Is low-priced primary care bad for quality? Evidence from Australian general practice

ABSTRACT

We examine whether patients’ perceptions of general practitioner (GP) care varies by the price paid for consultations. Australian consumer survey data from 2275 individuals were used to analyse the relationship between price and patient experience of GP care. Using both standard models for count data and a latent class model that distinguishes between patients with high- and low-quality experiences, we find no evidence that lower prices have a negative impact on patients’ perceptions of GP quality. Nevertheless, some patient characteristics such as age, gender and health status play a significant role in quality-of-care perceptions. The results show that Australian patients have not had to compromise GP quality, as expressed in terms of patient experience, when seeking low-priced care. This supports the view that there are sufficient checks and balances on the GP sector in Australia to ensure positive patient experiences even for low-cost GP consultations.

KEYWORDS:

• Quality
• bulk billing
• general practice
• Australia

JEL CLASSIFICATION:

• I11
• I14
• I18

Ethics approval

The study was part of a research programme approved by the University of Technology Sydney Human Research Ethics Committee (UTS HREC REF NO. 2009‐143P).

Disclosure statement

The authors have no conflict of interest.

Notes

¹ Concession cardholders include households on low income, people receiving age pensions or government welfare benefits.The incentive becomes $11 if the patient also lives in a rural, remote or designated outer metropolitan region.

² We also estimate a negative binomial (NB) model that handles data with over-dispersion. Consistent results are obtained and they are available upon request.

³ Local Government Areas (LGA) are one of the spatial units defined under the Australian Standard geographical Classification (ASGC) and there are a total of 667 LGAs in Australia in 2011.

⁴ Recently published data from the Department of Health shows that in fact around 65% of the population is consistently bulk billed throughout a calendar year (DoH 2016). This suggests that our sample reflects national administrative data very well.

⁵ The number of GPs by postcode was provided by the Australian Health Practitioner Regulation Agency. The data was accessed via the National Centre for Geographic & Resource Analysis in Primary Health Care (GRAPHC), Research School of Population Health, Australian National University (ANU).

Additional information

Funding

The authors are supported by REFinE at the Centre for Health Economics Research and Evaluation at UTS, a Centre of Research Excellence under the Australian Primary Health Care Research Institute, which is supported by a grant from the Commonwealth of Australia as represented by the Department of Health. The information and opinions contained in this article do not necessarily reflect the views or policy of the Australian Primary Health Care Research Institute or the Commonwealth of Australia (or the Department of Health).