Relationship between socioeconomic status and general practitioner visits for children in the first 12 months of life: an Australian study*
Xanthe A. Golenko A E , Rania Shibl B , Paul A. Scuffham C and Cate M. Cameron DA Griffith Health Institute, School of Medicine, Griffith University, Logan Campus, University Drive, Meadowbrook, Qld 4131, Australia.
B QUT Business School, QUT, Gardens Point Campus, 2 George Street, Brisbane, Qld 4000, Australia. Email: rania.shibl@qut.edu.au
C Griffith Health Institute, Centre for Applied Health Economics, School of Medicine, Griffith University, Logan Campus, University Drive, Meadowbrook, Qld 4131, Australia. Email: p.scuffham@griffith.edu.au
D Griffith Health Institute, Centre of National Research on Disability and Rehabilitation, School of Human Services and Social Work, Griffith University, Logan Campus, University Drive, Meadowbrook, Qld 4131, Australia. Email: cate.cameron@griffith.edu.au
E Corresponding author. Email: x.golenko@griffith.edu.au
Australian Health Review 39(2) 136-145 https://doi.org/10.1071/AH14108
Submitted: 14 July 2014 Accepted: 29 October 2014 Published: 22 December 2014
Abstract
Objective The aim of the present study was to examine the relationship between socioeconomic status (SES) and child general practitioner (GP) visits in the first 12 months of life.
Methods A longitudinal analysis of 1202 mother and child dyads was conducted as part of the Environments for Healthy Living study from south-east Queensland, Australia, for participants enrolled between 2006 and 2009. Maternally reported survey data (sociodemographic and child health information) were linked with individual Medical Benefits Scheme data from birth to 12 months, identifying GP service use.
Results On average, children visited the GP 10.2 times in the first 12 months of life. An inverse relationship was found for SES and child GP visits, with maternal education and child gender the strongest predictors of the total number of GP visits. Almost 70% of participants had all GP consultations bulk billed and only 3.5% paid more than A$100 in total.
Conclusions Children from lower SES families may have a greater need for health services due to higher rates of illness and injury. Bulk billing and low-cost access to GP services, regardless of length of consultation, improve equity of access; however, indirect costs may prevent low-income mothers from accessing care for their child when needed.
What is known about the topic? The relationship between health and SES, and the influence that health service use can have on this relationship, are well recognised. Previous studies on adult populations in Australia suggest that people of lower SES have more frequent GP consultations due to greater exposure to health risk. However, consultation times are often shorter because short consultations are more likely to be bulk billed, which is resulting in ongoing unmet need. Early childhood visits to the GP can strongly influence long-term health outcomes; however, relatively few studies have examined GP service use among children in Australia.
What does this paper add? This paper builds on current knowledge by providing valuable insights into GP service use in the first 12 months of life. It provides evidence to suggest that the relationship between SES and health risk already exists in the first 12 months of life and that bulk billing and low-cost access to GP services improves equity of access. It also highlights the importance of health policy and practice that enables GP service utilisation based on need rather than ability to pay.
What are the implications for practitioners? Policies and practice that promote equity of access, such as bulk billing for lower SES families, can assist in improving long-term health outcomes for disadvantaged populations. Greater equity with regard to length of consultation and bulk billing for adults may assist in reducing the disparities in health outcomes between the higher and lower SES populations. Furthermore, indirect costs and the availability of appropriate services for specific groups, such as low income, rural and remote and linguistically and culturally diverse populations, may also be important barriers to access.
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