Utilisation of general practitioner services by socio-economic disadvantage and geographic remoteness.
OBJECTIVE
To examine the association between socio-economic status (SES) and GP utilisation across Statistical Local Areas (SLAs) that differed in their geographic remoteness, and to assess whether Indigenous status and GP availability modified the association.


METHODS
Retrospective analysis of Medicare data for all unreferred GP consultations (1996/97) for 952 SLAs comprising the six Australian States. Geographic remoteness was ascertained using the Area Remoteness Index of Australia (ARIA), and SES was measured by grouping SLAs into tertiles based on their Index of Relative Socioeconomic Disadvantage score.


METHODS
Age/sex standardised rates of GP utilisation for each SLA.


RESULTS
In SLAs classified as 'highly accessible', rates of GP use were 10.8% higher (95% CI 5.7-16.0) in the most socio-economically disadvantaged tertile after adjustment for Indigenous status and GP availability. A very different pattern of GP utilsation was found in 'remote/very remote' SLAs. After adjustment, rates of GP use in the most socio-economically disadvantaged tertile were 25.3% lower (95% CI 5.9-40.7) than in the most advantaged tertile.


CONCLUSIONS
People in socio-economically disadvantaged metropolitan SLAs have higher rates of GP utilisation, as would be expected due to their poorer health. This is not true for people living in disadvantaged remote/very remote SLAs: in these areas, those most in need of GP services are least likely to receive them. Australia may lay claim to having a primary health care system that provides universal coverage, but we are still some way from having a system that is economically and geographically accessible to all.
Turrell
Gavin
G
School of Public Health, Queensland University of Technology, Kelvin Grove, Queensland. g.turrell@qut.edu.au
Oldenburg
Brian F
BF
Harris
Elizabeth
E
Jolley
Damien
D
D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001315:Australia; D005194:Family Practice / Q000458:organization & administration*; D006297:Health Services Accessibility; D009313:National Health Programs; D012189:Retrospective Studies; D012923:Social Class; D012935:Social Justice