C M Martin1, R G Attewell, M Nisa, J McCallum, C J Raymond. 1. National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT. Carmel.Martin@nceph.anu.edu.au
Abstract
OBJECTIVE: To assess the association between general practitioner (GP) billing for "longer" consultations, patient factors linked with health care need, and other consultation characteristics. DESIGN: Retrospective analysis of data from Medicare (1984-1992), Australian Morbidity and Treatment Survey (1990-1991) and Australian Capital Territory Record Linkage Study (1988-1992). SETTING: Australian general practice, 1984 (introduction of Medicare) to 1992. MAIN OUTCOME MEASURES: Consultations billed as longer (> or = 20 or > 25 minutes) compared with standard; type of billing (bulk or private); patient health care need (defined as health and sociodemographic factors linked to worse health outcomes); consultation continuity, type of care given and number of problems managed. RESULTS: Longer billed consultations increased between 1984 and 1992, from 2.8% to 6.7% of all standard and longer consultations. Longer consultations were more likely to be bulk-billed than privately billed (odds ratio [OR], 1.74). They were more likely than standard consultations to deal with psychological diagnoses (OR, 2.06; 95% confidence interval [95% Cl], 1.83-2.32) or multiple problems (OR for four versus one diagnosis, 5.18; 95% Cl, 4.31-6.22) and to involve patients aged under 50 years, new to the practice or with new problems, but not chronic disease. In the ACT, those billed for longer consultations were more commonly tertiary educated (OR, 1.99; 95% Cl, 1.35-2.94), bulk-billed (OR, 2.75; 95% Cl, 2.51-3.10), aged 40-49 years and non-obese. CONCLUSION: Longer billed consultations were not associated with greater patient need, other than psychosocial need, but with bulk billing and patient socioeconomic advantage. However, evaluation was complicated by the effects of continuity of care and number of problems managed in the consultation.
OBJECTIVE: To assess the association between general practitioner (GP) billing for "longer" consultations, patient factors linked with health care need, and other consultation characteristics. DESIGN: Retrospective analysis of data from Medicare (1984-1992), Australian Morbidity and Treatment Survey (1990-1991) and Australian Capital Territory Record Linkage Study (1988-1992). SETTING: Australian general practice, 1984 (introduction of Medicare) to 1992. MAIN OUTCOME MEASURES: Consultations billed as longer (> or = 20 or > 25 minutes) compared with standard; type of billing (bulk or private); patient health care need (defined as health and sociodemographic factors linked to worse health outcomes); consultation continuity, type of care given and number of problems managed. RESULTS: Longer billed consultations increased between 1984 and 1992, from 2.8% to 6.7% of all standard and longer consultations. Longer consultations were more likely to be bulk-billed than privately billed (odds ratio [OR], 1.74). They were more likely than standard consultations to deal with psychological diagnoses (OR, 2.06; 95% confidence interval [95% Cl], 1.83-2.32) or multiple problems (OR for four versus one diagnosis, 5.18; 95% Cl, 4.31-6.22) and to involve patients aged under 50 years, new to the practice or with new problems, but not chronic disease. In the ACT, those billed for longer consultations were more commonly tertiary educated (OR, 1.99; 95% Cl, 1.35-2.94), bulk-billed (OR, 2.75; 95% Cl, 2.51-3.10), aged 40-49 years and non-obese. CONCLUSION: Longer billed consultations were not associated with greater patient need, other than psychosocial need, but with bulk billing and patient socioeconomic advantage. However, evaluation was complicated by the effects of continuity of care and number of problems managed in the consultation.