Cash-strapped Aussies skipping the GP

The number of patients who delayed or did not see a GP last year due to cost has doubled, according to new Australian Bureau of Statistics (ABS) data.
 
The new statistics estimate that out-of-pocket costs were a barrier to 7% of people, especially the most vulnerable, younger people and those living in areas of most socioeconomic disadvantage.
 
Australians aged 25–34 were more likely to delay or not use a health service due to cost – a conclusion backed up by new CommBank data, which found 25–29-year-olds decreased their overall spending by 5.1% this quarter, the most of any age group.
 
Dr Tim Senior, Chair of RACGP Specific Interests Poverty and Health, told newsGP the data adds to a long list of evidence that indicates the cost-of-living crisis is hitting hard.
 
‘It’s significant that it’s people in more disadvantaged communities that are putting off that healthcare more, and that’s understandable – when they’re balancing much tighter budgets, health is one of the things that takes a hit,’ he said.
 
‘But we also know that those people tend to have more chronic disease, more multimorbidity, more disability, or mental health problems, so they would benefit from seeing a GP more.
 
‘That’s a whole group of people who could really benefit from care who are not able to get it.’
 
The ABS data found 19.3% of patients could not afford to see a healthcare professional for their mental health, up from 16.7% last year.
 
More than 10% put off seeing a specialist, 3.2% avoided going to hospital, and 7.6% did not get prescription medication, all in a bid to save money.
 
Those figures come at the same some as bulk-billing rates continue to plummet, with new health department data revealing the proportion of non-referred bulk billed GP services sank to 76.5% from July to September, down from the previous low of 78.1%.
 
Bulk-billing rates were highest in the South Western Sydney region at 94.2%, while they were lowest in the Australian Capital Territory, at just 51.3% of patients.

However, RACGP President Dr Nicole Higgins told newsGP it is disappointing to see so many patients delaying care due to a fear of cost, saying most people are still being bulk billed despite the dropping rates.
 
‘Yes, bulk-billing rates have dropped but they’re still very high and this is reflecting that GPs are still subsidising patient care, but it’s also highlighting that those who need it the most, such as our vulnerable populations, are continuing to be bulk billed,’ she said.
 
‘I think we really need to look at the narrative, which is that the gap is increasing for some people, but GPs are still subsidising patient care significantly.
 
‘We need to make sure that we’re putting out accurate information to inform people’s choices because the narrative has been that the GP is too expensive when we know that GPs overwhelmingly do look after their patients.’
 
Dr Senior said patients delaying care often does not come down to the actual cost of seeing a GP, but the perceived cost.

‘Even asking to be bulk billed and being refused, or the shame of admitting that you can’t afford something, so you actually just avoid going,’ he said.

‘There’s more funding going into practices serving well-off areas than there is going into practices serving not so well-off areas, so we’re directing funding where it’s least needed and that exacerbates need.
 
‘We’ve ended up with a perfect storm, with patients in more deprived areas choosing not to see services, and that means practices aren’t sustainable because patients are staying away.’
 
At the same time as cost cements its place as one of the greatest barriers to accessing care, other reasons to delay seeing a GP are decreasing, including that services are not available, patients being too busy, or wait time being too long.
 
And when patients did see a GP, their experiences were overall positive, with the ABS finding around three-quarters of people said their doctor always listened carefully, showed respect, and spent enough time with them.
 
But as the gap between those receiving healthcare and those going without continues to widen, Dr Higgins said adequate funding is vital to ensuring everyone gets the care they deserve.
 
‘We need to place value within our health system onto general practices, and that means looking at the narrative and the funding that goes into general practice,’ she said.
 
‘We need to be moving funding from the end of the line in hospitals back to the start, and we need to make sure we value the time that GPs are spending with patients.’
 
Dr Senior said if action is not taken, this gap between the healthy and the unhealthy will continue to widen, as sickness takes over disadvantaged communities.

‘We will end up having this large, two-tiered health system where we abandon universal healthcare,’ he said.
 
‘We’ll end up with one system that’s doing alright due to patient contributions, and then one that is scraping funds together through poorly funded government programs or philanthropy and then having to raise money, but it’s fragmented care.
 
‘We’ll just see a widening of the gap, both in terms of health outcomes, but also in terms of services available for people.’
 
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