General practitioners and consultation drift: the effects of supply-side changes and reforms on service delivery patterns

Abstract

Objectives To determine what types of supply-side change underpinned the recent decline in longer (Level C and D) consultation provision and to evaluate the impact of the May 2010 reforms in realigning Medicare with long-term health policy objectives. Methods Retrospective analysis of Level C and D consultation provision by general practitioners (GPs) across Australia. Outcome measures were extent (number of consultations per providing GP) and participation (proportion of GPs providing these consultations). Results The proportion of GPs participating in Level C consultation provision is substantial (96%) and constant; however, extent of provision per GP decreased by 21% between 2006 and 2010. Level D participation decreased from 72% during 2006 to a nadir of 62% in 2009, and extent of provision decreased by 26% between 2006 and 2010. Conclusion Two distinct types of change underpinned the overall decline in Level C and D consultation provision. GPs appear to be providing Level C consultations less often, but the overwhelming majority still provide these consultations to some extent. The extent of provision of Level D consultations and the proportion of GPs providing them has decreased; an appreciable number of GPs simply stopped providing Level D consultations. Medicare reforms appear ineffective in realigning Medicare with long-term policy objectives. What is known about the topic? Previous research has demonstrated that GP consultation delivery patterns under Medicare have changed profoundly in recent years, with provision of Level C and D GP consultations having declined substantially. What does this paper add? This research shows that the overall decline in longer consultations is underpinned by distinct supply-side changes: (1) a decrease in average consultation provision per GP (for Levels C and D) and (2) the effective abandonment of Level D consultations by GPs. Medicare reforms do not appear to be entirely effective in addressing these supply changes. What are the implications for practitioners? Despite their centrality to health policy objectives of improved preventive care, chronic disease management and mental healthcare, longer GP consultations are declining in very distinct ways. The ability of the current Medicare model to achieve these health policy objectives appears increasingly questionable.