No frivolity among the frequently ill
The vast majority of patients who are the heaviest users of GP services suffer from complex and chronic health problems and are typically older, sicker and poorer than other Australians, ground-breaking research has found.
As the Federal Government clings to the idea of imposing a “price signal” on patients to discourage unnecessary doctor visits, a detailed investigation has found that those who see a GP most frequently are generally quite unwell, have long-term health conditions that are complex and difficult to manage, and are much more likely to be admitted to hospital.
Altogether, the analysis by the National Health Performance Authority (NHPA) found that almost three millions Australians see a GP at least 12 times a year, including around 950,000 who visit a doctor more than 20 times.
In addition to seeing GPs much more than the average, these very high and frequent attenders are also heavy users of other health services, including having multiple pathology tests, radiology examinations and visits to specialists.
Unsurprisingly, such patients are also relatively expensive to care for.
According to the NHPA, the 2.9 million patients who saw GPs 12 or more times a year cost the system $6.5 billion – around 41 per cent of non-hospital Medicare expenditure – for GP, specialist, pathology, diagnostic imaging and allied health services.
In all, the Authority estimated Medicare annually spent an average of $3202 on those who saw GPs more than 20 times a year, compared with $1850 for patients who visited a doctor between 12 and 19 times a year, $993 for above-average users (between six and 11 visits a year), $551 for occasional users (four to five visits) and $257 a year for low users (one to three visits).
In an attempt to damp down on Medicare expenditure the Government has unsuccessfully sought, through various forms of a co-payment, to introduce a “price signal” to discourage those it regards as seeing their doctor unnecessarily.
But the AMA said the NHPA report showed that the idea that a significant number of patients – particularly those who attended most frequently - were seeing GPs on a whim was wrong.
“Contrary to what was implied by some in the recent debate over co-payments, these patients are not frivolous users of the health system,” AMA President Associate Professor Brian Owler said. “It shows that the people who most frequently attend their GP are generally unwell, and have complex and chronic conditions.”
The NHPA report found that those who saw a GP 12 or more times a year typically had at least one chronic health complaint, and almost 30 per cent had three or more long-term conditions - the most common being arthritis, osteoporosis, heart and circulatory problems, though long-term injuries, asthma, diabetes and mental health disorders were also prevalent.
Such patients usually rated their health as no better than fair and, as a measure of the severity of their illness, between 30 and 40 per cent reported visiting a hospital emergency department during the year, and they accounted for 60 per cent of all adult patients admitted to hospital at least four times in a 12-month period.
A/Professor Owler said the experience of these patients underlined the important role played by GPs in co-ordinating care and keeping patients out of hospital as much as possible by helping manage their conditions in the community.
These types of patients are consuming significant health resources, and there is a significant need to target these patients with extra support, coordinated by their usual GP,” he said.
“Patients whose care is well managed and coordinated by their usual GP are less likely to cost the health system more in the long run because their GP-coordinated care will keep them out of hospital.
“Supporting general practice to continue managing these patients – who are growing in number each year - is an investment in health care that can help make the health system more sustainable.”
The AMA is expected to use insights from the NHPA report to urge the Government to increase investment in general practice as part of reforms to improve the efficiency and cost effectiveness of Medicare.
Published: 19 Mar 2015