What Explains the Regional Variation in the Use of General Practitioners in Australia?

Abstract

Background: Regional variation in the use of health care services is widespread. Identifying and understanding the sources of variation and how much variation is unwarranted can inform policy interventions to improve the efficiency and equity of health care delivery. Methods: We examined the regional variation in the use of general practitioners (GPs) using data from the Social Health Atlas of Australia by Statistical Local Area (SLAs). 756 SLAs were included in the analysis. The outcome variable of GP visits per capita by SLAs was regressed on a series of demand-side factors measuring population health status and demographic characteristics and supply-side factors measuring access to physicians. Each group of variables was entered into the model sequentially to assess their explanatory share on regional differences in GP usage. Results: Both demand-side and supply-side factors were found to influence the frequency of GP visits. Specifically, areas in urban regions, areas with a higher percentage of the population who are obese, who have profound or severe disability, and who hold concession cards, and areas with a smaller percentage of the population who reported difficulty in accessing services have higher GP usage. The availability of more GPs led to higher use of GP services while the supply of more specialists reduced use. 30.56% of the variation was explained by medical need. Together, both need-related and supply-side variables accounted for 32.24% of the regional differences as measured by the standard deviation of adjusted GP-consultation rate. Conclusions: There was substantial variation in GP use across Australian regions with only a small proportion of them being explained by population health needs, indicating a high level of unwarranted clinical variation. Supply factors did not add a lot to the explanatory power. There was a lot of variation that was not attributable to the factors we could observe. This could be due to more subtle aspects of population need or preferences and therefore warranted. However, it could be due to practice patterns or other aspects of supply and be unwarranted. Future work should try to explain the remaining unexplained variation. Keywords : GP usage, Regional variation, Statistical Local Areas, Australia

Area-level and individual-socioeconomic variation in use of GP and specialist services. A multilevel analysis using linked data

“…using aggregated area-level data consistently nd increased use of GP and specialist services in major cities compared with more remote areas [5, 8,13]. To date, no Australian studies have examined individual socioeconomic variation in use of primary and specialist services while accounting for area-variation in use of services, or quanti ed the extent of variation at the area-level, beyond that explained by the characteristics of individuals living in those areas.…”

“…Further, an effective primary healthcare system requires ready access to supporting specialist care. Yet often individuals' socioeconomic circumstances or where they live, as much as their need for care, determine their use of services [5][6][7][8][9]; that is, access to care is inequitable. Examining and quantifying these differing sources of variation in care is essential for directing policy responses for achieving an equitable healthcare system.…”

“…Failure to address inequitable specialist use may undermine equity gains within the PHC system. Policies should also focus on local variation.using aggregated area-level data consistently nd increased use of GP and specialist services in major cities compared with more remote areas [5, 8,13]. To date, no Australian studies have examined individual socioeconomic variation in use of primary and specialist services while accounting for area-variation in use of services, or quanti ed the extent of variation at the area-level, beyond that explained by the characteristics of individuals living in those areas.The aim of this study was to use large-scale linked data and multi-level analysis [14,15] to examine the extent to which GP and specialist service use varied at the area-level, having accounted for the characteristics of people who lived in those areas.…”

Does individual-socioeconomic variation in quality-of-primary care vary according to area-level service organisation? Multilevel analysis using linked data

“…In Australia, like many countries with universal health insurance, PHC service organisation and delivery varies across smallareas [12][13][14]. There is also evidence that service delivery characteristics, such as supply of primary care providers, scope of practice and after-hours arrangements, are associated with primary care service use [15][16][17] and perceived quality-of-care [18]. However, these findings were based on aggregated area-level data or examined practice-level service characteristics and individual outcomes.…”