The Australian healthcare model, comprising both public and private sectors, has often raised concerns regarding equitable access to healthcare services. In a recent study, researchers delved into the realm of preventive health checks in general practice, focusing on women in mid-life. Specifically, they sought to determine whether disparities existed in the provision of preventive health checks among different demographic groups.
In Australia, two primary categories of mid-life preventive health checks are available: one for individuals aged 40 to 49 at risk of type 2 diabetes or aged 45 to 49 at risk of chronic diseases, and the other being a heart health check introduced in 2019.
The investigation drew upon data from the Australian Longitudinal Study on Women’s Health (ALSWH), encompassing women born between January 1, 1973, and December 31, 1978. This cohort was randomly selected from the Medicare database, with rural and remote residents being oversampled to facilitate urban-rural comparisons. Data from the most recent ALSWH surveys conducted before the participants’ 40th birthdays (completed in 2009, 2012, 2015, or 2018) were linked with Medicare Benefits Schedule (MBS) data spanning from January 1, 2013, to August 30, 2021.
The study examined associations between indicators of higher healthcare needs and the utilization of health checks through both univariate and multivariable log-binomial regression models. It’s important to note that the ALSWH study had received ethics approval from the human research ethics committees of the University of Newcastle (H-076-0795) and the University of Queensland (2004000224).
Out of the 14,247 women in the ALSWH 1973–1978 cohort, 93 were excluded due to premature deaths (0.6%), 746 did not consent to MBS data linkage (5.2%), 2,165 had responded only to the initial ALSWH survey conducted in 1996 (at least fifteen years before their 40th birthdays; 15.2%), and 1,081 had incomplete data (7.6%). During the period from January 1, 2013, to August 30, 2021, 10% of the 10,162 included women had undergone at least one health check, and from April 1, 2019, to August 30, 2021, fewer than 1% of eligible women, accounting for 44 individuals, had heart health checks. In the univariate analysis, women were more likely to have undergone health checks if they exhibited risk factors for chronic disease, such as obesity or self-rated fair or poor health, visited general practitioners four or more times annually, or did not hold university degrees. These associations, however, were less pronounced after adjusting for socio-demographic and health-related factors. Notably, when accounting for the annual number of general practitioner visits, not having a university degree and visiting general practitioners four or more times a year emerged as the major factors associated with health checks. Out of the 1,018 women who had undergone at least one preventive health check, only thirteen (1.3%) incurred out-of-pocket expenses that exceeded the scheduled Medicare rebate for the visit.
While conducting this analysis, one limitation was that the mean age of survey participants was 36 years, with a standard deviation of four years. Nevertheless, a sensitivity analysis restricted to the 7,678 women aged 35 years or older at the time of the survey yielded results consistent with the primary analysis.
These findings diverge from previous Australian reports suggesting that fewer general practitioner services are rendered to individuals with unhealthy behaviors and that consultation times tend to be shorter in areas of higher socio-economic disadvantage. However, they align with a study on health checks for Aboriginal and Torres Strait Islander people, which found that these checks were more frequent among individuals with greater medical needs and higher levels of cardiovascular disease risk. The study suggests that the Medicare rebate for preventive health checks, particularly for those at risk of diabetes and chronic diseases, may serve as a sufficient incentive for general practitioners to offer such care. Nonetheless, the low utilization of heart health checks among women raises questions about the adequacy of the rebate for this specific service.
In summary, the research reveals that general practitioners proactively extend preventive healthcare services to those with the greatest healthcare needs, possibly due in part to sufficiently high rebate levels.
