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Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
RESEARCH ARTICLE (Open Access)

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

Bree Graham A * , Estie Kruger https://orcid.org/0000-0002-4883-6793 A , Marc Tennant A and Yulia Shiikha A
+ Author Affiliations
- Author Affiliations

A School of Human Sciences, University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA 6009, Australia.

* Correspondence to: 21444854@student.uwa.edu.au

Australian Journal of Primary Health 29(5) 437-444 https://doi.org/10.1071/PY22125
Submitted: 21 June 2022  Accepted: 15 January 2023   Published: 23 February 2023

© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

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.

Keywords: Australia, bulk billing only, General Practitioner (GP) services, GIS, medical practices, out-of-pocket expenses, practice billing policies, practice-to-population ratio, socio-economic status.


References

Achat HM, Thomas P, Close GR, Moerkerken LR, Harris MF (2010) General health care service utilisation: where, when and by whom in a socioeconomically disadvantaged population. Australian Journal of Primary Health 16, 132–140.
General health care service utilisation: where, when and by whom in a socioeconomically disadvantaged population.Crossref | GoogleScholarGoogle Scholar |

Australia Institute of Health and Welfare (2016) Australia’s health 2016: 5.1 Health across socioeconomic groups. (AIHW: Canberra, ACT, Australia) Available at https://www.aihw.gov.au/getmedia/405d9955-c170-4c39-a496-3839059149f7/ah16-5-1-health-across-socioeconomicgroups.pdf.aspx [Verified 16 May 2021]

Australia Institute of Health and Welfare (2018) Australia’s health 2018: 2.1 How does Australia’s health system work. (AIHW: Canberra, ACT, Australia) Available at https://www.aihw.gov.au/getmedia/63fe0895-b306-4375-95ff-162149ffc34b/aihw-aus-221-chapter-21.pdf.aspx [Verified 16 May 2021]

Australia Institute of Health and Welfare (2019) Health expenditure Australia 2017–18. (AIHW: Canberra, ACT, Australia) Available at https://www.aihw.gov.au/getmedia/91e1dc31-b09a-41a2-bf9f8deb2a3d7485/aihw-hwe-77-25092019.pdf.aspx [Verified 18 May 2021]

Australian Bureau of Statistics (2016a) 1270.0.55.001 – Australian Statistical Geography Standard (ASGS): Volume 1 – Main Structure and Greater Capital City Statistical Areas, July 2016. (ABS: Canberra, ACT, Australia) Available at www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/1270.0.55.001 [Verified 2 December 2020]

Australian Bureau of Statistics (2016b) 2033.0.55.001 – Census of population and housing: socio-economic indexes for areas (SEIFA), Australia, 2016. (ABS: Canberra, ACT, Australia) Available at https://www.abs.gov.au/ausstats/abs@.nsf/mf/1270.0.55.001 [Verified 2 December 2020]

Australian Medical Association (2015) Guide for patients on how the health care system fund medical care. Available at https://ama.com.au/articles/guide-patientshow-health-care-system-funds-medical-care#First [Verified 16 May 2021]

Australian Medical Association (2017) AMA position statement : setting medical fees and billing practices. Available at https://ama.com.au/position-statement/settingmedical-fees-and-billing-practices-2017 [Verified 18 May 2021]

Britt H, Valenti L, Miller GC, Farmer J (2004) Determinants of GP billing in Australia: content and time. Medical Journal of Australia 181, 100–104.
Determinants of GP billing in Australia: content and time.Crossref | GoogleScholarGoogle Scholar |

Butler DC, Petterson S, Bazemore A, Douglas KA (2010) Use of measures of socioeconomic deprivation in planning primary health care workforce and defining health care need in Australia. The Australian Journal of Rural Health 18, 199–204.
Use of measures of socioeconomic deprivation in planning primary health care workforce and defining health care need in Australia.Crossref | GoogleScholarGoogle Scholar |

Callander EJ, Corscadden L, Levesque J-F (2017) Out-of-pocket healthcare expenditure and chronic disease – do Australians forgo care because of the cost? Australian Journal of Primary Health 23, 15–22.
Out-of-pocket healthcare expenditure and chronic disease – do Australians forgo care because of the cost?Crossref | GoogleScholarGoogle Scholar |

De Abreu Lourenco R, Kenny P, Haas MR, Hall JP (2015) Factors affecting general practitioner charges and Medicare bulk-billing: results of a survey of Australians. Medical Journal of Australia 202, 87–90.
Factors affecting general practitioner charges and Medicare bulk-billing: results of a survey of Australians.Crossref | GoogleScholarGoogle Scholar |

Department of Health (2020) Annual medicare statistics: financial year 1984–85 to 2019–20. (DoH: Canberra, ACT, Australia) Available at https://www1.health.gov.au/internet/main/publishing.nsf/Content/Medicare%20Statistics-1 [Verified 16 May 2021]

Dingwall S, Henderson J, Britt H, Harrison C (2020) Adequacy of Australia’s GP workforce: estimating supply and demand, 2005–06 to 2015–16. Australian Health Review 44, 328–333.
Adequacy of Australia’s GP workforce: estimating supply and demand, 2005–06 to 2015–16.Crossref | GoogleScholarGoogle Scholar |

Dudko Y, Robey DE, Kruger E, Tennant M (2018) Selecting a location for a primary healthcare facility: combining a mathematical approach with a Geographic Information System to rank areas of relative need. Australian Journal of Primary Health 24, 130–134.
Selecting a location for a primary healthcare facility: combining a mathematical approach with a Geographic Information System to rank areas of relative need.Crossref | GoogleScholarGoogle Scholar |

Fisher M, Baum F, Kay A, Friel S (2017) Are changes in Australian national primary healthcare policy likely to promote or impede equity of access? A narrative review. Australian Journal of Primary Health 23, 209–215.
Are changes in Australian national primary healthcare policy likely to promote or impede equity of access? A narrative review.Crossref | GoogleScholarGoogle Scholar |

Harrison C, Bayram C, Miller GC, Britt HC (2015) The cost of freezing general practice. Medical Journal of Australia 202, 313–316.
The cost of freezing general practice.Crossref | GoogleScholarGoogle Scholar |

Hyndman JCG, Holman CDJ (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 |

Ireland MJ, March S, Crawford-Williams F, Cassimatis M, Aitken JF, Hyde MK, Chambers S K, Sun J, Dunn J (2017) A systematic review of geographical differences in management and outcomes for colorectal cancer in Australia. BMC Cancer 17, 95
A systematic review of geographical differences in management and outcomes for colorectal cancer in Australia.Crossref | GoogleScholarGoogle Scholar |

Laurence COM, Karnon J (2017) What will make a difference? Assessing the impact of policy and non-policy scenarios on estimations of the future GP workforce. Human Resources for Health 15, 43
What will make a difference? Assessing the impact of policy and non-policy scenarios on estimations of the future GP workforce.Crossref | GoogleScholarGoogle Scholar |

Lyle G, Hendrie D (2019) Predicting general practitioner utilisation at a small area level across Western Australia. Australian Journal of Primary Health 25, 570–576.
Predicting general practitioner utilisation at a small area level across Western Australia.Crossref | GoogleScholarGoogle Scholar |

McGrail MR (2012) Spatial accessibility of primary health care utilising the two step floating catchment area method: an assessment of recent improvements. International Journal of Health Geographics 11, 50
Spatial accessibility of primary health care utilising the two step floating catchment area method: an assessment of recent improvements.Crossref | GoogleScholarGoogle Scholar |

McIsaac M, Scott A, Kalb G (2019) The role of financial factors in the mobility and location choices of General Practitioners in Australia. Human Resources for Health 17, 34
The role of financial factors in the mobility and location choices of General Practitioners in Australia.Crossref | GoogleScholarGoogle Scholar |

McRae I, Butler JRG (2014) Supply and demand in physician markets: a panel data analysis of GP services in Australia. International Journal of Health Care Finance and Economics 14, 269–287.
Supply and demand in physician markets: a panel data analysis of GP services in Australia.Crossref | GoogleScholarGoogle Scholar |

Mu C, Hall J (2020) What explains the regional variation in the use of general practitioners in Australia? BMC Health Services Research 20, 325
What explains the regional variation in the use of general practitioners in Australia?Crossref | GoogleScholarGoogle Scholar |

O’Sullivan BG, Kippen R, Hickson H, Wallace G (2022) Mandatory bulk billing policies may have differential rural effects: an exploration of Australian data. Rural and Remote Health 22, 7138
Mandatory bulk billing policies may have differential rural effects: an exploration of Australian data.Crossref | GoogleScholarGoogle Scholar |

Pulok MH, van Gool K, Hall J (2020a) Horizontal inequity in the utilisation of healthcare services in Australia. Health Policy (Amsterdam) 124, 1263–1271.
Horizontal inequity in the utilisation of healthcare services in Australia.Crossref | GoogleScholarGoogle Scholar |

Pulok MH, van Gool K, Hajizadeh M, Allin S, Hall J (2020b) Measuring horizontal inequity in healthcare utilisation: a review of methodological developments and debates. The European Journal of Health Economics 21, 171–180.
Measuring horizontal inequity in healthcare utilisation: a review of methodological developments and debates.Crossref | GoogleScholarGoogle Scholar |

Rezayatmand R, Pavlova M, Groot W (2013) The impact of out-of-pocket payments on prevention and health-related lifestyle: a systematic literature review. European Journal of Public Health 23, 74–79.
The impact of out-of-pocket payments on prevention and health-related lifestyle: a systematic literature review.Crossref | GoogleScholarGoogle Scholar |

Roeger LS, Reed RL, Smith BP (2010) Equity of access in the spatial distribution of GPs within an Australian metropolitan city. Australian Journal of Primary Health 16, 284–290.
Equity of access in the spatial distribution of GPs within an Australian metropolitan city.Crossref | GoogleScholarGoogle Scholar |

Royal Australian College of General Practitioners (2018) Billing for general practice services. Available at https://www.racgp.org.au/advocacy/position-statements/view-all-position-statements/health-systems-and-environmental/billing-for-general-practice-services [Verified 16 May 2021]

Royal Australian College of General Practitioners (2020) General practice: health of the nation. Available at https://www.racgp.org.au/health-of-the-nation/health-of-the-nation [Verified 16 May 2021]

Tudor Hart J (1971) The inverse care law. The Lancet 297, 405–412.
The inverse care law.Crossref | GoogleScholarGoogle Scholar |

Turner M, Fielding S, Ong Y, Dibben C, Feng Z, Brewster DH, Black C, Lee A, Murchie P (2017) A cancer geography paradox? Poorer cancer outcomes with longer travelling times to healthcare facilities despite prompter diagnosis and treatment: a data-linkage study. British Journal of Cancer 117, 439–449.
A cancer geography paradox? Poorer cancer outcomes with longer travelling times to healthcare facilities despite prompter diagnosis and treatment: a data-linkage study.Crossref | GoogleScholarGoogle Scholar |

Whitehead J, Pearson AL, Lawrenson R, Atatoa-Carr P (2018) Framework for examining the spatial equity and sustainability of general practitioner services. The Australian Journal of Rural Health 26, 336–341.
Framework for examining the spatial equity and sustainability of general practitioner services.Crossref | GoogleScholarGoogle Scholar |

World Health Organization (2010) The world health report 2010. Health systems financing: the path to universal coverage. (World Health Organization: Geneva, Switzerland) Available at https://www.who.int/publications/i/item/9789241564021 [Verified 16 May 2021]