Adequacy of Australia's GP workforce: estimating supply and demand, 2005-06 to 2015-16

An assessment of the spatial distribution of bulk billing-only GP services in Australia in relation to area-based socio-economic status

BACKGROUND

The accessibility to affordable primary healthcare services contributes to population health and health equity. A key aspect to accessibility is the geographical distribution of primary healthcare services. Limited studies have assessed the nationwide spatial distribution of bulk billing-only medical practices or 'no-fee' services. The aim of this study was to provide a nationwide approximation of bulk billing-only services and evaluate the socio-demographic status and population characteristics in relation to the distribution of bulk billing-only GP services.

METHODS

The methodology in this study used Geographic Information System (GIS) technology to map the locations of all bulk bulking-only medical practices collected in mid-2020 and linked this with population data. The population data and practice locations were analysed at the level of Statistical Areas Level 2 (SA2) regions and used the most recent Census data.

RESULTS

The study sample included (n =2095) bulk billing-only medical practice locations. The nationwide average Population-to-Practice (PtP) ratio was 1 practice to 8529 people for regions with access to bulk billing-only practice, and 57.4% of the Australian population lives within an SA2 that has access to at least one bulk billing-only medical practices. No significant associations were identified between practice distribution and area socio-economic status.

CONCLUSION

The study identified areas with low access to affordable GP services, with many SA2 regions having no access to bulk billing-only practices. Findings also indicate that there was no association between area socio-economic status and the distribution of bulk billing-only services.

Primary Care Visits in the USA and Australia 2000-2016

BACKGROUND

There are major concerns about the sustainability of the US primary care (PC) system.

OBJECTIVE

We use similar data from the USA and Australia on adult visits to primary care physicians to examine how primary care service delivery and content in the countries have changed since the year 2001.

DESIGN/SETTING/PARTICIPANTS

Longitudinal analyses of nationally representative data collected in a similar manner on outpatient visits to PC in the USA (National Ambulatory Medical Care Survey, NAMCS) and Australia (Bettering the Evaluation and Care of Health, BEACH), 2001-2016.

MAIN MEASURES

For each visit, we ascertained the problems/diagnoses managed; the length of the visit in minutes; what medications were recorded; whether counseling, advice, or education was provided; the rate of imaging and diagnostics tests; the laboratory tests ordered; and whether the visit resulted in a referral to another physician.

KEY RESULTS

Between 2001 and 2016, there were 128,770 encounters with adult patients in NAMCS and 1,338,963 in BEACH. In the USA, the proportion of encounters with 3 or more problems managed increased from 28.7 to 54.8% whereas Australia started at a lower proportion (10.6%) and increased to just 14.1%. Visit times in the USA increased from 17.2 min in 2001 to 22.9 min in 2016 as compared to 14.4 min increasing to 15.2 in Australia. There were significantly more medications recorded over time in NAMCS than BEACH (2.02 in 2001 to 3.32 in 2016, USA, and 1.10 and 1.04, Australia), and US encounters resulted in imaging studies, lab tests, or referrals with relatively increasing frequency.

CONCLUSION

Relative to Australia, PC visits in the USA increasingly entail more complexity with visits that have grown comparatively longer over time, with more problems addressed, and with more content.

Service utilisation trends in the manual therapy professions within the Australian private healthcare setting between 2008 and 2017

BACKGROUND

Better understanding of the dynamics and temporal changes in manual therapy service utilisation may assist with healthcare planning and resource allocation. The objectives of this study were to quantify, describe, and compare service utilisation trends in the manual therapy professions within the Australian private healthcare setting between 2008 and 2017.

METHODS

Data regarding the number of services, total cost, and benefits paid were extracted for each manual therapy profession (i.e. chiropractic, osteopathy, and physiotherapy) for the period 2008-2017 from the Australian Prudential Regulation Authority. The number of registered providers for each profession were obtained from the Australian Health Practitioner Regulation Agency. Descriptive statistics were produced for two time periods (i.e. 2008-2012 and 2013-2017) for each manual therapy profession. Annual percentage change during each time period was estimated by fitting Poisson regression models. Test for the equality of regression coefficients was used to compare the trends in the two time periods within each profession, and to compare the trends across professions within a time period.

RESULTS

A cumulative total of 198.6 million manual therapy services with a total cost of $12.8 billion was provided within the Australian private healthcare setting between 2008 and 2017. Although service utilisation and total cost increased throughout the ten-year period, the annual growth was significantly lower during 2013-2017 than 2008-2012. Whereas osteopathy and physiotherapy experienced significant annual growth in the number of services and total cost during 2013-2017, negative growth in the number of services was observed for chiropractic during the same period. The annual number of services per provider declined significantly for chiropractic and physiotherapy between 2013 and 2017.

CONCLUSION

Service provision under private health insurance general treatment cover constitute a major source of revenue for manual therapy professions in Australia. Although manual therapy service utilisation increased throughout the ten-year period from 2008 to 2017, the annual growth declined. There were diverging trends across the three professions, including significantly greater decline in annual growth for chiropractic than for osteopathy and physiotherapy.