Quick Post: Average number of GP visits per Australian

Medicare in Australia's brand.
Medicare in Australia’s brand. (Photo credit: Wikipedia)

Following Tony Shepherd’s odd-sounding claim that the average Australian sees a GP 11 times per year, there have been a few different calculations floating around.  Here’s mine using the Medicare Item Reports.

I used a slightly anachronistic version of the Medicare Benefits Schedule Book, but my total population count is going to be a bit out as well.

I’m going to count only professional attendances by a GP.  So sayeth the Schedule Book:

A.2.. PROFESSIONAL ATTENDANCES

Professional attendances by medical practitioners cover consultations during which the practitioner: evaluates the patient’s
health­ related issue or issues, using certain health screening services if applicable; formulates a management plan in
relation to one or more health ­related issues for the patient; provides advice to the patient and/or relatives (if authorised by
the patient); provides appropriate preventive health care; and records the clinical detail of the service(s) provided to the
patient. (See the General Explanatory Notes for more information on health screening services.)

A.3.. SERVICES NOT ATTRACTING MEDICARE BENEFITS

Telephone consultations, letters of advice by medical practitioners, the issue of repeat prescriptions when the patient is not
in attendance, post mortem examinations, the issue of death certificates, cremation certificates, counselling of relatives
(Note ­ items 348, 350 and 352 are not counselling services), group attendances (other than group attendances covered by
items 170, 171, 172, 342, 344 and 346) such as group counselling, health education, weight reduction or fitness classes do
not qualify for benefit.

I end up with two groups of numbers.  The first group are those Medicare items which relate only to when a person goes to see a GP.  That is, they get up and drive over to the GP’s consulting rooms and see the GP in the GP’s office or wherever.  They are items: 3, 23, 36, 44, 5000, 5020, 5040, 5060.

Then there are the items which relate to when a GP sees a patient, regardless of whether the patient came to the GP or the GP went to the patient (say, at a hospital or a Residential Aged Care Facility).  That gives us the group: 20,35, 43, 51, 5010, 5028, 5049, 5067, 4, 24, 2503, 2518, 2547, 37, 2506, 2522, 2553, 47, 2509, 2526, 2559, 5003, 5023, 5043, 5063, 3, 23, 36, 44, 5000, 5020, 5040, 5060.

Population of Australia (today): 23,480,869 (it’s a bit high for an exact figure, but it’s close enough).

For the calendar year beginning January 2013 and ending December 2013, the number of times a patient went to see a GP at the GP’s office or whatever:  111,447,266.

Average number: 111,447,266/23,480,869 = 4.75.

For the calendar year beginning January 2013 and ending December 2013, the number of times a GP saw a patient wherever:  115,883,440.

Average number: 115,883,440/23,480,869 = 4.94.

This excludes things like telehealth, &c., &c., but I’m fairly sure they won’t rock the boat much.  I could be missing Medicare items (the range I’ve got is items 3 to 51, 193, 195, 197, 199, 597, 599, 2497­-2559 and 5000-­5067 — although 193, 195, 197, 199, are acupuncture) but nothing significant.  Some incentive payments will be missed; no big deal.

So there you go.  Tony Shepherd said that he worked out his number this way:

I use that as a bit of a throwaway line, but put it this way: there are 253 million visits a year. That’s 11 times 23. So, you know, there’s a lot of visits going on each year in our – to doctors and providers under the Medicare system. [Source]

The Department of Human Services’ annual report 2012-13, said there were 265 million Medicare services bulk billed.  So Tony Shepherd is actually saying that we have an average of eleven Medicare billed items per person.  If the average person is seeing the doctor a bit under 5 times per year, this statistic actually means that the very sick in our society are requiring significantly more services than the ordinary person.  Well, no duh.

The question arising from all of this: if the average number of visits to the GP is less than 5, are we really going to introduce a $15 GP fee to push it down even further?

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Quick Post: In defence of the Level A metric for spotting healthcare waste

It’s been a weird 24 hours.

A piece I wrote for AusOpinion was circulated quite widely, even being cross posted at The Guardian.  A former public servant turned adviser has reheated a policy proposal from the early ’90s to introduce a co-payment for bulk billed services of $5.  The theory is that because healthcare is free (in some circumstances) people don’t value it and therefore waste it.  The major point is simple: where is the evidence that there’s waste arising from patient demand?

To show the problem, I drew attention to the rates of Level A consultations with a GP (specifically, consultations where the patient went to the clinic during standard hours).  Level A consultations are for simple and straightforward things.

Last financial year, there were less than 3 million Level A consultations of this kind.  As you can read in the article, this is tiny in the scheme of things.

But using the billing data in this way caused considerable grief for a number of respondents.

Continue reading “Quick Post: In defence of the Level A metric for spotting healthcare waste”