The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.Robert W Pegram, Lisa Valent

Pegram, Robert William

Valenti, Lisa

The Medical Journal of Australia

Adelaide Research &amp; Scholarship

 PUBLISHED VERSION   Pegram, Robert William; Valenti, Lisa  Factors influencing billing status in general practice Medical Journal of Australia, 2004; 181(2):115-115  This article is available from the Medical Journal of Australia at:   http://www.mja.com.au/public/issues/181_02_190704/peg075_fm.html                             http://hdl.handle.net/2440/32778   PERMISSIONS   This document has been archived with permission from the editor of the Medical Journal of Australia, 26 April 2007.    MJA • Volume 181 Number • 19 July 2004 115GP FUN DING — LETTERThe Medical Journal of Aus-tralia ISSN: 0025-729X 19July 2004 181 2 115-115©The Medical Journal of Aus-tralia 2004 www.mja.com.auGP Funding — LetterFactors influencing billing status in general practiceRobert W Pegram,* Lisa Valenti†* Senior Lecturer, Department of General Practice, University of Adelaide, Adelaide, SA; † Senior Analyst, General Practice Statistics and Classification Unit, University of Sydney, Wentworthville, NSW.Robert.pegram@adelaide.edu.auTO THE EDITOR: Young and Dobson’sarticle1 examining the bulk-billing status ofservices provided to women generatedmuch debate.2,3 To add to that debate weundertook an analysis of 5546 Medicare-claimable general-practice encounters. Datawere provided by 200 general practitionersbetween May and July 2002, using theBEACH (Bettering the Evaluation and Careof Health) methodology.4 We examinedwhich encounter, GP and patient character-istics determine billing status (patient-billedor bulk-billed). From time and day of serv-ice we determined which consultations were“after hours”.Over two-thirds of services (69.8%; 95%CI, 65.4%–74.3%) were bulk-billed. One infourteen services (7.1%; 95% CI, 2.2%–12.1%) were delivered “after hours” asdefined by the Australian GovernmentDepartment of Health and Ageing5 (ie,between 6 pm and 8 am on weekdays orbetween 1 pm Saturday and 8 am Mondayon weekends). The results after simple andmultiple logistic regression analysis areshown in the Box.After-hours consultations were signifi-cantly more likely to have been bulk-billedthan those held during standard office hours(odds ratio [OR], 1.9).Patients aged < 15, 15–24 years and  75years were significantly more likely to bebulk-billed than working-age adults(P < 0.0001).Also significantly more likely to be bulk-billed were patients from non-English-speaking backgrounds (OR, 7.3), living inan urban area (OR, 2.6), holding a health-care card (OR, 3.5) and/or coming from alow socioeconomic status background (OR,2.3).There was no significant associationbetween the likelihood of being bulk-billedand the age or sex of the GP, the practice sizeor the number of problems managed at theencounter.Interestingly, the variable with the largestimpact on bulk-billing rates was whetherpatients were from a non-English-speakingbackground. These patients were over seventimes more likely to be bulk-billed thanpatients from an English-speaking back-ground.This study adds further support to thefindings of Young and Dobson1 that patientsin urban areas were significantly more likelyto be bulk-billed for general practice consul-tations than their rural counterparts. We cango one step further and say that consulta-tions given after hours were also significantlymore likely to be bulk-billed. The conclusionis that bulk-billing decisions by GPs are notuniformly influenced by timing, location andpatient characteristics. This has implicationsfor assessing the likely impact of bulk-billingstrategies such as MedicarePlus.6AcknowledgementsThanks to all the GP participants and to HelenaBritt for critically appraising the text. Funding wasprovided by the Australian Department of Healthand Ageing, AstraZeneca (Australia) Pty Ltd, Jans-sen-Cilag Pty Ltd, Merck Sharp and Dohme (Aus-tralia) Pty Ltd and Roche Products Pty Ltd.1 Young AF, Dobson AJ. The decline in bulk-billingand increase in out-of-pocket costs for generalpractice consultations in rural areas of Australia,1995–2001. Med J Aust 2003; 178: 122-126. 2 Arnold PC. The decline in bulk-billing and increasein out-of-pocket costs for general practice consulta-tions in rural areas of Australia, 1995-2001 [letter].Med J Aust 2003; 178: 470-471. 3 Harrison CA. The decline in bulk-billing andincrease in out-of-pocket costs for general practiceconsultations in rural areas of Australia, 1995-2001[letter]. Med J Aust 2003; 178: 470. 4 Britt H, Miller GC, Knox S, et al. General practiceactivity in Australia 2002-03. Canberra: AustralianInstitute of Health and Welfare, 2003. (AIHW Cata-logue No. GEP 14.)5 Medicare benefits schedule. Explanatory notes.Canberra: Australian Government Department ofHealth and Ageing, 2003: 31-32. Available at:www.health.gov.au/pubs/mbs (accessed May 2004).6 Australian Government Department of Health andAgeing. MedicarePlus. 2004. Available at:www.health.gov.au/medicareplus (accessed May2004). ❏Factors influencing the likelihood of bulk-billing in Australian general practice*Simple logistic regression analysisMultiple logistic regression analysisTime of consultationOR (95% CI) (n = 5546)Adjusted OR (95% CI) (n = 4793)“After hours” status (standard hours : after hours) 1.5 (0.9–2.5) 1.9 (1.1–3.3)Other variablesNon-English-speaking background (no : yes) 8.8 (4.8–16.3) 7.3 (3.8–14.0)Aboriginal or Torres Strait Islander descent (no : yes) 2.0 (0.7–6.0) nsPatient new to practice (new : not new) 1.5 (1.0–2.2) nsRural/urban place of residence (rural : urban) 2.2 (1.3–3.7) 2.6 (1.5–4.7)Having health care card (no : yes) 3.4 (2.4–5.0) 3.5 (2.3–5.2)Socioeconomic status† (higher SES : low SES) 3.2 (1.8–5.7) 2.3 (1.2–4.5)Practice size   (5+ GPs : solo GP) 2.4 (1.0–5.8) ns   (5+ GPs : 2–4 GPs) 1.4 (0.9–2.3) nsPatient age (years)   (25–64 : < 15) 1.5 (1.1–2.0) 1.4 (1.0–1.9)   (25–64: 15–24) 1.4 (1.2–1.8) 1.4 (1.1–1.9)   (25–64 : 65–74) 1.8 (1.4–2.5) 1.2 (0.8–1.6)   (25–64 :  75) 2.5 (1.7–3.8) 1.7 (1.1–3.8)Patient sex (female : male) 1.1 (0.9–1.3) nsGP age (years) (25–54 :  55) 1.6 (1.0–2.8) nsGP sex (female : male) 1.1 (0.7–1.8) nsNumber of problems managed per encounter‡ 1.0 (0.9–1.2) nsGP = general practitioner. ns = not significant at 5% level. OR = odds ratio. * For each variable, the first-mentioned category is the reference. † Assessed by SEIFA (Socioeconomic Indexes for Areas) categories of the Australian Bureau of Statistics. ‡ The reference point for this variable is the number of problems managed (1, 2, 3 or 4), measured against whether the patient is bulk-billed. The OR here indicates that for each unit increase in problems managed the odds of the encounter being bulk-billed do not change.

Factors influencing billing status in general practice

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Factors influencing billing status in general practice

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Factors influencing billing status in general practice

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