Abstract
Australia has a universal healthcare system, yet organisation and delivery of primary healthcare (PHC) services varies across local areas. Understanding the nature and extent of this variation is essential to improve quality of care and health equity, but this has been hampered by a lack of suitable measures across the breadth of effective PHC systems. Using a suite of measures constructed at the area-level, this study explored their application in assessing area-level variation in PHC organisation and delivery. Routinely collected data from New South Wales, Australia were used to construct 13 small area-level measures of PHC service organisation and delivery that best approximated access (availability, affordability, accommodation) comprehensiveness and coordination. Regression analyses and pairwise Pearson's correlations were used to examine variation by area, and by remoteness and area disadvantage. PHC service delivery varied geographically at the small-area level-within cities and more remote locations. Areas in major cities were more accessible (all measures), while in remote areas, services were more comprehensive and coordinated. In disadvantaged areas of major cities, there were fewer GPs (most disadvantaged quintile 0.9[SD 0.1] vs least 1.0[SD 0.2]), services were more affordable (97.4%[1.6] bulk-billed vs 75.7[11.3]), a greater proportion were after-hours (10.3%[3.0] vs 6.2[2.9]) and for chronic disease care (28%[3.4] vs 17.6[8.0]) but fewer for preventive care (50.7%[3.8] had cervical screening vs 62.5[4.9]). Patterns were similar in regional locations, other than disadvantaged areas had less after-hours care (1.3%[0.7] vs 6.1%[3.9]). Measures were positively correlated, except GP supply and affordability in major cities (-0.41, p < .01). Application of constructed measures revealed inequity in PHC service delivery amenable to policy intervention. Initiatives should consider the maldistribution of GPs not only by remoteness but also by area disadvantage. Avenues for improvement in disadvantaged areas include preventative care across all regions and after-hours care in regional locations.
Highlights
Measuring how organisation and delivery of primary health care (PHC) services varies between and within countries is essential to identify best practice for achieving system goals of high-quality care and health equity [1,2,3,4]
Detailed information for accessing the data underlying the results presented in the study are available from: AIHW health workforce, https:// www.aihw.gov.au/about-our-data/accessing-datathrough-the-aihw/data-on-request; Australian Medical Publishing company (AMPCo) Medical workforce, https://www.ampco.com.au/ampcodata-services/; Health Establishment Registration Online (HERO) data, http://www.healthstats. nsw.gov.au; Medicare Benefit Schedule (MBS) claims, https://www. servicesaustralia.gov.au/organisations/about-us/ reports-and-statistics/statistical-information-anddata#contacts; and ARIA + https://arts.adelaide. edu.au/hugo-centre/services/aria
While Australia has universal health care, PHC service organisation and access to care varies according to remoteness [5,6,7,8] and area disadvantage [7,8,9,10], with the disparity in access between metropolitan and more remote areas preeminent in the literature and policy discourse [11,12,13,14]
Summary
Measuring how organisation and delivery of primary health care (PHC) services varies between and within countries is essential to identify best practice for achieving system goals of high-quality care and health equity [1,2,3,4]. The service delivery level (or process level) relating to organisational characteristics of health services more generally (access, including availability, affordability and accommodation) and those considered integral to primary healthcare (comprehensiveness, continuity and coordination). These PHC service delivery characteristics can be viewed to operate, in part, at the geographic arealevel, and are modifiable. Understanding the nature and extent of this variation is essential to improve quality of care and health equity, but this has been hampered by a lack of suitable measures across the breadth of effective PHC systems. Using a suite of measures constructed at the area-level, this study explored their application in assessing area-level variation in PHC organisation and delivery
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