Last Thursday, the National Commission of Audit, headed by the outgoing President of the Business Council of Australia,Tony Shepherd, was publicly released with much fanfare. It was immediately followed by much fear and angst due to the range and size of the cuts to many government programs it recommended. One of the most widely reported and controversial recommendations was for a $15 Medicare co-payment to be applied to GP visits, reduced to $7.50 for concession holders. After 15 visits in a year this would be reduced to $5 and $2.50 respectively. During the press conference announcing the report, Tony Shepherd justified this new charge (some including me would call it a tax) by implying Australians go to the doctor too often and that there is overservicing by GP’s in Australia.
“All Australians, on average, go to the doctor now 11 times per year. I just don’t think we’re that crook”
Some commentators such as Anne Henderson on the ABC’s current affairs discussion panel The Drum, said this was due to some going to see their GP for a ‘chat’ due to loneliness, rather than any real health needs.
Tony Shepherd repeated this claim in the Senate hearings the day after the report was released:
CHAIR (Senator Richard Di Natale): “Mr Shepherd, I have some questions about the changes to Medicare and the health system. Let me begin with the statement that I think you made yesterday where you stated that on average people saw a GP 11 times and year and I think you said, ‘Australians just aren’t that crook.’ On what evidence are you making that statement?”
Mr Shepherd : “The average is the average and we have that. That seems to me to be excessive in any layman’s look at the thing.”
Senator Di Natale then went on to press Mr. Shepherd about what evidence he had for the existence of overservicing of GP attendances. Just like in the report he provided no evidence for the figure of 11, nor of any overservicing, just a “potential risk of over servicing”. The National Commission of Audits’ Head Secretariat, Peter Crone called this notion a “judgment call” (the full Hansard transcript is well worth a read).
Three days later, Mr. Shepherd was still making the claim on ABC’s Lateline, even giving a total number of 253 million visits:
EMMA ALBERICI: “What made you think 11 visits was too many?”
TONY SHEPHERD: “Well I use that as a bit of a throwaway line, but put it this way: there are 253 million visits a year. That’s 11 times 23. So, you know, there’s a lot of visits going on each year in our – to doctors and providers under the Medicare system.”
Mr. Shepherd did mention providers in general as well as specifically GP’s, though it wasn’t clear if these are included in the 253 million total visits he cites.
11 visits per person sounded like a pretty high number to me, so I went looking instead for the median number of GP visits rather than the average, as the average would be skewed higher by those with chronic conditions that need constant supervision by their GP’s. The median is the point where someone has 50% of Australians seeing a GP more times per year than themselves and the other 50% seeing a GP fewer times. In other words, a person at the median is exactly in the middle of the population and it is therefore often a more relevant figure to the typical Australian’s experience. However the median figure proved quite hard to find but what I did find was the following statistics in a National Health Performance Authority report from June 2013 (p33). As an aside, the NHPA is to be merged with other health bodies under the Commission of Audit’s recommendations (no. 53).
So what’s going on here? There is simply no way the national average could be 11 while the average in Medicare Local regions range from 2.4 – 7.4. Looking through the report I couldn’t find any mention of 11 GP visits per person let alone a source for it. It seems that this number has been plucked out of thin air.
So what’s the actual number of GP visits on average per person in Australia as a whole? Turns out it is a lot lower than 11. It’s actually 5.8 and has stayed fairly steady since the early 1990’s. This number is also entirely consistent with the averages for Medicare Local regions from the NHPA’s report.
So where could Tony Shepherd have gotten the number 11 from? Is it the number of visits to all health professionals, such as GP’s, specialists, psychologists and others? Well no, the number of medicare items for Item Group 1 ‘Professional Attendances’, during the 2012-13 financial year was 160.4 million. With Australia’s population for that year estimated by the ABS at 23.1 million, that’s an average of just 6.4 per person, once again far short of the 11 visits per person repeatedly cited by Tony Shepherd.
How about all health services in total provided by medicare, including professional attendances, pathology, scans, dental services etc?
Here we find the average is higher than 11, it’s actually 14.8, having risen from 10 to 11 in the early 1990’s. So that can’t be where his number comes from. Maybe he is using ten year old numbers for health services and he has mixed them up with GP visit’s? That wouldn’t surprise me.
Whether the increase in this number of health services per person is due to overservicing or instead a number of other possible factors, such as increased availability of new tests and procedures for various conditions or simply greater awareness of the need to look after our health, is not clear. I would hazard a guess that it’s far more likely to be the latter, though some level of overservicing is possible. However I have yet to see any evidence for this “judgment call” other than the musings of Mr. Shepard and a few comments based on what seems to be pure ideology. Without any solid evidence of people seeing a GP unnecessarily it’s a pretty thin argument to base imposing a co-payment on Australians, even if it’s just $6, not the $15 recommended by the National Commission of Audit.
I still haven’t found an official median for the number of GP visits or health services, but the ABS does conduct a yearly survey of Australian’s who are 15 years old or more about their experiences with GP’s. Included in the questionnaire is a question on how often we see, or don’t see, a GP per year. Here’s is what they found in their latest release:
63.5% of us see a GP 3 times per year or less, and 32.7% once per year or not at all. The median is therefore somewhere around 2 visits per person per year. This is gives us a better idea of what the typical Australian will think when they ask them selves “How often do I see my GP?”. What can also be seen from this data is that a fairly small proportion of us, somewhere in the range of 15-30%, see GP’s 5.8 times a year.
But the really important statistic here is the 0.6% (0.8% the previous year) who didn’t go see a GP when they needed to. That sounds like a small number but in a population of 18.64 million Australians 15 years old or more, that’s 112,000 people. Introducing a co-payment when seeing a GP will surely cause that number to rise. What we do know is that the earlier someone seeks treatment the less it costs taxpayers in the long run. We should not be placing more barriers to seeing a doctor, instead we should be making it easier so more people get preventative care and medical conditions are diagnosed earlier and their treatment has a better chance of being both successful and less expensive. If you want to save money, increase productivity and eliminate waste in the health system, introducing a co-payments is heading in the completely wrong direction.
Up until the last day or so this figure of 11 GP visit’s has been taken at face value by journalists and even Senators in the Committee hearings last week. Jenna Price in yesterday’s Canberra Times, picked up on this and I hope other journalists get a chance to ask Tony Shepherd what his source for the number is and why it doesn’t relate, even closely, to the official figures. Because if we are to take his and the National Commission of Audit’s recommendations, we need more than ideologically based thought bubbles to convince us of their merit.