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Variation in health care use in Australia : demand vs. supply of services?


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Farrell, F. Hiong 1997 , 'Variation in health care use in Australia : demand vs. supply of services?', Research Master thesis, University of Tasmania.

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This study raises serious questions with respect to equity and quality of
health care in Australia. It attempted to explain the variation in
referral rates by general practitioners as a function of respondents'
socioeconomic and health characteristics by adopting Andersen's
behavioural model of health care utilisation to the Australian context.
The study was conducted in three stages. The supply factor - the ratios
of health personnel and facilities to population - was dropped from the
analyses at Stages 1 and 2 because it was not feasible to obtain these
Stage 1, using a subset of the National Health Survey 1989/90 data
(NHS89/90), examined the factors that determine GP consultation and
referral rates at the individual level. Logistic regression analysis
findings showed that Andersen's model was better at explaining the
probability of consulting a GP than the probability of being referred to
other health care services. Results showed that the model correctly
predicted 68% of respondents as to whether or not they saw a doctor.
This prediction compared to predicting 55% of respondents as to
whether or not they were referred to other health care services. Since the characteristics stipulated by Andersen's model were found to
contribute to predicting utilisation rates (GP consultation and referral
rates) these same variables were used in Stage 2. This stage, using the
total sample from the NHS89/90 data, examined variation in referral
rates at the aggregate level for the 47 health regions in Australia. Path analysis was used to examine the variance accounted for by these
characteristics. The full set of independent variables accounted for
43% of the variance in the referral rates, suggesting that one or more
predictor variables might have been excluded from the model.
In light of the remaining variance to be explained and literature
suggesting the importance of the supply factor a preliminary
exploration of its possible contribution was conducted in Stage 3. For
this, the two health regions with the highest and the lowest referral
rates were compared with respect to the availability of doctors,
specialists, x-ray and pathological services. Findings supported the
importance of the supply factor. In the region with the highest referral
rates, there was a considerable concentration of doctors, specialists and
services compared to the region with the lowest referral rates. While the design of the study does not allow one to determine whether
the supply factors "drive" these different rates, the findings do raise
important questions for further research. In particular, research should
focus on access and health outcomes. Individual specialist services
should be carefully studied as these too can have important cost and
health implications.

Item Type: Thesis - Research Master
Authors/Creators:Farrell, F. Hiong
Keywords: Medical referral
Copyright Holders: The Author
Additional Information:

Thesis (M.Soc.Sc.)--University of Tasmania, 1997. Includes bibliographical references

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