“All Australians, on average, go to the doctor now 11 times per year. I just don’t think we’re that crook.”
– Tony Shepherd, Commission of Audit Chairman, press conference on the report’s launch, May 1
The National Commission of Audit’s report, released late last week, recommends a $15 co-payment for all Medicare services. It suggests this cost fall to $7.50 after a “safety net” of 15 visits or services and that concession-card holders pay $5 initially and $2.50 once they exceed the safety net.
Commission chairman Tony Shepherd said
the idea stemmed from a view that the system was being abused as Australians were visiting their GP an average of 11 times a year.
“Something that’s free is not valued; this will give people pause to think, ‘Will I go or not?’”
Shepherd did not clarify whether the figure he quotes is intended to refer to the number of general practitioner visits, or to the total number of doctor visits. And the Department of Finance, which is handling media for the Commission of Audit, could not provide a source for the figure before deadline.
But there are several data sources that show how many times the average Australian accesses general practitioner and other services each year.
Data from the Medical Benefits Schedule
All medical services eligible for government subsidy are listed as items on the Medical Benefits Schedule. The most frequently is a 20-minute consultation in a GP surgery with general practitioners (item 23).
Data from the financial years 2008/9 to 2012/3 on the Medicare Australia website breaks down per capita use of each Medical Benefits Schedule item. For item 23, the number actually remains steady over the period, in the range 3.73 to 3.78 per person per year.
While this range is for the most commonly claimed type of consultation, there are other items that relate to care we receive from general practitioners. These differ according to either consultation length, location, or reason, and should be added to item 23 figures to better reflect all GP services.
The broader group of services containing all GP attendances is known on the Medical Benefits Schedule as Group A1. The trend in claims for Group A1, which includes item 23, is shown below. Once we total all contacts, the average number of items claimed per person per year in 2012/2013 is 4.61.
General practitioner item number claims from the medical Benefits Schedule, by financial year from 2000/1 to 2012/13.
But there are a range of other items on the schedule that can be claimed by general practitioners, beyond this standard set. These include acupuncture, after-hours care, health assessments, a range of items to encourage multidisciplinary planning for people with chronic conditions, cervical smears (general practitioners don’t claim the standard consultation fee for these), and management of diabetes and of asthma.
This is where the numbers get a little more complicated as, while the items listed in Group A1 are only for general practitioners, some of these latter items can be claimed by other professionals, such as nurse practitioners.
Still, these items are not claimed in high volume. Indeed, if we assume that all claims under these items are from general practitioners, the increase adds another 0.32 visits per person per year. Adding this to the 4.61 from Group A1 items above gives a total of 4.93 per person per year.
An alternative approach would be to consider the total number of professional attendances claimed on the Medical Benefits Schedule. This includes a very broad range of doctor contacts, not only general practitioners, but also various specialists, psychiatrists, and optometrists, among others.
This gives us a total of 6.91 visits per person per year.
Other data sources
The National Health Performance Authority uses Medical Benefit Schedule data to explore patterns of health and health-care delivery, and reports on the distribution of GP consultations per person per year.
The strength of these data is that they report figures for each Medicare Local catchment, so we can see the variability in patterns across regions. For instance, the mean number of GP consultations per person ranged from 2.6 in Kimberley-Pilbara (WA) to 7.5 in South Western Sydney.
The same website estimates the number of people with greater than 12 GP attendances in 2010/11; the range is between 5% and 18%, considerably lower than would be expected if the mean number of attendances nationally was 11.
In January 2014, the Productivity Commission reported the number of GP consultations per person per year (Report of Government Services). Considering all unreferred contacts, including those done by professionals other than general practitioners, such as practice nurses, it estimated a figure of 5.77. The slightly higher figure reflects its inclusion of primary care services other than GP attendances.
One other possible source for the figure of 11 comes from a speech made a few hours before the Commission released its report by health minister Peter Dutton at The George Institute for Global Health. He said:
In our country with a population of 23 million people, the taxpayer currently funds 263 million free services a year under Medicare, and if we are to have a strong and sustainable health system in to the future, that figure is not sustainable.
These figures are correct for services claimed both in and out of hospital in 2012-13. Of the 343 million services claimed in the financial year 2012/13, 76.5% were bulk-billed, giving the 263 million Peter Dutton cites. This means that Australians did use (approximately) an average of 11 free services per person per year.
But Medicare-funded services do not universally correspond with seeing a doctor. Pathology collection, for instance, will generally be claimed alongside visits, so one visit to a doctor could lead to several service claims.
Indeed, one visit to a general practitioner might lead to three pathology tests, plus an item for collection of blood, an X-ray, and a follow-up consultation. Two visits like this can involve seven separate claims!
Tony Shepherd may well have conflated attendances and claims, and overstated the number of doctor visits.
Verdict
The weight of evidence places the true number of time the average Australian “goes to the doctor” at below 7, with some variability due to differing definitions of what constitutes a consultation. While these definitions place the figure variously at 3.73, 4.61, 4.93, 5.77 or 6.91, none come very close to Tony Shepherd’s claim of a purported 11 visits to the doctor by the average Australian every year.
Review
This FactCheck comprehensively examines various data sources that can be used to determine how many times, on average, Australians visit the doctor in a year.
It shows that even when taking a very broad view of what constitutes a visit to the doctor (that is, including data on visits to general practitioners, medical specialists and some other health professionals), the number is nowhere near 11. Only by including other Medicare-funded services is it possible to replicate this outcome, and that makes the statement incorrect.
Some people do visit the doctor more than 11 times a year. Data from the Australian Bureau of Statistics show that in 2012-13, 12% of people saw a general practitioner more than 12 times, and 33% consulted one between four and 11 times.
There was a clear positive correlation between age and the number of visits (with a spike for women of child-bearing age), suggesting that people tend to visit doctors more frequently as they get older.
It must also be noted that this data comes from a survey rather than a record of patient visits to the doctor. Because it’s relying on people’s memory over the last year, it is less reliable than other data sources.
At any rate, it does not appear to be possible to replicate Tony Shepherd’s statement about doctor visits (not all other Medicare funded services) using publicly available data. If the data does exist to show that this claim is correct, it should be released immediately because it’s being used as the basis for introducing a co-payment for medical services and making a major change to Medicare. – Anne-marie Boxall
Richard Norman receives funding from the National Health and Medical Research Council and the Australian Research Council.
Philip Haywood does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.
Source: The conversation