Equity of access in the spatial distribution of GPs within an Australian metropolitan city
Leigh S. Roeger A B , Richard L. Reed A and Bradley P. Smith A
+ Author Affiliations
- Author Affiliations
A Flinders University, Department of General Practice, GPO Box 2100, Adelaide, SA 5001, Australia.
B Corresponding author. Email: leigh.roeger@flinders.edu.au
Australian Journal of Primary Health 16(4) 284-290 https://doi.org/10.1071/PY10021
Submitted: 28 May 2010 Accepted: 19 July 2010 Published: 3 December 2010
Abstract
Equitable access to primary health care is a key objective for health policy makers. In Australia, poor access to primary care providers has been well documented for many rural areas, yet the distribution of general practitioners (GPs) in metropolitan regions remains relatively unknown. Traditional methods of determining geographic access to GPs are limited as they rely on simple population to provider ratios within artificial administrative borders and, among other things, fail to take into account patients that utilise close-by facilities outside of these borders. This study utilised specialised geographic information systems to examine the equity of access to GPs in an Australia capital city (Adelaide). Results showed that by Australian standards, residents of metropolitan Adelaide have low GP ratios. However, an inequitable spatial distribution of GPs within metropolitan Adelaide was found, with ~16% of residents considered to be living in areas of GP workforce shortage. Residents in the outer suburbs and those with lower social economic status appeared to be the most disadvantaged. It is recommended that future studies employ specialised GIS techniques as they provide a more accurate measurement of variations in spatial accessibility to primary care within metropolitan cities.
Additional keywords: Adelaide, floating catchment, geographic information systems, GP shortage.
References
Adhikari P (2006) Socio-economic indexes for areas: introduction, use and future directions. Cat. No. 1351.0.55.015. Australia Bureau of Statistics, Canberra.Armstrong K, Tess D, Walsh J, Hui Q, Lam W, et al. (2005) Technical paper: general practice workforce modelling. Australian Medical Workforce Advisory Committee (AMWAC) & AMWAC General Practice Working Party. Available at http://www.nhwt.gov.au/documents/Publications/2005/General%20practice%20workforce%20modelling%20-%20Technical%20paper.pdf [Verified 25 May 2010]
Australian Bureau of Statistics (2007a) Population by age and sex, Australia, 2006. Cat. No. 3235.0. Available at http://www.abs.gov.au/AUSSTATS/abs@.nsf/allprimarymainfeatures/2F33D3E91BA0F08FCA2574A900130EE7?opendocument [Verified 25 May 2010]
Australian Bureau of Statistics (2007b) Australian Standard Geographical Classification (ASGC) Remoteness Structure (RA) Digital Boundaries, Australia, 2006. Cat. No. 1259.0.30.004. Available at http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/1259.0.30.0042006?OpenDocument [Verified 25 May 2010]
Australian Bureau of Statistics (2008a) Mesh block digital boundaries, Australia, 2006. Cat. No. 1209.0.55.002. Available at http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/1209.0.55.0022006?OpenDocument [Verified 25 May 2010]
Australian Bureau of Statistics (2008b) Census of population and housing: socio-economic indexes for areas (SEIFA), Australia – data only, 2006. Cat. No. 2033.0.55.001. Available at http://www.abs.gov.au/ausstats/abs@.nsf/mf/2033.0.55.001/ [Verified 25 May 2010]
Australian Bureau of Statistics (2009) A picture of the nation: the statistician’s report on the 2006 Census. Cat. No. 2070.0. Available at http://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/LookupAttach/2070.0Publication29.01.096/$File/20700_Population_overview.pdf [Verified 25 May 2010]
Bagheri N, Benwell GL, Holt A (2006) Primary health care accessibility for rural Otago: ‘a spatial analysis’. In ‘Proceeding of the HIC 2006 and HINZ 2006’. (Eds J Westbrook, J Callen, G Margelis, J Warren) pp. 365–376. (Health Informatics Society of Australia: Melbourne)
Brabyn L, Barnett R (2004) Population need and geographical access to general practitioners in rural New Zealand. The New Zealand Medical Journal 117(1199). Available at http://www.nzma.org.nz/journal/117-1199/996/content.pdf [Verified 25 May 2010]
Department of Health and Ageing (2008a) Medicare Australia statistics. Australian Government, Department of Health and Ageing, Canberra. Available at http://www.health.gov.au/medicarestats [Verified 25 May 2010]
Department of Health and Ageing (2008b) District of workforce shortage factsheet. Australian Government, Department of Health and Ageing, Canberra. Available at http://www.health.gov.au/internet/main/publishing.nsf/Content/work-pr-dws-fact [Verified 23 September 2010]
Department of Health and Ageing (2008c) General practice statistics: number of general practitioners. Australian Government, Canberra. Available at http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pcd-statistics-gpnos.htm [Verified 25 May 2010]
Department of Health and Ageing (2009) Primary health care reform in Australia: report to support Australia’s first national primary health care strategy. Publications No. P3–5480. Australian Government, Canberra. Available at http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/nphc-draftreportsupp-toc/$FILE/NPHC-supp.pdf [Verified 25 May 2010]
Department of Health and Ageing (2010a) Building a 21st century primary health care system: Australia’s first national primary health care strategy. Publications No. 6594. Australian Government, Canberra. Available at http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/550436A8DA6839ECCA25771B00220E23/$File/6552%20NPHC%201205.pdf [Verified 25 May 2010]
Department of Health and Ageing (2010b) A national health and hospitals network for Australia’s future: delivering better health and better hospitals. Publications No. 6620. Australian Government, Canberra. Available at http://www.health.gov.au/internet/yourhealth/publishing.nsf/Content/report-redbook/$File/HRT_report3.pdf [Verified 25 May 2010]
Guagliardo M (2004) Spatial accessibility of primary care: concepts, methods and challenges. International Journal of Health Geographics 3(3), Available at http://www.ij-healthgeographics.com/content/pdf/1476-072X-3-3.pdf [Verified 25 May 2010]
Guagliardo M, Ronzio C, Cheung I, Chacko E, Joseph J (2004) Physician accessibility: an urban case study of pediatric providers. Health & Place 10, 273–283.
| Physician accessibility: an urban case study of pediatric providers.Crossref | GoogleScholarGoogle Scholar | 15177201PubMed |
Hyndman JCG, D’Arcy C, Holman J (2001) Accessibility and spatial distribution of general practice services in an Australian city by levels of social disadvantage. Social Science & Medicine 53, 1599–1609.
| Accessibility and spatial distribution of general practice services in an Australian city by levels of social disadvantage.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD38%2FjsVWqtg%3D%3D&md5=d9557793e5e163eabb83c45f83f32323CAS |
Joseph A, Phillips D (1984) ‘Accessibility and utilization: geographical perspectives on health care delivery.’ (Harper & Row: New York)
Langford M, Higgs G (2006) Measuring potential access to primary healthcare services: the influence of alternative spatial representations of population. The Professional Geographer 58, 294–306.
| Measuring potential access to primary healthcare services: the influence of alternative spatial representations of population.Crossref | GoogleScholarGoogle Scholar |
Luo W (2004) Using a GIS-based floating catchment method to assess areas with shortage of physicians. Health & Place 10, 1–11.
| Using a GIS-based floating catchment method to assess areas with shortage of physicians.Crossref | GoogleScholarGoogle Scholar | 14637284PubMed |
Luo W, Wang F (2003) Measures of spatial accessibility to healthcare in a GIS environment: synthesis and a case study in Chicago region. Environment and Planning B: Planning and Design 30, 865–884.
| Measures of spatial accessibility to healthcare in a GIS environment: synthesis and a case study in Chicago region.Crossref | GoogleScholarGoogle Scholar |
McGrail M, Humphreys J (2009) Measuring spatial accessibility to primary care in rural areas: improving the effectiveness of the two-step floating catchment area method. Applied Geography (Sevenoaks, England) 29, 533–541.
| Measuring spatial accessibility to primary care in rural areas: improving the effectiveness of the two-step floating catchment area method.Crossref | GoogleScholarGoogle Scholar |
Reed R, Roeger L, Reinfeld-Kirkman N, Howard S (2008) Access to general practitioners in South Australia: a population survey. The Medical Journal of Australia 189, 95–99.
Schoen C, Osborn R, Doty M, Bishop M, Peugh J, Murukutla N (2007) Toward higher-performance health systems: adults’ health care experiences. Health Affairs 26, w717–w734.
| Toward higher-performance health systems: adults’ health care experiences.Crossref | GoogleScholarGoogle Scholar | 17978360PubMed |
Scott J, Larson A, Jefferies F, Veenendaal B (2006) Small-area estimates of general practice workforce shortage in rural and remote Western Australia. The Australian Journal of Rural Health 14, 209–213.
| Small-area estimates of general practice workforce shortage in rural and remote Western Australia.Crossref | GoogleScholarGoogle Scholar | 17032297PubMed |
Turrell G, Mathers C (2000) Socioeconomic status and health in Australia. The Medical Journal of Australia 172, 434–438.
Wang F (2006) ‘Quantitative methods and applications in GIS.’ (Taylor & Francis: Boca Raton, FL)
Yang D-H, Goerge R, Mullner R (2006) Comparing GIS-based methods of measuring spatial accessibility to health services. Journal of Medical Systems 30, 23–32.
| Comparing GIS-based methods of measuring spatial accessibility to health services.Crossref | GoogleScholarGoogle Scholar | 16548411PubMed |
