Women in rural areas paying more for GP visits as bulk billing rates continue to decline
Embargoed until 12.00 Noon Sunday 2 February 2003
A study of changes in bulk-billing and out-of-pocket costs for Australian general practice consultations over the period 1995-2001 has found that women living in rural Australia are paying more out-of-pocket expenses for visits to the doctor than their city counterparts.
As reported in the latest edition of the Medical Journal of Australia, the study highlights growing social inequities as Australia's GP bulk billing rates continue to decline.
The study was conducted by Professor Annette J Dobson, School of Population Health, University of Queensland, and Dr Anne F Young, Research Centre for Gender and Health, University of Newcastle.
They analysed 1996-2001 survey data from the Australian Longitudinal Study on Women's Health (ALSWH), linked with Medicare and Department of Veterans' Affairs (DVA data on general practice consultations from 1995 to 2001.
Information relating to 22,633 women was involved in the study. Analysis was based on out-of-pocket costs paid by patients for GP consultations, by calendar year, urban/rural area of residence, age, frequency of attendance, self-rated health, and education level.
Professor Dobson says that for each age group and year studied, the use of bulk billing was lower in rural areas than in urban areas.
For example, in 2000, the percentage of women in rural and urban areas, respectively, who had all their GP consultations bulk billed was 31 per cent v 52 per cent (young women), 24 per cent v 45 per cent (mid-age women), and 58 per cent v 79 per cent (older women).
"There has been a steady decline in bulk billing for GP consultations in rural areas since 1995," Professor Dobson says.
"The average out-of-pocket cost per consultation for women in rural areas was higher than the cost for women living in the cities.
"After adjusting for age, health and socioeconomic factors, we found that women living in the city were more than twice as likely to have all their GP consultations bulk billed as women living in the country.
"In Australia, the geographical differential in the cost of GP consultations is widening.
"Not only are the rates of bulk billing lower, and declining, in rural areas, but the out-of-pocket expenses are increasing.
"It is to be hoped that policy changes already underway will enable women in rural and remote areas to have access to affordable healthcare services," Professor Dobson says.
The Medical Journal of Australia is a publication of the Australian Medical Association.
CONTACT: Professor Annette Dobson (07) 3365 5346 B/H; (0417) 214 501
Email: a.dobson@sph.uq.edu.au
Judith Tokley, AMA Public Affairs (0408) 824 306