title: The decline in bulk-billing and increase in out-of-pocket costs for general practice consultations in rural areas of Australia, 1995-2001.
abstract: OBJECTIVE
  To describe the changes in bulk-billing and out-of-pocket costs for Australian general practice consultations over the period 1995-2001.
  
  
  METHODS
  Retrospective analysis of 1996-2001 survey data from the Australian Longitudinal Study on Women's Health (ALSWH), linked with Medicare and Department of Veterans' Affairs (DVA) data on general practice consultations from 1995 to 2001.
  
  
  METHODS
  22 633 women who gave consent to linkage of their ALSWH data with Medicare/DVA records. In 1996, women in the "young" cohort (n = 6219) were aged 18-23 years, those in the "mid-age" cohort (n = 8883) were aged 45-50 years, and those in the "older" cohort (n = 7531) were aged 70-75 years.
  
  
  METHODS
  Out-of-pocket costs paid by patients for general practice consultations, by calendar year, urban/rural area of residence, age, frequency of attendance, self-rated health, and education level.
  
  
  RESULTS
  For each age group and year studied, the use of bulk-billing was lower in rural areas than in urban areas. For example, in 2000, the percentage of women in rural and urban areas, respectively, who had all their general practice consultations bulk-billed was 31% v 52% (young women), 24% v 45% (mid-age women) and 58% v 79% (older women). There has been a steady decline in bulk-billing for general practice consultations in rural areas since 1995. The average out-of-pocket cost per consultation for women in rural areas was higher than the cost for women living in urban areas. After adjusting for age, health and socioeconomic factors, women living in urban areas were more than twice as likely to have all their consultations bulk-billed as women living in rural areas: odds ratio (OR), 2.4 (95% CI, 2.1-2.7) (young women); OR, 2.5 (95% CI, 2.3-2.8) (mid-age women); OR, 2.6 (95% CI, 2.3-2.9) (older women).
  
  
  CONCLUSIONS
  In Australia, the geographic differential in the cost of general practice consultations is widening. Policy changes are required to enable women in rural and remote areas to have access to affordable healthcare services.
authors.affiliation: Research Centre for Gender and Health, University of Newcastle, Callaghan, NSW, Australia.
authors.forename: Anne F
authors.initials: AF
authors.lastname: Young
authors.forename: Annette J
authors.initials: AJ
authors.lastname: Dobson
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001315:Australia; D003669:Deductibles and Coinsurance; D005194:Family Practice / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D005382:Financing, Personal / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D009819:Office Visits / Q000191:economics* / Q000706:statistics & numerical data; D010350:Patient Credit and Collection / Q000379:methods*; D012189:Retrospective Studies; D012424:Rural Population / Q000706:statistics & numerical data; D014505:Urban Population; D014932:Women's Health Services / Q000191:economics*