Academic journal article Australian Health Review

Private General Paediatric Care Availability in Melbourne

Academic journal article Australian Health Review

Private General Paediatric Care Availability in Melbourne

Article excerpt

Introduction

In Australia, ambulatory general paediatric care is provided by general paediatricians, who are specialist practitioners working in either private or public settings. The public-private mix of service delivery and financing is common throughout the Australian health system; however, concerns exist that access to health services is becoming less equitable.1 To understand potential barriers to ambulatory paediatric care, it is important to assess appointment availability and any potential financial burden that may impede access to general paediatricians.

In the public sector, patients can receive care from a general paediatrician free of charge in out-patient clinics of public hospitals that are funded through Medicare or from the state budget. Community health services, funded by the states, also provide free paediatric care.2 However, some patients may elect to pursue general paediatric care privately. In the private sector, general paediatricians charge a fee for service and either 'bulk-bill' Medicare (i.e. accept the Medicare benefit as full payment for the services rendered) or bill patients directly. Medicare benefits are based on the Medicare Benefits Schedule (MBS), a listing of the fees for the Medicare services paid by the Commonwealth Government. A paediatrician may charge a higher amount than a Medicare schedule fee. In these instances, patients may claim the Medicare benefit amount back from Medicare (85% of the schedule fee for a specialist consultation), termed the Medicare rebate, but will pay out-of-pocket expenses for the gap between the consultation fee and the rebate.2

Out-of-pocket expenses for specialist care are not covered by private health insurance in Australia (Private Health Insurance Act 2007 No. 31, 2007, Australia) and may present a substantial financial burden to patients. Nationally, expenditure on specialist doctors' fees represents 10% of Australian households' weekly expenditure on health.3 The average charge for a private paediatric consultation for a newborn (with no complications) has been estimated to be A$250-400, resulting in an out-of-pocket expense of A$125-275 after the Medicare rebate.4 It is difficult to determine the extent to which the cost of general paediatric consultations may act as a barrier to access, because there are no data available on the actual cost of private paediatric consultations that are based on real-time assessments.

In addition, there are no recent empirical data on appointment availability and waiting times for appointments with general paediatricians in Australia. Data collected in 1998 suggested that the average waiting time for a first standard consultation with a general paediatrician in a private room was 14.1 days, whereas patients being seen in public hospital-based out-patient clinics waited, on average, 36 days.5 These findings have not been updated for more than 15 years and are based on self-reports from Australian Medical Workforce Advisory Committee (AMWAC) surveys, not actual availability and accessibility of such services. Data regarding wait times for an appointment in other paediatric services suggest much longer periods: 5 months for paediatric weight management services6 and from 5.4 (private) to 10.6 months (public) for paediatric allergy services.7 These reports too were based on the estimates of service providers, not actual availability of the service. No previous studies to date have provided a real-time assessment of general paediatricians availability from a patient perspective.

The aims of the present study were to determine the actual availability and charges for general paediatric services in the private sector for children with chronic conditions of low acuity and urgency. The study used actual, real-time assessments from a patient perspective.

Methods

Study design

The study used an audit methodology with 'secret shopper' techniques, a well-recognised method in healthcare research, to investigate the actual availability of services. …

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