CoverClear

Methodology & sources

What the numbers are

Service-utilisation RATE (MBS services per 1,000 population), NOT a unique-patient probability; a cohort can exceed 1000/1,000.

Why a one-month 2016 window? The published MBS clinical-category service counts used here are a single representative monthly extract from 2016 — the vintage at which this category-level breakdown is openly available — while the population denominator uses the latest ABS estimates (2025). It is a deliberate prototype choice to get the joins and rankings into a trustworthy, queryable state, not a data error; the mismatched periods are why the rates are presented as directional rather than headline-accurate.

How a cohort ranking is derived

For a given age and sex, we take the MBS service counts for that cohort, divide by the ABS resident population for the same age band and sex to get a rate per 1,000, and rank the clinical categories by that rate. A household averages each category's rate across the entered people. The data resolves 10 age bands and Male/Female cohorts only.

PHI tier overlay

Each clinical category carries the lowest PHI product tier (Basic → Bronze → Silver → Gold, cumulative) that must cover it under the Private Health Insurance (Complying Product) Rules. Coverage % is the share of expected PHI service volume covered at a tier — eligibility to claim, not payment of every item, and not a probability of needing care. Gold-tier categories are tied to specific individual needs and are listed separately.

Sources

SourceFilePeriodDownloaded
abs_population_age_sex source.csv 2025-09 2026-05-24T01:39:56+00:00
abs_population_age_sex source.xml 2025-09 2026-05-24T01:39:56+00:00
abs_regional_population_age_sex lga.xlsx 2024 2026-05-24T02:28:59+00:00
abs_regional_population_age_sex sa2.xlsx 2024 2026-05-24T02:28:59+00:00
mbs_patient_demographics source.csv 2016 2026-05-24T01:39:55+00:00
phi_clinical_category source.xlsx 2026-03-01 2026-05-24T01:39:55+00:00
phi_clinical_category_definitions source.docx 2026-03-01 2026-05-24T02:28:52+00:00

Model built: 2026-05-24T04:40:15+00:00. Licensed under CC BY 4.0.

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