Private general paediatric care availability in Melbourne
Marina Kunin A , Amy R. Allen A , Caroline Nicolas A and Gary L. Freed A BA Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, 207 Bouverie Street, Carlton, Vic. 3053, Australia. Email: marina.kunin@unimelb.edu.au; amy.allen@unimelb.edu.au; cnicolas@live.com.au
B Corresponding author. Email: gary.freed@unimelb.edu.au
Australian Health Review 41(1) 63-67 https://doi.org/10.1071/AH15218
Submitted: 13 November 2015 Accepted: 9 February 2016 Published: 24 March 2016
Abstract
Objective The aims of the present study were to determine the actual availability of private general paediatric appointments in the Melbourne metropolitan region for children with non-urgent chronic illnesses and the cost of such care.
Methods A ‘secret shopper’ method was used. Telephone calls were made to a random sample of 47 private paediatric clinics. A trained research assistant posed as a parent, requesting the first available appointment with a specific paediatrician. Data regarding appointment availability, total potential charges and net charges after the Medicare rebate were collected.
Results Appointments were available in 79% (n = 37) of clinics, with 72% (n = 34) able to offer an appointment with the requested general paediatrician. The number of days until available appointments varied from same day appointments to a wait of 124 days, with an average wait of 33 days. Of practices that provided information about the appointment cost (n = 42), five bulk-billed for the consultation, whereas the remainder (n = 37) were fee-paying clinics. The potential maximum charge for an initial consultation in the fee-paying clinics ranged from A$177 to A$430, with an average cost of A$279. The potential maximum out-of-pocket cost for patients ranged from A$40 to A$222, with an average out-of-pocket cost of A$128.
Conclusions Private paediatric care in the Melbourne metropolitan region is generally available. The out-of-pocket cost of private paediatric out-patient care may present a potential economic barrier for some families.
What is known about the topic? In Australia, out-of-pocket expenses for private specialist care are not covered by private health insurance. There are no data available on the actual cost of private paediatric consultations that are based on real-time assessments. Data collected in 1998 suggested that the average waiting time for a first standard consultation with a general paediatrician in a private room was 14.1 days. There are no recent empirical data on appointment availability and waiting time for appointments with general paediatricians in Australia.
What does this paper add? There is high availability of paediatric consultations in the private sector. Waiting times for an appointment vary considerably from same day appointments to a wait of 124 days, with an average wait of 33 days. The cost of a private paediatric consultation in Australia to the patient is considerable, with an average potential maximum up-front charge for an initial consultation of A$279 and an average potential maximum out-of-pocket cost of A$128.
What are the implications for practitioners? Data on the availability and cost of private paediatric consultations are imperative to formulate evidence-informed policy and better understand variations in the availability of public and private care.
References
[1] Armstrong BK, Gillespie JA, Leeder SR, Rubin GL, Russell LM. Challenges in health and health care for Australia. Med J Aust 2007; 187 485–9.| 17979607PubMed |
[2] Healy J, Sharman E, Lokuge B. Australia: health system review. Health Syst Transit 2006; 8 1–158.
[3] Australian Bureau of Statistics. Year book Australia, 2012. Canberra: ABS; 2012.
[4] Nib Health Funds Limited. The costs of having a baby. Private system. Nib health funds; NSW. Available at: https://www.nib.com.au/health-information/content/assets/pdf/nib-costs-of-baby-guide.pdf [verified August 2015].
[5] Australian Medical Workforce Advisory Committee. The consultant paediatric workforce in Australia. Report 1999.6 Sydney: AMWAC; 1999. Available at: http://www.ahwo.gov.au/documents/Publications/1999/The%20consultant%20paediatric%20workforce%20in%20Australia.pdf [verified August 2015].
[6] Spilchak PJ, Denney-Wilson E, King L, Baur LA. Tertiary paediatric obesity services in Australia. J Paediatr Child Health 2008; 44 243–7.
| Tertiary paediatric obesity services in Australia.Crossref | GoogleScholarGoogle Scholar | 18194196PubMed |
[7] Morawetz DY, Hiscock H, Allen KJ, Davies S, Danchin MH. Management of food allergy: a survey of Australian paediatricians. J Paediatr Child Health 2014; 50 432–7.
| Management of food allergy: a survey of Australian paediatricians.Crossref | GoogleScholarGoogle Scholar | 24612031PubMed |
[8] Chaudhry SB, Armbrecht ES, Shin Y, Matula S, Caffrey C, Varade R, Jones L, Siegried E. Pediatric access to dermatologists: Medicaid versus private insurance. J Am Acad Dermatol 2013; 68 738–48.
| Pediatric access to dermatologists: Medicaid versus private insurance.Crossref | GoogleScholarGoogle Scholar | 23474423PubMed |
[9] Bisgaier J, Rhodes KV. Auditing access to specialty care for children with public insurance. N Engl J Med 2011; 364 2324–33.
| Auditing access to specialty care for children with public insurance.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3MXns12gtrc%3D&md5=960b9491958d80ced24cb892946c9c1bCAS | 21675891PubMed |
[10] Freed GL, Bingham A, Allen AR, Freed M, Sanci LA, Spike N. Actual availability of general practice appointments for mildly ill children. Med J Aust 2015; 203 145–145e.5.
| Actual availability of general practice appointments for mildly ill children.Crossref | GoogleScholarGoogle Scholar | 26224186PubMed |
[11] Australian Bureau of Statistics. Australian demographic statistics, table 59. Estimated resident population by single year of age, Australia. Canberra: ABS; 2014.
[12] Freed GL, Sewell J, Spike N, Moran L, Brooks P. Changes in the demography of Australia and therefore general practice patient populations. Aust Fam Physician 2012; 41 715–19.
| 22962651PubMed |
[13] Freed GL, Spike NA, Sewell JR, Moran LM, Britt H, Valenti L, Brooks P. Changes in longer consultations for children in general practice. J Paediatr Child Health 2013; 49 325–9.
| Changes in longer consultations for children in general practice.Crossref | GoogleScholarGoogle Scholar | 23517187PubMed |
[14] Burström B. Increasing inequalities in health care utilisation across income groups in Sweden during the 1990s? Health Policy 2002; 62 117–29.
| Increasing inequalities in health care utilisation across income groups in Sweden during the 1990s?Crossref | GoogleScholarGoogle Scholar | 12354407PubMed |
[15] Duckett S, Breadon P. Out-of-pocket costs: hitting the most vulnerable hardest. Grattan Institute submission to the Senate Standing Committee on Community Affairs Inquiry into the out-of-pocket costs in Australian healthcare. Melbourne: Grattan Institute; 2014.
[16] Australian Bureau of Statistics. Patient experiences in Australia: summary of findings, 2013–14. Canberra: ABS; 2015.
[17] Carpenter A, Islam MM, Yen L, McRae I. Affordability of out-of-pocket health care expenses among older Australians. Health Policy 2015; 119 907–14.
| Affordability of out-of-pocket health care expenses among older Australians.Crossref | GoogleScholarGoogle Scholar | 25896218PubMed |
[18] Organization For Economic Cooperation and Development (OECD). OECD health statistics 2014 – frequently requested data. 2014. Available at: http://www.oecd.org/els/health-systems/oecd-health-statistics-2014-frequently-requested-data.htm [verified 15 August 2015].
[19] World Health Organization (WHO). Primary health care – now more than ever. Geneva: WHO; 2008.
[20] Rollins A. ‘Lazy’ rebate freeze should join co-payment on scrapheap: AMA. Aust Med 2015. Available at: https://ama.com.au/ausmed/%E2%80%98lazy%E2%80%99-rebate-freeze-should-join-co-payment-scrap-heap-ama [verified 15 August 2015].
[21] Australian Government. Budget 2014–15: budget measures. Canberra: Commonwealth of Australia; 2014. Available at: http://budget.gov.au/2014-15/content/bp2/download/BP2_consolidated.pdf [verified October 2015].
[22] Harrison C, Bayram C, Miller GC, Britt HC. The cost of freezing general practice. Med J Aust 2015; 202 313–16.
| The cost of freezing general practice.Crossref | GoogleScholarGoogle Scholar | 25832157PubMed |
[23] System Intelligence and Analytics Branch, Department of Health and Human Services. Specialist clinics activity and wait time report, June quarter 2014–15. Melbourne: Victorian Government; 2015. Available at: file:///C:/Users/mkunin/Downloads/Specialist%20Clinics%20Quarterly%20Activity%20and%20Wait%20Time%20Report%20June%202015%20Quarter%20-%20Final.pdf [verified October 2015].
