Barriers to accessing primary health care: comparing Australian experiences internationallyLisa Corscadden A H , Jean-Frederic Levesque A B , Virginia Lewis C , Mylaine Breton D , Kim Sutherland A , Jan-Willem Weenink E , Jeannie Haggerty F and Grant Russell G
A Bureau of Health Information, Level 11, 67 Albert Avenue, Chatswood, NSW 2067, Australia.
B Centre for Primary Health Care and Equity, University of New South Wales, Sydney NSW 2052, Australia.
C Australian Institute for Primary Care & Ageing, LaTrobe University, Melbourne, Vic. 3068, Australia.
D Community Health Sciences Department, Université de Sherbrooke, Longueuil, QC, J4K 0A8, Canada.
E IQ healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center PO Box 9101, NL-6500 HB Nijmegen, Netherlands.
F Faculty of Medicine, McGill University, Montreal, QC, H3A 0G4, Canada.
G Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, Clayton, Vic. 3800, Australia.
H Corresponding author. Email: email@example.com
Australian Journal of Primary Health 23(3) 223-228 https://doi.org/10.1071/PY16093
Submitted: 2 August 2016 Accepted: 7 October 2016 Published: 8 December 2016
Most highly developed economies have embarked on a process of primary health care (PHC) transformation. To provide evidence on how nations vary in terms of accessing PHC, the aim of this study is to describe the extent to which barriers to access were experienced by adults in Australia compared with other countries. Communities participating in an international research project on PHC access interventions were engaged to prioritise questions from the 2013 Commonwealth Fund International Health Policy Survey within a framework that conceptualises access across dimensions of approachability, acceptability, availability, affordability and appropriateness. Logistic regression models, with barriers to access as outcomes, found measures of availability to be a problematic dimension in Australia; 27% of adults experienced difficulties with out-of-hours access, which was higher than 5 of 10 comparator countries. Although less prevalent, affordability was also perceived as a substantial barrier; 16% of Australians said they had forgone health care due to cost in the previous year. After adjusting for age and health status, this barrier was more common in Australia than 7 of 10 countries. Findings of this integrated assessment of barriers to access offer insights for policymakers and researchers on Australia’s international performance in this crucial PHC domain.
ReferencesBureau of Health Information (2010) ‘Healthcare in Focus. How NSW Compares Internationally? Annual performance report: December 2010’ (BHI: Sydney, NSW, Australia) Available at http://www.bhi.nsw.gov.au/__data/assets/pdf_file/0009/170595/APR-2010_healthcare-in-focus.pdf [Verified 29 November 2016]
Bureau of Health Information (2014) ‘Healthcare in Focus 2013. How does NSW Measure Up? Annual performance report’ (BHI: Sydney, NSW, Australia) Available at http://www.bhi.nsw.gov.au/__data/assets/pdf_file/0008/216971/Main-report_HealthcareInFocus-2013.pdf [Verified 21 October 2016]
Davis K, Stremikis K, Schoen C (2014) ‘Mirror, Mirror on the Wall Update: How the US Health Care System Compares Internationally.’ (The Commonwealth Fund: New York)
Fiscella K (2011) Health care reform and equity: promise, pitfalls, and prescriptions. Annals of Family Medicine 9, 78–84.
| Health care reform and equity: promise, pitfalls, and prescriptions.CrossRef |
Fradgley EA, Paul CL, Bryant J (2015) A systematic review of barriers to optimal outpatient specialist services for individuals with prevalent chronic diseases: what are the unique and common barriers experienced by patients in high income countries. International Journal for Equity in Health 14, 52
| A systematic review of barriers to optimal outpatient specialist services for individuals with prevalent chronic diseases: what are the unique and common barriers experienced by patients in high income countries.CrossRef |
Frenk J (1992) The concept and measurement of accessibility. In ‘Health Services Research: an Anthology’. (Eds KL White, J Frenk, C Ordonez, JM Paganini, B Starfield) pp. 858–864. (Pan American Health Organization: Washington, DC, USA)
Gulliford M, Fiqueroa-Munoz J, Morgan M, Gibson B, Beech R, Hudson M (2002) What does ‘access to health care’ mean? Journal of Health Services Research & Policy 7, 186–188.
| What does ‘access to health care’ mean?CrossRef |
Levesque J-F, Harris MF, Russell G (2013) Patient-centred access to health care: conceptualising access at the interface of health systems and populations. International Journal for Equity in Health 12, 18
| Patient-centred access to health care: conceptualising access at the interface of health systems and populations.CrossRef |
Mossialos D, Wenzl M, Osborn R, Anderson C (2015) International profiles of health care systems, 2014. (The Commonwealth Fund: New York, NY, USA) Available at http://www.commonwealthfund.org/~/media/files/publications/fund-report/2016/jan/1857_mossialos_intl_profiles_2015_v7.pdf [Verified 21 October 2016]
OECD (2015) Health at a glance 2015: OECD indicators. (OECD Publishing: Paris, France) Available at http://www.oecd.org/els/health-systems/health-at-a-glance-19991312.htm [Verified 21 October 2016]
Penchansky R, Thomas JW (1981) The concept of access: definition and relationship to consumer satisfaction. Medical Care 19, 127–140.
| The concept of access: definition and relationship to consumer satisfaction.CrossRef | 1:STN:280:DyaL3M7kslahug%3D%3D&md5=48a0ebf095e66258627bda594a53ae21CAS |
Schoen C, Osborn R, Squires D, Doty M, Pierson R, Applebaum S (2010) ‘How health Insurance Design Affects Access to Care and Costs, by Income, in Eleven Countries.’ (Health Affairs Web First) Available at http://content.healthaffairs.org/content/29/12/2323.full?keytype=ref&siteid=healthaff&ijkey=Ho5XaxzsdWHVE [Verified 21 October 2016]
Schoen C, Osborn R, Squires D, Doty MM (2013) Access, affordability, and insurance complexity are often worse in the United States compared to ten other countries. Health Affairs 32, 2205–2215.
| Access, affordability, and insurance complexity are often worse in the United States compared to ten other countries.CrossRef |
Starfield B (2005) ‘Primary Care: Balancing Health Needs, Services, and Technology.’ (Oxford University Press: New York, NY, USA)
Starfield B (2012) Primary care: an increasingly important contributor to effectiveness, equity, and efficiency of health services. SESPAS report 2012. Gaceta Sanitaria 26, 20–26.
| Primary care: an increasingly important contributor to effectiveness, equity, and efficiency of health services. SESPAS report 2012.CrossRef |
Starfield B, Shi L, Macinko J (2005) Contribution of primary care to health systems and health. The Milbank Quarterly 83, 457–502.
| Contribution of primary care to health systems and health.CrossRef |
Ward B, Humphreys J, Mcgrail M, Wakerman J, Chisholm M (2015) Which dimensions of access are most important when rural residents decide to visit a general practitioner for non-emergency care? Australian Health Review 39, 121–126.
| Which dimensions of access are most important when rural residents decide to visit a general practitioner for non-emergency care?CrossRef | 1:CAS:528:DC%2BC2MXlt1KksQ%3D%3D&md5=a4d4144c07e088334a47ddc43abbac77CAS |