Many Australians are fortunate to experience very good or excellent health and have few or no longterm health conditions. They might visit a GP once or twice a year or they may go the whole year without any visits. Overall, Australians see GPs 5.6 times per year on average.* However, many other Australians need to see a GP more often than this.
Those patients who see a doctor much more than the average, as well as those who see many different doctors, are of considerable interest to health system managers and clinicians because in many cases these patients have the greatest need for effective and well-coordinated health care. Improvements targeted at these patients therefore have the potential to bring significant benefits in terms of patient outcomes and system efficiencies. However, until now there has been limited publicly available information about these types of patients, such as their age, geographic distribution and other characteristics.
The National Health Performance Authority (the Authority) aims to fill some of these gaps in knowledge by providing in this report the most detailed picture to date of who are these ‘frequent GP attenders’ and which local areas have greater or lesser percentages of them. It breaks down the Australian population into groups according to how often they went to a GP in 2012–13, and how many different GPs and specialists they saw.
The results show how the two highest GP user groups compare to other attendance groups in terms of their age, socioeconomic and insurance status, the extent to which they have chronic or other health problems, and how many times they went to an emergency department or were admitted to hospital. The results also show how much money was contributed through Medicare towards GP, medical specialist and pathology and diagnostic imaging services for the two highest GP user groups in each local area.
Through the use of tables and maps, the report also shows which local areas have the highest and lowest percentages of very high and frequent ‘GP attenders’.
To derive the results, the Australian population was divided into six groups, based on the number of times people visited a GP in 2012–13 (referred to as a ‘GP attendance’). The groups are:
- Very high GP attenders: 20 or more visits per year
- Frequent GP attenders: 12–19 visits
- Above average GP attenders: 6–11 visits
- Occasional GP attenders: 4–5 visits
- Low GP attenders: 1–3 visits
- Did not attend: no visits.
Findings are presented for each of the local areas that are covered by the national network of Medicare Locals. In mid-2015, Medicare Locals are due to be replaced by Primary Health Networks (PHNs). PHNs will have a critical role in increasing the efficiency and effectiveness of medical services for patients, particularly those at risk of poorer health outcomes.1 Boundaries for the PHNs were announced in late 2014 and information showing which Medicare Local catchments lie within each PHN area has recently been made available on the Authority’s MyHealthyCommunities website (www.myhealthycommunities.gov.au).
The report shows that more than one-third of the population (35.3%) visited a GP six or more times in 2012–13, and more than one in 10 Australians (12.5%) went to a GP 12 or more times a year (Table 1).
These very high (20+ visits) and frequent (12–19 visits) GP attenders were also much more likely than other GP user groups to see many different GPs. Very high GP attenders saw 4.8 different GPs on average, compared to 3.9 GPs for frequent GP attenders and 3.2 for above average GP attenders. Taken together, more than one-third (36%) of the very high and frequent GP attenders saw five or more different GPs in 2012–13 (Table 2 and Table 3).
Very high and frequent GP attenders also account for a high proportion of hospital admissions. Taken together, patients in these two groups represented nearly 60% of all adult Australians who reported in 2012–13 that they were admitted to hospital four times or more in the previous year.
These two groups also accounted for 41.0% of non-hospital Medicare expenditure ($6.5 billion) in 2012–13 (Table 1).
What does this report cover
How often Australians visit a GP and how many they see
The report finds that 84.7% of Australians visited a GP at least once in 2012–13. One-third (33.6%) of Australians made between one and three visits (low GP attenders), and just over one in five (22.8%) visited a GP between six and 11 times (above average GP attenders). One in 11 Australians (8.7%) were frequent GP attenders (12–19 visits) and 3.8% were very high GP attenders (20+ visits) (Table 1).
Very high GP attenders saw three times as many different GPs compared to low attenders (4.8 compared to 1.5), and saw almost twice as many medical specialists (2.4 compared to 1.3) (Table 2).
Just over one-third (34%) of very high and frequent GP attenders combined saw three to four GPs in 2012–13, while a further 36% of very high and frequent GP attenders saw five or more. Over the same period, one-quarter (25%) of very high and frequent attenders saw two to three medical specialists, and nearly one in 10 (9%) saw four or more specialists (Table 3).
The value (or reduction in value) involved in patients seeing multiple health service providers is an issue for health system managers, policy makers and individual clinicians to assess.
In terms of regional variations, differences were seen in the distribution of very high and frequent GP attenders, even when restricting comparisons to local areas that share similar characteristics such as socioeconomic status.
To assist in comparing areas on a more equitable basis, local areas were assigned to peer groups based on their distance from major centres, socioeconomic status and distance to hospitals. Among higher-income inner-city catchments (Metro 1 peer group), the percentage of very high and frequent GP attenders was twice as high in the local area with the highest percentage (Inner West Sydney, 14.5%) compared to the local area with the lowest percentage (Australian Capital Territory, 7.1%).
There was a similar range among the local areas in the lower-income regional peer group (Regional 2), where the local area with the highest percentage of very high and frequent users (Wide Bay in Queensland, 15.3%) was almost double that in the areas with the lowest (New England in NSW and South West WA, 8.3%) (Figure 1, and Maps for Very high and Frequent attenders).
Regional differences in prevalence of very high and frequent GP attenders remain even after differences in the age of populations in local areas is considered.
Expenditure on health services
Across Australia, very high and frequent GP attenders accounted for 41.0% of all non-hospital Medicare expenditure (including but not limited to GP, medical specialists, pathology, diagnostic imaging, and allied health services) in 2012–13. As this implies, there was a marked difference in the amounts of money Medicare contributed on a per-person basis for patients in each of the attendance groups, as follows:
- Very high (20+ visits): $3,202 per person
- Frequent (12–19 visits): $1,850 per person
- Above average (6–11 visits): $993 per person
- Occasional (4–5 visits): $551 per person
- Low (1–3 visits): $257 per person
To break this expenditure down further, for very high and frequent GP attenders combined, federal expenditure on non-hospital Medicare services was spent in the following ways:
- GP attendances: $906 per person
- Specialist attendances: $205 per person
- Pathology and diagnostic imaging services: $611 per person
- All other*: $540 per person
Across local areas, there were differences in the average per-person expenditure for very high and frequent GP attenders even after accounting for broad geographic and socioeconomic circumstances:
- Across higher-income inner-city catchments (Metro 1 peer group), the per-person expenditure for very high and frequent GP attenders varied from $2,026 per person in Australian Capital Territory to $2,667 per person in Eastern Sydney
- Across the middle-income outerurban catchments (Regional 1 peer group), the per-person expenditure for very high and frequent GP attenders varied from $1,988 per person in Perth South Coastal to $2,684 per person in Central Coast (NSW)
* About half of which was spent on allied health and nursing services (including the Chronic Disease Dental Scheme which ceased on 1 Dec 2012) and half on medical-related services.
Use of health and hospital services
Very high and frequent GP attenders not only used a large number of GP services, they also accessed large numbers of other non-hospital Medicare-funded services.
Most very high GP attenders had at least one pathology episode (93.0%), diagnostic imaging service (77.8%), or specialist attendance (68.4%). Those that accessed these services did so at higher rates than other GP attendance groups. For example, very high GP attenders who had a pathology episode (see Glossary), on average had 6.5 episodes in 2012–13. In 2012–13, over half (51.1%) of very high GP attenders claimed at least one GP chronic disease planning and management service (see Glossary) (Table 4 and Figure 3).
Very high and frequent GP attenders are often quite unwell and have complex and chronic health conditions. A considerable percentage of these groups attended emergency departments (EDs) and were also often admitted to hospital.
Among adults in Australia, differences were found between GP attendance groups that reported visiting an ED in 2012–13 with just over 40% of very high and 30% of frequent GP attenders reported visiting an ED compared to 10% of low GP attenders and 4% of people who said they did not attend a GP (Figure 4).
For all adults who reported visiting an ED in the past 12 months, almost one-quarter (23%) felt their most recent ED visit was for care that could have been provided by a GP. Analysis suggests that low GP attenders were more likely than very high GP attenders to report that their most recent visit to an ED was for care that could have been provided by a GP (28% compared to 19%) (Figure 5).
A considerable percentage (43%) of very high GP attenders and just over one-third (35%) of frequent GP attenders reported being admitted to hospital in 2012–13 (Figure 6).
Barriers to GP care
At the national level, the report suggests that cost barriers and waiting times to see a GP are no more or less common for people who often see a GP. At the national level, there were only slight variations between GP attendance groups in whether people delayed or did not see a GP due to cost or waited longer than they felt acceptable to visit a GP (Figure 7, Figure 8 and Figure 9).
Age, wealth and health characteristics
Very high and frequent GP attenders include a broad mix of people from different age groups and socioeconomic backgrounds. However, they are more likely to be older, live in areas with the most socioeconomic disadvantage and have the lowest rates of private health insurance coverage (Figure 10, Figure 11 and Figure 12).
Three-quarters (75%) of very high GP attenders were aged 45 or above, 57% were aged 60 and above, and 32% were aged 75 and above. In contrast, 45% of frequent attenders, and 28% of above average attenders were aged 60 and above, while the percentages of over-75s in these groups were 20% and 9% respectively (Figure 10).
Very high GP attenders generally rated their health as fair or poor (64%) though a small proportion (16%) rated their health as very good or excellent (Figure 13).
The vast majority of very high and frequent GP attenders (89% and 84% respectively) had one or more long-term health conditions such as arthritis or osteoporosis and a heart or circulatory condition (Figure 14).
Patients in the higher GP attendance groups were also much more likely to have three or more long-term health conditions. Of very high GP attenders, 36% had three or more long-term conditions, compared to 29% of frequent, 16% of above average and just 8% of occasional attenders.
While people with long-term health conditions are highly represented in the very high and frequent GP attendance groups, more than half of people with three or more long-term health conditions are either low (15%), occasional (16%) or above average (27%) GP attenders.
Arthritis or osteoporosis were the two most common long-term health conditions among very high and frequent GP attenders, affecting a considerable proportion (44%) of people in these groups. Around one-third of very high (34%) or frequent (31%) GP attenders have a heart or circulatory condition (Figure 15).
Long-term injury, asthma, diabetes and mental health conditions are also common among very high and frequent GP attenders, affecting around one in four to one in six people.
How can the report information be used?
The report does not define frequent access as either ‘good’ or ‘bad’, nor does it try to assess the degree to which patient needs are being met appropriately in any of the GP attendance groups.
There will be various factors at play in each local area that may help to explain that area’s mix of frequent and less frequent GP attenders. With local knowledge and experience, community-level health service providers may be able to identify the factors relevant to their region and to better understand patient populations.
Additional patient experience information on MyHealthyCommunities
This report is available to download at www.myhealthycommunities.gov.au along with information on crude and age-standardised percentages of very high and frequent GP attenders across Medicare Local catchments and more than 300 local areas.
The website also includes updated patient experience data on use and experiences with primary health care. The additional information available on the website is based on a locallevel breakdown of data from the ABS Patient Experience Survey 2012–13 and covers the following measures:
- Australians with a long-term health condition
- Seeing a GP
- Seeing a medical specialist
- Admissions to hospital
- Visits to hospital EDs
- Visits to hospital EDs instead of GPs
- Waiting times for GP appointments
- Waiting times for urgent GP appointments
- Cost barriers to GP care
- Cost barriers to prescribed medication
- Cost barriers to seeing a medical specialist
- Seeing three or more health professionals.
There are also over 100 measures of health and care at Medicare Local catchment level available on the MyHealthyCommunities website.
In 2012–13: 13% of Australians were very high and frequent GPO attenders, with 4% of the population making 20+ visits (very high) and 9% making 12-19 visits (frequent) per year, tallying 2.9 million people. They accounted for $6.5 billion (41%) of non-hospital Medicare expenditure.
Very high and frequent GP attenders have a high need for quality coordinated primary and hopsital care.
Very high GP attenders visit a GP 20 or more times a year. They are a group that are generally quite unwell and also see a greater number of other service providers.
- 89% of very high attenders had at least one long-term health condition
- 64% of very high attenders rated their health fair or poor
- 9 out of 10 had pathology episodes, averaging 6 per person
- 7 out of 10 had specialist attendances, averaging 5 per person
- 4 out of 10 visited an emergency department
Population rates of very high and frequent GP attenders across Australia
Among higher-income inner-city catchments (Metro 1), the percentage of very high and frequent GP attenders was 7.1% in Australian Capital Territory compared to 14.5% in Inner West Sydney
Among lower-income regional areas (Regional 2), the percentage of very high and frequent GP attenders was 8.3% in New England (NSW) and South West WA compared to 15.3% in Wide Bay (Qld)
* Average number of non-hospital GP attendances per person (including non-GP attenders). National Health Performance Authority analysis of Department of Health Medicare Statistics (via MedicareWiz), January 2015.
1. Australian Government Department of Health. Primary Health Networks [Internet]. Canberra: Commonwealth of Australia; 2014 [cited 2015 Jan 30]. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/primary_Health_NetworksExternal link, opens in a new window.