During the period 1996 to 2003 the number of GP services per capita in Australia fell by 14 percent and the proportion of services bulk billed (ie provided at no cost to the patient) fell by 12 percentage points. The Government responded to these trends by outlaying hundreds of millions of dollars to increase Government medical insurance rebates, to increase the number of GPs in Australia, and to provide incentives for GPs to bulk bill.
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There has been no comprehensive modelling of the GP market to assist in understanding the reasons for either the declining trends or whether the Government responses were successful. This thesis aims to fill that gap.
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Previous Australian modelling of the GP market has been cross sectional and mostly demand focused. This thesis uses panel data to minimise the biases caused by unobserved heterogeneity and border crossing, and to estimate explicit supply and demand equations to enable the relationship between supply and demand to be explored.
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This approach estimates the impact on GP market outcomes of both policy decisions regarding rebates and GP numbers, and of external changes such as the trends in social attitudes and age. The likely future paths of the market without further policy change can be considered, and the measures needed to meet given policy targets determined.
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In addressing these questions it is also shown that supplier induced demand does apply in Australian general practice but is not material, that previous cross sectional analysis was biased due to border crossing by patients, that GPs who charge patients with concession cards less than other patients are behaving economically rationally, and that when the Government increases the Medicare rebate payment, 85% of the increase goes to the GP and 15% to the patient. The analysis also shows that GP density has no significant effect on mortality in Australia, and was unable to detect any effect of the business cycle on mortality.
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The demand curve for Australian general practice services is shown to be fundamentally determined by the real value of the MBS rebate in the short term, where the real value adjusted for growth in average weekly earnings.
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The supply curve is determined by aggregate numbers of GPs and by the number of services they each provide. The average number of services provided per GP is determined by GP age and gender, but more importantly by a trend effect thought to be due to attitudinal changes which must be explored further, and must be incorporated into any prediction of GP market outcomes.
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The thesis provides the first empirically based overview of the behaviour of the GP market at end of the twentieth century, and shows how Government policy levers and other trends interact to generate the market outcomes. If the Government has targets for service levels or charging patterns in general practice, these models can facilitate determination of the policy options appropriate to achieve those targets.
| Identifer | oai:union.ndltd.org:ADTP/233141 |
| Date | January 2008 |
| Creators | McRae, Ian Stewart, ian.s.mcrae@anu.edu.au |
| Publisher | The Australian National University. College of Medicine & Health Sciences |
| Source Sets | Australiasian Digital Theses Program |
| Language | English |
| Detected Language | English |
| Rights | http://www.anu.edu.au/legal/copyrit.html), Copyright Ian Stewart McRae |
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