What explains the regional variation in the use of general practitioners in Australia?
Open Access
- 19 April 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Health Services Research
- Vol. 20 (1), 1-11
- https://doi.org/10.1186/s12913-020-05137-1
Abstract
Regional variation in the use of health care services is widespread. Identifying and understanding the sources of variation and how much variation is unexplained can inform policy interventions to improve the efficiency and equity of health care delivery. 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. 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. 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 unexplained 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 unexplained. Future work should try to explain the remaining unexplained variation.Other Versions
Funding Information
- Commonwealth of Australia
This publication has 19 references indexed in Scilit:
- Unraveling the drivers of regional variation in healthcare spending by analyzing prevalent chronic diseasesBMC Health Services Research, 2018
- The rural pipeline to longer-term rural practice: General practitioners and specialistsPLOS ONE, 2017
- The age profile of the location decision of Australian general practitionersSocial Science & Medicine (1982), 2015
- Determinants of Regional Variation in Health Expenditures in GermanyHealth Economics, 2015
- Analyzing regional variation in health care utilization using (rich) household microdataHealth Policy, 2014
- Disparities in access to health care in three French regionsHealth Policy, 2013
- Exploring spatial patterns in general practice expenditureThe European Journal of Health Economics, 2008
- Primary care physician supply and other key determinants of health care utilisation: the case of SwitzerlandBMC Health Services Research, 2008
- Association Between Primary Care Practice Characteristics and Emergency Department Use in a Medicaid Managed Care OrganizationMedical Care, 2005
- Social Inequality: Utilisation of general practitioner services by socio‐economic disadvantage and geographic remotenessAustralian and New Zealand Journal of Public Health, 2004