Are patients disadvantaged by socioeconomic status?

There is a trend for doctors to provide shorter consultations, comprising around 89 percent of all consultations each year, and the rate of short consultations increased with increasing socioeconomic disadvantage. However, there was a significant increase in the number of longer consultations the higher the socioeconomic status.

"Length of consultation is an important characteristic of general practice care," says Dr Furler.

"People in disadvantaged areas visit GPs more often, but they are less likely to have a long consultation.

"The rate of long or prolonged consultations per person increased by almost 4% with each step up in socioeconomic status.

"There is a financial disincentive for GPs to provide longer consultations if they bulk bill, and this needs to be considered if this inequality in healthcare is to be addressed.

"Almost 95 per cent of consultations in disadvantaged areas were bulk billed, compared with 70 to 80 percent in more advantaged areas.

"There is a need to strengthen health promotion and provide increased GP and health services to disadvantaged communities.

"Whatever the underlying reason, it seems that people from disadvantaged areas are less likely to have longer consultations with GPs in their area.

"This is despite the fact that, as a group, they have a significantly higher need for care. This indicates that this aspect of high quality general practitioner care is inequitably distributed in our community," Dr Furler said.

An accompanying editorial by Mr John O'Dea from the Australian Medical Association, and Mr Roger Kilham from Access Economics, says that this situation challenges the key principles of Medicare such as universality and equity.

Mr O'Dea says that opinions differ over the supply of GPs, but that in recent years the Federal Government has had to address the shortage of GPs in outer-metropolitan and remote and rural areas.

"Overall, Australia has a shortage of GPs, which is becoming increasingly apparent in outer urban areas, often areas of significant socioeconomic disadvantage," Mr O'Dea said.

A recent report by Access Economics predicts that Australia is heading toward GP shortages that would be socially and politically unacceptable.

"To get the 'right' number of doctors is hard. To solve the distributional problems is harder still. But get it right we must, especially in light of our ageing population with its burden of chronic illnesses," Mr O'Dea said.

The Medical Journal of Australia is a publication of the Australian Medical Association.

CONTACTS: (Research) Dr John Furler (03) 8344 4747 (B/H)

(0419) 393 156 (A/H)

(Editorial) Mr John O'Dea (02) 6270 5463 (B/H)

(0418) 407 044 Friday + (A/H)

Sarah Crichton (0419) 440 076

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