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Decline with a capital D: long-term changes in general practice consultation patterns across Australia
Michael J Taylor1, Dell Horey, Charles Livingstone
1Australian Institute for Primary Care, La Trobe University, Melbourne, VIC, Australia. michael.taylor@latrobe.edu.au
The Medical Journal of Australia
|July 21, 2010
Summary
General practice consultation patterns have shifted dramatically, with fewer long consultations and more short ones. While special Medicare Benefits Schedule (MBS) items initially offset this, their impact is waning, challenging health policy goals.
Area of Science:
- Health Services Research
- Primary Care Medicine
- Health Economics
Background:
- General practice consultations are central to preventive care and chronic disease management.
- Understanding trends in consultation types and their relationship with special Medicare Benefits Schedule (MBS) items is crucial for health policy.
- Previous analyses indicated a rise in longer consultations and the use of specific MBS items.
Purpose of the Study:
- To analyze changes in the utilization of standard general practice consultations (Levels A-D) from 1994 to 2009.
- To assess the extent to which the use of special MBS items compensated for shifts in standard consultation patterns.
- To evaluate the alignment of observed consultation trends with health policy objectives.
Main Methods:
- A population-based retrospective analysis of Medicare claims data spanning 1994-2009.
- Age- and sex-standardized utilization rates for general practice consultations (Levels A, B, C, D) were examined.
- The study also analyzed the combined use of standard consultations with health assessments, care plans, and other special MBS items.
Main Results:
- Utilization of Level C and D (long) consultations increased until 2004, followed by a significant decline by 2009.
- A reverse trend was observed for Level A (short) consultations, showing increased utilization.
- Combined utilization of special MBS items and long consultations initially trended upward but declined in 2008-2009.
Conclusions:
- A dramatic decrease in long general practice consultations (Level C/D) has occurred, paralleled by an increase in short consultations (Level A).
- Special MBS items have partially offset the decline in long consultations, but this effect has weakened recently.
- Current consultation trends are misaligned with health policy goals for preventive and chronic care, and recent Medicare reforms may not suffice to alter these patterns.
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