General health care service utilisation: where, when and by whom in a socioeconomically disadvantaged population
Helen M. Achat A E , Paul Thomas B , Glenn R. Close C , Leendert R. Moerkerken A and Mark F. Harris DA Sydney West Area Health Service, Gungurra Bld 68, Locked Bag 7118, Parramatta BC, NSW 2150, Australia.
B Aboriginal Medical Service Western Sydney, 2 Palmerston Road, Mt Druitt, NSW 2770, Australia.
C Sydney West Area Health Service, Area Executive Unit, PO Box 63, Penrith 2751, Australia.
D Centre for Primary Health Care and Equity, University of New South Wales, Australia.
E Corresponding author. Email: helen_achat@wsahs.nsw.gov.au
Australian Journal of Primary Health 16(2) 132-140 https://doi.org/10.1071/PY09066
Published: 19 May 2010
Abstract
This paper aimed to examine the utilisation of and preferences related to health care services by residents of a disadvantaged area and to identify factors associated with levels of current and future use. Data were collected from face-to-face structured interviews of randomly selected residents of a disadvantaged local government area in 2003–04. Information about respondents’ health and socioeconomic status and patterns of use and preferred features of health care was analysed in PASW Statistic 17. Chi-square statistics were used to examine differences in utilisation by sex and simple logistic regression provided sex specific age-adjusted odds ratios about frequent visits. Most respondents (95%) attended a ‘usual’ general practitioner (GP) service and about two-fifths had obtained other health care in the last 12 months. The median number of visits was four and most providers offered bulk billing (83%). Less common were visits to the dentist (32%), emergency department (14%), specialists (29%) and the hospital (5%). Providers’ skills and traits, physical access and bulk billing were key considerations for men and women when choosing a health care provider. Disadvantaged communities want skilled practitioners who reflect their demographic mix and are located at convenient and accessible clinics, which preferably bulk bill. Apart from GP visits, this group appears to make only moderate use of specialists and emergency departments, and little routine use of other primary health services.
Additional keywords: general practitioner, primary health care.
Acknowledgements
The views expressed in this article are those of the authors, and do not necessarily represent the views of any institution. The authors would like to acknowledge Rowena Saheb and Doungkamol Sindhusake for their assistance with data cleaning and coding.
Anderson R,
Sorlie P,
Backlund E,
Johnson N, Kaplan G
(1997) Mortality effects of community socioeconomic status. Epidemiology 8, 42–47.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
[Verified 23 June 2009]
Bolton P,
Mira M,
Roberts L, Usher H
(1998) Is health care card status related to consultation time? The Medical Journal of Australia 168, 527–528.
| PubMed |
[Verified April 2009]
Field K, Briggs DJ
(2001) Socio-economic and locational determinants of accessibility and utilization of primary health-care. Health & Social Care in the Community 9(5), 294–308.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
Fiscella K, Williams D
(2004) Health disparities based on socioeconomic inequalities: implications for urban health care. Academic Medicine 79(12), 1139–1147.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
Friedman A, Lahad A
(2007) Association between maternal and adult offspring utilization of primary health care. The Israel Medical Association Journal 9(2), 86–89.
| PubMed |
Furler J,
Harris E,
Chondros P,
Powell Davies PG,
Harris MF, Young DY
(2002) The inverse care law revisited: impact of disadvantaged location on accessing longer GP consultation times. The Medical Journal of Australia 177(2), 80–83.
| PubMed |
Green C, Pope C
(1999) Gender, psychosocial factors and use of medical services: a longitudinal analysis. Social Science & Medicine 48(10), 1363–1372.
| Crossref | GoogleScholarGoogle Scholar |
Harris M, Furler J
(2002) How can primary care increase equity in health? NSW Public Health Bulletin 13(3), 35–38.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
Harris M, Harris E
(2006) Facing the challenges: general practice in 2020. The Medical Journal of Australia 185(2), 122–124.
| PubMed |
Harvey P
(2003) Managing health care in Australia: steps on the health care roundabout? Australian Journal of Primary Health 9(3), 105–108.
| Crossref | GoogleScholarGoogle Scholar |
Hayes L
(2002) Socioeconomic inequalities in all-cause and specific-cause mortality in Australia: 1985–1987 and 1995–1997. International Journal of Epidemiology 31(1), 257–258.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
Ho KM,
Dobb GJ,
Knuiman M,
Finn J, Webb SA
(2008) The effect of socioeconomic status on outcomes for seriously ill patients: a linked data cohort study. The Medical Journal of Australia 189(1), 26–30.
| PubMed |
Howie J,
Heaney D,
Maxwell M,
Walker J,
Freeman G, Rai H
(1999) Quality at general practice consultations: cross sectional survey. British Medical Journal 319(7212), 738–743.
| PubMed |
Hyndman J,
D’Arcy C,
Holman J, Pritchard DA
(2003) The influence of attractiveness factors and distance to general practice surgeries by level of social disadvantage and global access in Perth, Western Australia. Social Science & Medicine 56(2), 387–403.
| Crossref | GoogleScholarGoogle Scholar |
Kahana E,
Stange K,
Meehan R, Raff L
(1997) Forced disruption in continuity of primary care: the patients’ perspective. Sociological Focus 30, 177–187.
Kelaher M,
Dunt D,
Day S, Feldman P
(2006) Effects of financial disadvantage on use and non-use of after hours care in Australia. Health Policy 79(1), 16–23.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
Kelsall HL,
Baglietto L,
Muller D,
Haydon AM,
English DR, Giles GG
(2009) The effect of socioeconomic status on survival from colorectal cancer in the Melbourne Collaborative Cohort Study. Social Science & Medicine 68(2), 290–297.
| Crossref | GoogleScholarGoogle Scholar |
Korda RJ,
Butler JR,
Clements MS, Kunitz SJ
(2007) Differential impacts of health care in Australia: trend analysis of socioeconomic inequalities in avoidable mortality. International Journal of Epidemiology 36(1), 157–165.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
Ladwig K,
Marten-Mittag B,
Formanek B, Dammann G
(2000) Gender differences of symptom reporting and medical health care utilization in the German population. European Journal of Epidemiology 16(6), 511–518.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
Layte R,
Nolan A,
McGee H, O’Hanlon A
(2009) Do consultation charges deter general practitioner use among older people? A natural experiment. Social Science & Medicine 68(8), 1432–1438.
| Crossref | GoogleScholarGoogle Scholar |
Madden D,
Nolan A, Nolan B
(2005) GP reimbursement and visiting behaviour in Ireland. Health Economics 14(10), 1047–1060.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
Marmot M
(2005) Social determinants of health inequalities. Lancet 365(9464), 1099–1104.
| PubMed |
Marmot M,
Shipley M,
Brunner E, Hemingway H
(2001) Relative contribution of early life and adult socioeconomic factors to adult morbidity in the Whitehall II study. Journal of Epidemiology and Community Health 55, 301–307.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
Mercer SW,
Fitzpatrick B,
Gourlay G,
Vojt G,
McConnachie A, Watt GC
(2007) More time for complex consultations in a high-deprivation practice is associated with increased patient enablement. The British Journal of General Practice 57(545), 960–966.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
Morris S,
Sutton M, Gravelle H
(2005) Inequity and inequality in the use of health care in England: an empirical investigation. Social Science & Medicine 60(6), 1251–1266.
| Crossref | GoogleScholarGoogle Scholar |
Nabalamba A, Millar W
(2007) Going to the doctor. Health Reports 18(1), 23–35.
| PubMed |
Najman JM,
Toloo G, Siskind V
(2006) Socioeconomic disadvantage and changes in health risk behaviours in Australia: 1989–90 to 2001. Bulletin of the World Health Organization 84(12), 976–983.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
Phan K, Brown S
(2009) Decreased continuity in a residency clinic: a consequence of open access scheduling. Family Medicine 41(1), 46–50.
| PubMed |
Piers L,
Carson N,
Brown K, Ansari Z
(2007) Avoidable mortality in Victoria between 1979 and 2001. Australian and New Zealand Journal of Public Health 31(1), 5–12.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
Saultz J
(2003) Defining and measuring interpersonal continuity of care. Annals of Family Medicine 1(3), 134–143.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
Shi L,
Starfield B,
Politzer R, Regan J
(2002) Primary care, self-rated health, and reductions in social disparities in health. Health Services Research 37(3), 529–550.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
Siskind V,
Copeman R, Najman JM
(1987) Socioeconomic status and mortality: a Brisbane area analysis. Community Health Studies 11(1), 15–23.
| PubMed |
Spurrier N,
Sawyer MG,
Clark JJ, Baghurst P
(2003) Socio-economic differentials in the health-related quality of life of Australian children: results of a national study. Australian and New Zealand Journal of Public Health 27(1), 27–33.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
Turrell G,
Oldenburg BF,
Harris E,
Jolley DJ, Kimman ML
(2003) Socioeconomic disadvantage and use of general practitioners in rural and remote Australia. The Medical Journal of Australia 179(6), 325–326.
| PubMed |
Turrell G,
Oldenburg B,
Harris E, Jolley D
(2004) Utilisation of general practitioner services by socio-economic disadvantage and geographic remoteness. Australian and New Zealand Journal of Public Health 28(2), 152–158.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
Turrell G,
Bentley R,
Thomas LR,
Jolley D,
Subramanian S, Kavanagh AM
(2009) A multilevel study of area socio-economic status and food purchasing behaviour. Public Health Nutrition 12(11), 2074–2083.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
van den Hombergh P,
Künzi B,
Elwyn G,
van Doremalen J, Akkermans R , et al.
(2009) High workload and job stress are associated with lower practice performance in general practice: an observational study in 239 general practices in the Netherlands. BMC Health Services Research 9, 118.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
van Doorslaer E,
Masseria C, Koolman X
(2006) Inequalities in access to medical care by income in developed countries. Canadian Medical Association Journal 174(2), 177–183.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
van Doorslaer E,
Clarke P,
Savage E, Hall J
(2008) Horizontal inequities in Australia’s mixed public/private health care system. Health Policy 86, 97–108.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
Yu X,
O’Connell D,
Gibberd R, Armstrong B
(2008) Assessing the impact of socio-economic status on cancer survival in New South Wales, Australia 1996–2001. Cancer Causes & Control 19(10), 1383–1390.
| Crossref | GoogleScholarGoogle Scholar | PubMed |
