Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association
RESEARCH ARTICLE

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 D
+ Author Affiliations
- Author Affiliations

A 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.


References

[1]  Acheson D. Independent inquiry into inequalities in health. London: HMSO; 1998.

[2]  Bywood P, Katterl R, Lunnay B. Disparities in primary health care utilisation: who are the disadvantaged groups? How are they disadvantaged? What interventions work? Adelaide: Primary Health Care Research and Information Service (PHC RIS); 2011.

[3]  World Health Organization (WHO). Social determinants of health: WHO; 2012. Available at: http://www.who.int/social_determinants/en/ [verified 27 July 2012].

[4]  Australian Bureau of Statistics (ABS). Socioeconomic status. Canberra: ABS; 2011. Available at: http://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/4250.0.55.001Main%20Features12009?opendocument&tabname=Summary&prodno=4250.0.55.001&issue=2009&num=&view= [verified 11 October 2014].

[5]  Miech RA, Hauser RM. Socioeconomic status (SES) and health at midlife: a comparison of educational attainment with occupation-based indicators. Ann Epidemiol 2001; 11 75–84.
Socioeconomic status (SES) and health at midlife: a comparison of educational attainment with occupation-based indicators.CrossRef | 1:STN:280:DC%2BD3M7ptlGrsg%3D%3D&md5=12c22d85f7a562a95f5b728d867babc1CAS | 11164123PubMed |

[6]  Mueller CW, Parcel TL. Measures of socioeconomic status: alternatives and recommendations. Child Dev 1981; 52 13–30.
Measures of socioeconomic status: alternatives and recommendations.CrossRef |

[7]  Shavers VL. Measurement of socioeconomic status in health disparities research. J Natl Med Assoc 2007; 99 1013–23.
| 17913111PubMed |

[8]  Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health. Geneva: World Health Organization; 2008.

[9]  Liu DM, Alamanda C. Social determinants of health for native Hawaiian children and adolescents. Hawaii Med J 2011; 70 9–14.
| 22235151PubMed |

[10]  Chen E, Matthews K, Boyce T. Socio-economic differences in children’s health: how do these relationships change with age? Psychol Bull 2002; 128 295–329.
Socio-economic differences in children’s health: how do these relationships change with age?CrossRef | 11931521PubMed |

[11]  Janicke D, Finney J. Determinants of children’s primary health care use. J Clin Psychol Med Settings 2000; 7 29–39.
Determinants of children’s primary health care use.CrossRef |

[12]  Currie J Stabile M Socioeconomic status and health: Why is the relationship stronger for older children? Am Econ Rev 2003 93 1813 23

[13]  Case A, Lubotsky D, Paxon C. Economic status and health in childhood: The origins of the gradient. Am Econ Rev 2002; 92 1308–34.
Economic status and health in childhood: The origins of the gradient.CrossRef |

[14]  Dowd JB. Early childhood origins of the income/health gradient: the role of maternal health behaviours. Soc Sci Med 2007; 65 1202–13.
Early childhood origins of the income/health gradient: the role of maternal health behaviours.CrossRef | 17582666PubMed |

[15]  Goldfeld SR, Wright M, Oberklaid F. Parents, infants and health care: utilization of health services in the first 12 months of life. J Paediatr Child Health 2003; 39 249–53.
Parents, infants and health care: utilization of health services in the first 12 months of life.CrossRef | 1:STN:280:DC%2BD3szgt1equw%3D%3D&md5=a8d39bed7a6e3d5357a185404ad73e32CAS | 12755928PubMed |

[16]  Pittard WB,, Laditka JN, Laditka SB. Early and periodic screening, diagnosis, and treatment and infant health outcomes in Medicaid-insured infants in South Carolina. J Pediatr 2007; 151 414–8.
Early and periodic screening, diagnosis, and treatment and infant health outcomes in Medicaid-insured infants in South Carolina.CrossRef |

[17]  Furler JS, Harris E, Chondros P, Davies PG, Harris M, Young D. The inverse care law revisited: impact of disadvantaged location on accessing longer GP consultation times. Med J Aust 2002; 177 80–3.
| 12098344PubMed |

[18]  Ching P. User fees, demand for children’s health care and access across income groups: the Philippine case. Soc Sci Med 1995; 41 37–46.
User fees, demand for children’s health care and access across income groups: the Philippine case.CrossRef | 1:STN:280:DyaK2MzpslWrtQ%3D%3D&md5=18c47f36863a814ca7d697548cfa736aCAS | 7667672PubMed |

[19]  Curtis LJ, Dooley MD, Lipman EL, Feeny DH. The role of permanent income and family structure in the determination of child health in Canada. Health Econ 2001; 10 287–302.
The role of permanent income and family structure in the determination of child health in Canada.CrossRef | 1:STN:280:DC%2BD3MzjtFynuw%3D%3D&md5=77632bf2b38e526683aa67f803d04da0CAS | 11400252PubMed |

[20]  Cameron CM, Scuffham PA, Spinks A, Scott R, Sipe N, Ng S, Wilson A, Searle J, Lyons RA, Kendall E, Halford K, Griffiths LR, Homel R, McClure RJ. Environments for Healthy Living (EFHL) Griffith birth cohort study: background and methods. Matern Child Health J 2012; 16 1896–905.
Environments for Healthy Living (EFHL) Griffith birth cohort study: background and methods.CrossRef | 22311577PubMed |

[21]  Cameron CM, Scuffham PA, Shibl R, Ng S, Scott R, Spinks A, Mihala G, Wilson A, Kendall E, Sipe N, McClure RJ. Environments for Healthy Living (EFHL) Griffith birth cohort study: characteristics of sample and profile of antenatal exposures. BMC Public Health 2012; 12 1080
Environments for Healthy Living (EFHL) Griffith birth cohort study: characteristics of sample and profile of antenatal exposures.CrossRef | 23241307PubMed |

[22]  Homel R, Freiberg K, Lamb C, Leech M, Carr A, Hampshire A, Hay I, Elias G, Manning M, Teague R, Batchelor S. The pathways to prevention project: the first five years 1999–2004. Sydney: Mission Australia and the Key Centre for Ethics, Law, Justice & Governance, Griffith University; 2006.

[23]  Moos R, Moos B. Family environment scale manual: development, applications, research. 3rd edn. Palo Alto: Consulting Psychological Press; 1994.

[24]  McCullagh P, Nelder JA. Generalized linear models. 2nd edn. London: Chapman and Hall; 1989.

[25]  Gardner W, Mulvey EP, Shaw EC. Regression analyses of counts and rates: Poisson, overdispersed Poisson, and negative binomial models. Psychol Bull 1995; 118 392–404.
Regression analyses of counts and rates: Poisson, overdispersed Poisson, and negative binomial models.CrossRef | 1:STN:280:DyaK28%2FnslShsQ%3D%3D&md5=adb05fa0868ccfd22869b41e70fccd64CAS | 7501743PubMed |

[26]  Heck KE, Parker JD. Family structure, socioeconomic status, and access to health care for children. Health Serv Res 2002; 37 173–86.
| 11949919PubMed |

[27]  Connellan J, Baron-Cohen S, Wheelwright S, Batki A, Ahluwalia J. Sex differences in human neonatal social perception. Infant Behav Dev 2000; 23 113–8.
Sex differences in human neonatal social perception.CrossRef |

[28]  Courtenay WH. Constructions of masculinity and their influence on men’s well-being: a theory of gender and health. Soc Sci Med 2000; 50 1385–401.
Constructions of masculinity and their influence on men’s well-being: a theory of gender and health.CrossRef | 1:STN:280:DC%2BD3c3gtlKiuw%3D%3D&md5=213f6c3af56c750210ff8307ee0753cdCAS | 10741575PubMed |

[29]  MacKian S. A review of health seeking behaviour: problems and prospects. London: University of Manchester; 2001.

[30]  Hausmann-Muela S, Ribera J, Nyamongo I. DCPP Working Paper No. 14, Health-seeking behaviour and the health system response. London: London School of Hygiene and Tropical Medicine; 2003.

[31]  August KJ, Sorkin DH. Marital status and gender differences in managing a chronic illness: The function of health-related social control. Soc Sci Med 2010; 71 1831–8.
Marital status and gender differences in managing a chronic illness: The function of health-related social control.CrossRef | 20889249PubMed |

[32]  Mbagaya GM, Odhiambo M, Oniang’o R. Mother’s health seeking behaviour during child illness in a rural western Kenya community. Afr Health Sci 2005; 5 322–7.
| 16615844PubMed |

[33]  Goldman N, Heuveline P. Health-seeking behaviour for child illness in Guatemala. Trop Med Int Health 2000; 5 145–55.
Health-seeking behaviour for child illness in Guatemala.CrossRef | 1:STN:280:DC%2BD3c3htF2rug%3D%3D&md5=558c9e1aff3f6f9fa7c94684b0bb4365CAS | 10747275PubMed |

[34]  Taffa N, Chepngeno G. Determinants of health care seeking for childhood illnesses in Nairobi slums. Trop Med Int Health 2005; 10 240–5.
Determinants of health care seeking for childhood illnesses in Nairobi slums.CrossRef | 15730508PubMed |

[35]  Cline RJW, Haynes KM. Consumer health information seeking on the Internet: the state of the art. Health Educ Res 2001; 16 671–92.
Consumer health information seeking on the Internet: the state of the art.CrossRef | 1:STN:280:DC%2BD38%2FlsFGjug%3D%3D&md5=3e234af5fce2ea0aaeac14db37e631cdCAS |

[36]  Baker L, Wagner TH, Singer S, Bundorf M. Use of the Internet and e-mail for health care information: results from a national survey. JAMA 2003; 289 2400–6.
Use of the Internet and e-mail for health care information: results from a national survey.CrossRef | 12746364PubMed |

[37]  Umberson D. Gender, marital status and the social control of health behavior. Soc Sci Med 1992; 34 907–17.
Gender, marital status and the social control of health behavior.CrossRef | 1:STN:280:DyaK383psV2nsQ%3D%3D&md5=aba9ea409ca9a372f1561fefedaffe4cCAS | 1604380PubMed |

[38]  Wyke S, Ford G. Competing explanations for associations between marital status and health. Soc Sci Med 1992; 34 523–32.
Competing explanations for associations between marital status and health.CrossRef | 1:STN:280:DyaK383psV2iug%3D%3D&md5=3bff33938a7226a7fb222ce47ac56c12CAS | 1604359PubMed |

[39]  Shaikh BT, Hatcher J. Health seeking behaviour and health service utilization in Pakistan: challenging the policy makers. J Public Health (Oxf) 2005; 27 49–54.
Health seeking behaviour and health service utilization in Pakistan: challenging the policy makers.CrossRef |

[40]  Queensland Council of Social Service. Health equity and access. South Brisbane: Queensland Council of Social Service; 2011.

[41]  Saxena S, Majeed A, Jones M. Socioeconomic differences in childhood consultation rates in general practice in England and Wales: prospective cohort study. BMJ 1999; 318 642–6.
Socioeconomic differences in childhood consultation rates in general practice in England and Wales: prospective cohort study.CrossRef | 1:STN:280:DyaK1M7msFKruw%3D%3D&md5=b715cd5348b1eab5e8fa534d3d17c49dCAS | 10066207PubMed |

[42]  Begg S, Vos T, Barker B, Stevenson C, Stanley L, Lopez A. The burden of disease and injury in Australia 2003. Canberra: Australian Institute of Health and Welfare; 2007. Available at: http://www.aihw.gov.au/publication-detail/?id=6442467990&libID=6442467988 [verified 13 June 2012].

[43]  Brooks PM, Lapsley H, Butt D. Medical workforce issues in Australia: tomorrow’s doctors–too few, too far. Med J Aust 2003; 179 206–8.
| 12914512PubMed |

[44]  Gertler P, Locay L, Sanderson W. Are user fees regressive?: The welfare implications of health care financing proposals in Peru. J Econom 1987; 36 67–88.
Are user fees regressive?: The welfare implications of health care financing proposals in Peru.CrossRef |

[45]  Belli PC, Bustreo F, Preker A. Investing in children’s health: what are the economic benefits? Bull World Health Organ 2005; 83 777–84.
| 16283055PubMed |



Export Citation Cited By (4)

View Altmetrics