1000":55.61535352553096,"definition":null,"min_tier":null,"min_tier_rank":null,"is_phi_category":false,"model_flags":"TEMPORAL_MISMATCH,NON_CLINICAL","model_warning":"Service-utilisation RATE (MBS services per 1,000 population), NOT a unique-patient probability; a cohort can exceed 1000/1,000. MBS services are from 2016; ABS population is from 2025 — the rate spans mismatched periods and is directional, not headline-accurate.","mapping_coverage_pct":92.40867764382976,"rateable_pct":99.99993945247783,"per_person":[{"label":"Person 1","services_per_1000":55.61535352553096}],"rank":3},{"clinical_category":"Support List (di)","services_per_1000":52.58014227932574,"definition":null,"min_tier":null,"min_tier_rank":null,"is_phi_category":false,"model_flags":"TEMPORAL_MISMATCH","model_warning":"Service-utilisation RATE (MBS services per 1,000 population), NOT a unique-patient probability; a cohort can exceed 1000/1,000. MBS services are from 2016; ABS population is from 2025 — the rate spans mismatched periods and is directional, not headline-accurate.","mapping_coverage_pct":92.40867764382976,"rateable_pct":99.99993945247783,"per_person":[{"label":"Person 1","services_per_1000":52.58014227932574}],"rank":4},{"clinical_category":"Support List","services_per_1000":23.36334711961856,"definition":null,"min_tier":null,"min_tier_rank":null,"is_phi_category":false,"model_flags":"TEMPORAL_MISMATCH","model_warning":"Service-utilisation RATE (MBS services per 1,000 population), NOT a unique-patient probability; a cohort can exceed 1000/1,000. MBS services are from 2016; ABS population is from 2025 — the rate spans mismatched periods and is directional, not headline-accurate.","mapping_coverage_pct":92.40867764382976,"rateable_pct":99.99993945247783,"per_person":[{"label":"Person 1","services_per_1000":23.36334711961856}],"rank":5}]}