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RACGP advocates for gender equality in healthcare


Anastasia Tsirtsakis


2/05/2023 3:47:01 PM

The college has recommended a series of measures to the Government aimed at improving access to quality care for women and other disadvantaged groups.

A female doctor speaking with a patient.
Women are more likely to delay or avoid seeing their GP due to cost.

Women’s health-related matters are the fifth most reported reason for presentation in general practice. Despite this, however, there are a number of complex issues that act as barriers to gender equality in healthcare.
 
In a bid to address these, the RACGP has made a submission in response to the National Strategy to Achieve Gender Equality discussion paper featuring 10 recommendations – with funding of general practice and Medicare top of the agenda.
 
Evidence shows that while women are more likely than men to have multiple chronic conditions, they are also more likely to put off care due to cost, with recent data showing one in 25 have delayed or avoided seeing their GP at least once in the previous 12 months for this reason. That is compared to one in 40 males.
 
‘This majorly disadvantages women who may consequently miss out on opportunities for early intervention for chronic conditions, evidence-based screening and other preventive healthcare, [and] treatment for conditions that subsequently get worse and require hospital care,’ the submission states.
 
While the college acknowledges that systemic reforms ‘will take time to develop and implement’, the RACGP pre-budget submission 2023–24 outlines a range of measures that could be implemented quickly to improve healthcare affordability. These include:

  • a 20% increase to Medicare patient rebates for Level C (20–40 minutes) and Level D (40 minute plus) GP consultations
  • the re-introduction of Medicare patient rebates for phone consultations lasting longer than 20 minutes, mental health and GP management plans.
The re-introduction of patient rebates for longer telephone consultations, the college argues, will also enable access to care for women with complex health needs, as well as those in rural and remote areas.
 
As part of the submission, the RACGP has also renewed its calls for Government to allow pregnant patients to access higher rebates for complex antenatal consultations by allowing GPs to bill Level C and D time-based items for antenatal attendances that extend beyond 20 minutes.
 
Currently, GPs are restricted to billing MBS items 16500, 91853 and 91858, regardless of the length of appointment. This is despite advancements in the space, which the college argues has led to antenatal care being more ‘complex and individualised’, particularly for women in vulnerable and disadvantaged patient groups. 
 
‘Regular antenatal care, particularly in the first trimester, is associated with better material and child health in pregnancy, fewer interventions in late pregnancy, and positive child health outcomes,’ the submission states.
 
‘Patients should be able to access a higher rebate if a consultation is longer or more complex, just as they can for other consultations or conditions. This is a simple and positive step that can be taken.’
 
In a broader move to break down barriers, the college is also proposing that Government address the cost barrier beyond general practice to specialist care. Patients are increasingly facing high out-of-pocket costs and long wait times, while those in rural and remote areas face the added burden of long-distance travel.
 
With GPs better distributed in rural and remote areas than other medical specialists, the college has proposed increased funding and support for GPs to undertake additional training in a range of gynaecological procedures, such as ultrasound.
 
Further to that, the college recommends greater investment in GP reproductive health education, such as surgical abortion and long-acting reversible contraception insertion and removal, as well as gender-diverse care, particularly in areas of demonstrated workforce shortage.
 
More regional and rural placements for medical school students are also high on the agenda, in order to encourage future doctors to live and work outside of the major cities.
 
‘Existing barriers for Australian women, in general, is exacerbated … not only impacting on their health outcomes, but the health outcomes of their children and their families,’ the submission states.
 
‘GPs see the whole person. They are the usual first contact point for patients in the Australian health system, especially for women living in rural and remote areas.’
 
Other recommendations aimed at removing barriers to care, include:
  • extending the temporary telehealth items for blood-borne viruses, sexual or reproductive health consultations and for non-directive pregnancy support counselling beyond 30 June
  • funding for an extensive awareness and education campaign about recent cervical self-collection changes
  • including additional contraceptive options and menopause treatments to the Pharmaceutical Benefits Scheme (PBS)
  • increasing general practice support for patients experiencing domestic violence through longer consultations, ongoing education and peer support groups.
On a broader scale, the RACGP has also acknowledged the need for increased research funding focused on women’s health conditions, as well the way women, trans and gender diverse people experience health conditions, as historically medical research has been primarily undertaken on males, with research data extrapolated and applied to females.
 
‘This is not ideal and can result in adverse health impacts on women, including delay in treatment; applying inappropriate, ineffective, or harmful treatments; or the withholding of effective treatments,’ the submission states.
 
This was recently demonstrated in a study undertaken by the Australian National University, which found that women are 75% more likely to experience adverse reactions to prescription drugs compared to men due to a range of differences in traits between the sexes.
 
Another factor that has raised concern in this space is that women’s health tends to be complex, and is largely being undertaken by female GPs, who also tend to earn less than their male counterparts as they spend more time with patients – 16 compared to 19 minutes on average – on account of the complexity of their consultations, resulting in them seeing fewer patients in a day.
 
As it stands, the college argues that remuneration for these consultations ‘disadvantages those who undertake complex work such as mental health and women’s health’ – work mostly done by female GPs, who are expected to make up a larger proportion of the general practice workforce in the future.
 
‘Funding for longer general practice consultations, improving the availability and out-of-pocket costs of investigations and necessary specialist care will allow women [and all people] with complex conditions to get affordable healthcare,’ the submission states.   
 
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Prof Constance Dimity Pond   3/05/2023 8:42:09 AM

Another group of women that are disadvantaged is the group of older women especially 75 plus, who often have multiple chronic conditions, sometimes including cognitive impairment. Stats show they are poorer than their male counterparts because they earned less during their life. As women and as older people they are doubly disadvantaged: a problem called intersectionality (I think!) which is only just being recognised as a multiplier of disadvantage