whole_FarrellFHiong1997_thesis.pdf (8.29 MB)
Variation in health care use in Australia : demand vs. supply of services?
thesisposted on 2023-05-27, 00:34 authored by Farrell, F. Hiong
This study raises serious questions with respect to equity and quality of health care in Australia. It attempted to explain the variation in referral rates by general practitioners as a function of respondents' socioeconomic and health characteristics by adopting Andersen's behavioural model of health care utilisation to the Australian context. The study was conducted in three stages. The supply factor - the ratios of health personnel and facilities to population - was dropped from the analyses at Stages 1 and 2 because it was not feasible to obtain these data. Stage 1, using a subset of the National Health Survey 1989/90 data (NHS89/90), examined the factors that determine GP consultation and referral rates at the individual level. Logistic regression analysis findings showed that Andersen's model was better at explaining the probability of consulting a GP than the probability of being referred to other health care services. Results showed that the model correctly predicted 68% of respondents as to whether or not they saw a doctor. This prediction compared to predicting 55% of respondents as to whether or not they were referred to other health care services. Since the characteristics stipulated by Andersen's model were found to contribute to predicting utilisation rates (GP consultation and referral rates) these same variables were used in Stage 2. This stage, using the total sample from the NHS89/90 data, examined variation in referral rates at the aggregate level for the 47 health regions in Australia. Path analysis was used to examine the variance accounted for by these characteristics. The full set of independent variables accounted for 43% of the variance in the referral rates, suggesting that one or more predictor variables might have been excluded from the model. In light of the remaining variance to be explained and literature suggesting the importance of the supply factor a preliminary exploration of its possible contribution was conducted in Stage 3. For this, the two health regions with the highest and the lowest referral rates were compared with respect to the availability of doctors, specialists, x-ray and pathological services. Findings supported the importance of the supply factor. In the region with the highest referral rates, there was a considerable concentration of doctors, specialists and services compared to the region with the lowest referral rates. While the design of the study does not allow one to determine whether the supply factors \drive\" these different rates the findings do raise important questions for further research. In particular research should focus on access and health outcomes. Individual specialist services should be carefully studied as these too can have important cost and health implications."
Rights statementThesis (M.Soc.Sc.)--University of Tasmania, 1997. Includes bibliographical references