The National Health Performance Authority began operations in 2012 as an independent body to provide locally relevant and nationally consistent information on the performance of hospitals and other health care organisations.
This report, the Authority’s second, allows for the first time the public, clinicians and health managers to see results for both use and experience of GP care at a local level.
For most measures, the results are broken down into the 61 geographic areas that are covered by the new network of Medicare Locals, which were set up in 2011 to improve responsiveness, co-ordination and integration of health services. Where possible, results are broken down by still smaller geographic areas.
The report’s findings, largely based on interviews with nearly 27,000 adults, show that where people live makes a big difference both to their perceived heath status and to perceived experiences of care.
However, the findings also show that when patients do get in to see a GP, their perceptions of care can be quite positive.
This report examines use, patient experiences and the perceived health of populations living in each Medicare Local area against a range of indicators, including:
- GP attendances
- Measures of patient experiences
- Wait times for GP services
- After-hours GP service utilisation.
All of these data are linked to Medicare Local areas on the basis of where the patient lives, rather than the location where a health service is delivered.
Most data in this report were collected before Medicare Locals were set up. The value of these findings is that they provide a baseline at a lower level of geographic detail. This will be important over time in allowing clinicians and health managers to see what impact they are having in improving health care in their respective areas.
The report suggests that where Australians live has a noticeable impact on whether they will get care when they need it, within acceptable waiting times, and at a price they can afford. But the results show no one area does consistently well or poorly across all measures.
The findings also demonstrate wide variations in the use of after-hours GP services. From 1 July 2013, Medicare Locals will be responsible for ensuring comprehensive face-to-face after-hours services are available across their catchments according to population need.
Very large variations were seen between populations living within different Medicare Local catchment areas nationally, in terms of whether patients could afford to see a GP, how long they had to wait before securing a GP appointment, and how easily they could access after-hours GP care.
The percentage of patients who delayed or avoided seeing a doctor due to cost was up to five times higher in some areas than in other areas. The percentage ranged from 15% to 3% across Medicare Local populations nationally (Table 1 in the Key findings section and Table 2 in the Key findings section).
The percentage of patients who had seen a GP in the preceding 12 months, and who felt they waited longer than acceptable to get a GP appointment, was three times as high in some areas compared to other areas. The percentage ranged from 28% to 8% across Medicare Local populations nationally (Table 1 in the Key findings section and Table 2 in the Key findings section).
After-hours GP care
The number of after-hours GP visits per person differed greatly across the country from 0.71 visits per person to 0.03 in 2010–11, and from 0.79 visits to 0.05 in 2011–12. But just looking at metropolitan areas, the number of visits was five times higher in some areas compared to other areas. The number ranged from 0.71 visits per person to 0.14 visits across metro Medicare Local populations nationally in 2010–11 (Table 1 in the Key findings section), and from 0.79 visits to 0.15 visits in 2011–12.
The report suggests the vast majority of Australians considered themselves to be in good health in 2010–11, ranging from 91% to 81% of adults across Medicare Local catchments nationally who said their health was excellent, very good or good (Table 1 in the Key findings section and Table 2 in the Key findings section).
However, variations were also apparent on this measure. The percentage of adults who reported their health as fair or poor was twice as high in some areas than in other areas. The percentage ranged from 19% to 9% across Medicare Local populations nationally.
Adults who saw a GP
The percentage of adults who reported visiting a GP at least once in the preceding year varied across Medicare Local populations nationally, from 88% to 71%.
Number of visits to a GP
The number of GP visits per person differed greatly across the country, as did the Medicare Benefits expenditure on GP visits per person.
The number of annual visits to a GP per person was three times higher in some ares compared to other areas. The number ranged from 7.3 visits per person to 2.3 visits per person across Medicare Local populations nationally in 2010–11, and from 7.4 to 2.4 in 2011–12.
Medicare Benefits expenditure on GP attendances per person was nearly three times higher in some areas compared to others. Expenditure ranged from $302.95 to $104.81 per person in 2010–11, and from $321.03 to $114.39 in 2011–12.
Adults who had a preferred GP
The percentage of adults who reported having a preferred GP ranged from 95% to 78% across Medicare Local populations nationally. Having a preferred GP is considered conducive to improved health, as it should promote continuity of care.
The percentage of adults who reported that their GP always or often listened carefully to them was generally high across all Medicare Locals, ranging from 96% to 83%.
Information on whether patients thought their GP showed respect, spent enough time with them or explained reasons for referrals is reported in the Experiences with GPs: showed respect, Experiences with GPs: spent enough time, Specialist referrals by GPs sections.
Variations across and within peer groups
Results are reported for each Medicare Local catchment relative to the performance across all the Medicare Locals in the respective peer group (see Health status, Use of primary health care and Experiences with primary health care sections). This reflects the fact that the geographic areas for which Medicare Locals are responsible vary considerably in terms of remoteness and the socioeconomic status of the populations they serve.
Comparisons of Medicare Local areas within peer groups are more fair than comparisons across peer groups. There are three peer groups in metropolitan areas, two in regional areas and two in rural areas.
Table 1 in the Key findings section and Table 2 in the Key findings section set out a summary of Australians’ health, use and experiences with primary health care nationally. The tables identify Medicare Locals, and peer groups of Medicare Locals, where people have the most and least desirable experiences nationally.
Note that the green and orange highlights in Tables 1 and 2 portray a narrower variation on some measures than reported on Differences between Medicare Locals within peer groups in the Key findings section, and on the maps in the Health status, Use of primary health care and Experiences with primary health care sections (see Reading the data in the key findings section).
Why are there large differences in use and experiences with primary health care?
These findings raise important questions relevant to Australians and national reform. Do people who live in less healthy regions get access to more primary health care services? Do people who live in regions that use more primary health care services have more desirable experiences?
We don’t yet know the answers to these questions, so future reports will examine 'access to services relative to need' along with other indicators that the Council of Australian Governments (COAG) has asked the Authority to report on.
What else did we learn?
In piecing together national data in new ways to produce information that has never before been available, the Authority identified opportunities to improve the data.
We learnt that data are scant or not consistently collected in some local areas, so we don’t know about and can’t report on their experiences with primary health care. Accordingly, the Authority has made investments so the Australian Bureau of Statistics is now collecting more data from those communities.
We learnt that comparable data at the Medicare Local level is not available for reporting experiences with primary health care for Aboriginal and Torres Strait Islander peoples. Work is under way to determine what improvements are needed, and the best way to report into the future nationally on local experiences with primary health care among Aboriginal and Torres Strait Islander peoples.
We learnt that there is little nationally consistent data about Australians’ experiences in topics deemed a priority of health reform such as whether services are coordinated or integrated.
Accordingly, the Authority is working with the Australian Bureau of Statistics to ensure that the types of data collected in Australia reflect the needs of all people who want information about local health regions, to contribute to national and local efforts to improve care.
In the coming months, the National Health Performance Authority will look at Australians' experiences with a broader range of health care professionals including:
- Use of allied health
- Use of specialists
- Primary care-type emergency department attendances.
In 2013 the Authority will publish reports each quarter on the comparable performance of health care organisations to stimulate improvements in the Australian health system, to increase transparency and accountability and to inform consumers.
How does primary health care compare in your local area?
The National Health Performance Authority has released data for 2010–11, and where possible 2011–12, for Medicare Locals and more than 300 local areas covering:
Use of primary health care
- Adults who reported seeing a GP
- GP attendances (average number and expenditures)
- Primary care: GP care planning, comprising multidisciplinary care plans, case conferences and after-hours (attendances and expenditures)
- High use of GPs
- Use of GPs for urgent care
Experiences with primary health care
- Wait times for GP appointments
- Having a preferred GP
- Access to a preferred GP
- Cost barriers to seeing a GP
- Experiences with GPs: listening, showed respect and spent enough time
- Use of hospital EDs instead of GPs
- Referrals to specialists by GPs
To find more information about your local area, see Health status, Use of primary health care, Experiences with primary health care, Supplementary data: Use of primary health care and Supplementary data: Experiences with primary health care sections.