Abstract
BackgroundRecent increases in the bulk-billing rate have been taken as an indication that the Federal government's Strengthening Medicare initiative, and particularly the bulk-billing incentives, are 'working'. Given the enduring geographic differences in the supply of general practitioners (GPs) it is timely to reconsider the impact that this increase in the provision of 'free care' will have on access to Medicare-funded GP services in rural and urban areas of Australia. Utilisation has been modelled as two different stochastic processes: the decision to consult and the frequency of consultation.ResultsIn the decision to consult model the supply of FFS GPs is a more important predictor of utilisation than the bulk-billing rate. Paradoxically the modelling predicts that ceteris paribus increases in either GP supply or the bulk-billing rate appear to have perverse effects in some areas by decreasing utilisation. In the frequency of consultation model, GP density is not a predictor and increasing the bulk-billing rate will unambiguously increase the frequency of consultation across all areas. In both models, the positive impacts associated with changes in supply and cost are constrained outside the inner metropolitan area by reduced geographic accessibility to Medicare-funded GP services. The modelling also shows that people are more likely to consult a GP in areas of high socioeconomic disadvantage, although socioeconomic status is not a predictor of frequency of consultation.ConclusionBulk-billing rates and the supply of FFS GPs are important features of the Australian health care system that are, potentially, amenable to policy manipulation. The implications of this research are that government policies designed to achieve similarity in these characteristics across geographic areas will not result in equity of access because they fail to address problems caused by geographic inaccessibility in rural and remote areas. Attempting to increase bulk-billing rates in some of these areas may, in fact, reduce access to FFS GP services.
Highlights
Recent increases in the bulk-billing rate have been taken as an indication that the Federal government's Strengthening Medicare initiative, and the bulk-billing incentives, are 'working'
Because the primary aim of this research is to look at the likely impact of the Federal government's Strengthening Medicare policy on access to Medicare-funded general practitioners (GPs) services it is considered an appropriate methodology there are some caveats that need to be noted
To the extent that the Strengthening Medicare policy has increased bulk-billing rates, and bearing in mind the qualifications expressed in relation to the data, the modelling indicates that an increase in bulk-billing rates will not necessarily increase access across all Divisions
Summary
Recent increases in the bulk-billing rate have been taken as an indication that the Federal government's Strengthening Medicare initiative, and the bulk-billing incentives, are 'working'. In April 2003 the Federal government announced a policy initiative called A Fairer Medicare. This initiative was heavily criticised and enabling legislation failed to pass the Senate. One study with highly aggregated levels of data showed an increase in the frequency of consultation in low socioeconomic status areas [12]. Another indicated that the relationship was not so straightforward. Low socioeconomic status was associated with an increase in the consultation rate in highly accessible areas and low consultation rates in inaccessible areas, [13] suggesting supply side factors are important
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