scholarly journals Outpatient consultant physician service usage in Australia by specialty and state and territory

2019 ◽  
Vol 43 (2) ◽  
pp. 200 ◽  
Author(s):  
Gary L. Freed ◽  
Amy R. Allen
Keyword(s):  
Service Use ◽  
Geriatric Medicine ◽  
Physician Service ◽  
Marked Variation ◽  
Service Usage ◽  
Medical Specialties ◽  
Medical Speciality ◽  
Consultant Physician ◽  
Economic Barriers ◽  
Per Capita

Objectives To determine national service usage for initial and subsequent outpatient consultations with a consultant physician and any variation in service-use patterns between states and territories relative to population. Methods An analysis was conducted of consultant physician Medicare claims data from the year 2014 for an initial (item 110) and subsequent consultation (item 116) and, for patients with multiple morbidities, initial management planning (item 132) and review (133). The analysis included 12 medical specialties representative of common adult non-surgical medical care (cardiology, endocrinology, gastroenterology, general medicine, geriatric medicine, haematology, immunology and allergy, medical oncology, nephrology, neurology, respiratory medicine and rheumatology). Main outcome measures were per-capita service use by medical speciality and by state and territory and ratio of subsequent consultations to initial consultations by medical speciality and by state and territory. Results There was marked variation in per-capita consultant physician service use across the states and territories, tending higher than average in New South Wales and Victoria, and lower than average in the Northern Territory. There was variation between and within specialties across states and territories in the ratio of subsequent consultations to initial consultations. Conclusion Significant per-capita variation in consultant physician utilisation is occurring across Australia. Future studies should explore the variation in greater detail to discern whether workforce issues, access or economic barriers to care, or the possibility of over- or under-servicing in certain geographic areas is leading to this variation. What is known about the topic? There are nearly 11million initial and subsequent consultant physician consultations billed to Medicare per year, incurring nearly A$850million in Medicare benefits. Little attention has been paid to per-capita variation in rates of consultant physician service use across states and territories. What does this paper add? There is marked variation in per-capita consultant physician service use across different states and territories both within and between specialties. What are the implications for practitioners? Variation in service use may be due to limitations in the healthcare workforce, access or economic barriers, or systematic over- or under-servicing. The clinical appropriateness of repeated follow-up consultations is unclear.

scholarly journals Revenue of consultant physicians for private out-patient consultations

2019 ◽  
Vol 43 (2) ◽  
pp. 142
Author(s):  
Gary L. Freed ◽  
Amy R. Allen
Keyword(s):  
Government Expenditure ◽  
Unintended Consequences ◽  
Management Planning ◽  
Medical Specialties ◽  
Initial Management ◽  
Time Period ◽  
Initial Item ◽  
Consultant Physician ◽  
Changing Patterns ◽  
Multiple Morbidities

Objective The aim of this study was to determine the revenue to consultant physicians for private out-patient consultations. Specifically, the study determined changing patterns in revenue from 2011 to 2015 after accounting for bulk-billing rates, changes in gap fees and inflation. Methods An analysis was performed of consultant physician Medicare claims data from 2011 to 2015 for initial (Item 110) and subsequent (Item 116) consultations and, for patients with multiple morbidities, initial management planning (Item 132) and review consultations (Item 133). The analysis included 12 medical specialties representative of common adult non-surgical medical care. Revenue to consultant physicians was calculated for initial consultations (Item 110: standard; Item 132: complex) and subsequent consultations (Item 116: standard; Item 133: complex) accounting for bulk-billing rates, changes in gap fees and inflation. Results From 2011 to 2015, there was a decrease in inflation-adjusted revenue from standard initial and subsequent consultations (mean –$2.69 and –$1.03 respectively). Accounting for an increase in the use of item codes for complex consultations over the same time period, overall revenue from initial consultations increased (mean +$2.30) and overall revenue from subsequent consultations decreased slightly (mean –$0.28). All values reported are in Australian dollars. Conclusions The effect of the multiyear Medicare freeze on consultant physician revenue has been partially offset by changes in billing practices. What is known about the topic? There was a ‘freeze’ on Medicare schedule fees for consultations from November 2012 to July 2018. Concerns were expressed that the schedule has not kept pace with inflation and does not represent appropriate payments to physicians. What does this paper add? Accounting for bulk-billing, changes in gap fees and inflation, revenue from standard initial and subsequent consultations decreased from 2011 to 2015. Use of item codes for complex consultations (which have associated higher schedule fees) increased from 2011 to 2015. When standard and complex consultation codes are analysed together (and accounting for bulk-billing, changes in gap fees and inflation), revenue from initial consultations increased and revenue from subsequent consultations decreased slightly. What are the implications for practitioners? Efforts to control government expenditure through Medicare rebate payment freezes may result in unintended consequences. Although there were no overall decreases in bulk-billing rates, the shift to higher-rebate consultations was noticeable.

Demographic and Clinical Factors Associated with Physician Service Use in Systemic Sclerosis

2009 ◽  
Vol 36 (1) ◽  
pp. 96-98 ◽  
Author(s):  
SASHA BERNATSKY ◽  
PANTELIS PANOPOLIS ◽  
MARIE HUDSON ◽  
JANET POPE ◽  
SHARON LECLERCQ ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Service Use ◽  
Disease Onset ◽  
Physician Service ◽  
Clinical Factors ◽  
Physician Visits ◽  
Factors Associated ◽  
The Past ◽  
Sf 36 ◽  
Race Ethnicity

Objective.To assess physician service use in a large sample of patients with systemic sclerosis (SSc), and to determine factors associated with physician use.Methods.Our sample was a national SSc registry maintaining data on demographics (age, sex, race/ethnicity, education, income) and clinical factors (disease onset, organ involvement, etc.). Registry cohort members completed detailed questionnaires, and rheumatologists provided clinical assessments. We examined cross-sectional data from 397 patients who provided information on physician visits in the past 12 months. Patients were classified as high physician-users if they reported more than the median number (6) of physician visits in the past year. In multivariate logistic regressions, we assessed the independent effects of race/ethnicity, education, degree of skin involvement, comorbidity, and SF-36 scores on physician use.Results.On average, subjects reported 3.8 visits per year to specialty physicians (SD 4.2) and 3.5 visits per year to family physicians (SD 4.3). Regression models suggested the following factors as independently associated with number of physician visits: high skin scores, greater comorbidity, and low physical component summary scores on the SF-36.Conclusion.There is evidence of independent relationships between clinical characteristics and physician use by patients with SSc.

Antidepressant Pharmacotherapy: Economic Evaluation of Fluoxetine, Paroxetine and Sertraline in a Health Maintenance Organization

1995 ◽  
Vol 23 (6) ◽  
pp. 395-412 ◽  
Author(s):  
D A Sclar ◽  
L M Robison ◽  
T L Skaer ◽  
R S Galin ◽  
R F Legg ◽  
...  
Keyword(s):  
Health Service ◽  
Service Use ◽  
Health Maintenance Organization ◽  
Health Service Use ◽  
Health Maintenance ◽  
Physician Visits ◽  
Psychiatric Hospitalizations ◽  
Treatment Of Depression ◽  
Per Capita ◽  
Antidepressant Pharmacotherapy

The present study was designed to compare direct health service expenditures, for the treatment of depression, among patients enrolled in a health maintenance organization, and prescribed one of three selective serotonin reuptake inhibitors, fluoxetine, paroxetine or sertraline. Information regarding depression-related health service use was derived from the computer archive of a network-model health maintenance organization system serving 700 000 beneficiaries. A total of 744 health maintenance organization beneficiaries were found to satisfy the study selection criteria. Multivariate regression analysis was used to determine the incremental influence of selected demographic, clinical, financial and provider characteristics on health service expenditures related to the treatment of depression (ICD-9-CM, or DSM-IV code 296.2) 1 year after the start of antidepressant pharmacotherapy. Multivariate findings indicate that treatment with paroxetine increases average expenditures for physician visits ($31.93; P ≤ 0.05), psychiatric visits ($19.33; NS), laboratory tests ($2.35; P ≤ 0.05), hospitalizations ($85.33; P ≤ 0.05), psychiatric hospitalizations ($82.01; P ≤ 0.05), and antidepressant pharmacotherapy ($63.72; P ≤ 0.05), for a total per capita increase in health service use of $284.68 ( P ≤ 0.05), compared with treatment with fluoxetine. Sertraline treatment increases average expenditures for physician visits ($21.74; P ≤ 0.05), psychiatric visits ($56.79; P ≤ 0.05), laboratory tests ($1.21; P ≤ 0.05), hospitalizations ($70.59; P ≤ 0.05), psychiatric hospitalizations ($95.75; P ≤ 0.05), and antidepressant pharmacotherapy ($69.85; P ≤ 0.05), for a total per capita increase in health service use of $315.96 ( P ≤ 0.05), compared with treatment with fluoxetine. Economic comparisons between paroxetine and sertraline did not demonstrate any significant differences in expenditures for the health services examined.

scholarly journals Opioid overdose death in Wales: A linked data autopsy study

2020 ◽  
Author(s):  
Matthew Balquin Jones ◽  
Ceri Bradshaw ◽  
Gordon Fuller ◽  
Ann John ◽  
Jenna Jones ◽  
...  
Keyword(s):  
High Risk ◽  
Service Use ◽  
Public Health Problem ◽  
Demographic Characteristics ◽  
Opioid Overdose ◽  
Autopsy Study ◽  
Service Usage ◽  
Overdose Death ◽  
The Uk ◽  
Opioid Users

Abstract BackgroundFatal opioid overdose is a growing public health problem, the incidence of which is rising in the UK and in other western countries. We sought to describe factors associated with deaths, demographic characteristics, and service usage patterns of decedents of opioid overdose in a nation of the UK.MethodsWe carried out a retrospective cross-sectional analysis of opioid related deaths between 01/01/2012 and 11/10/2018 in Wales, UK, as identified from Office for National Statistics data. In addition to ONS records, the Welsh Demographic Service and National Health Service datasets were interrogated for records spanning the preceding three years. Records were linked on an individual basis using a deterministic algorithm. Decedents’ circumstances of death, demographic characteristics, and residency and service use patterns were described. Additionally, data pertaining to circumstances of death were briefly analysed.Results638 people died of opioid overdose in Wales between 01/01/2012 and 11/10/2018. Decedents were mostly male and around 50 years of age. Incidence per head of population was higher at the end of this period, peaking in 2015. In the 3 years prior to death the majority of decedents changed address at least once, but rarely moved far geographically. Over 80% of decedents visited the ED, the majority via emergency ambulance; over 60% were admitted to hospital; and over 30% visited specialist drug services on one or more occasion. Decedents who did not attend drug services were more likely to have died intentionally.ConclusionsHigh risk opioid users are often men of around 50 years of age living peripatetic lifestyles. It appears that those at high risk of dying from opioid overdose death use emergency medical services and are admitted to hospital comparatively often. They are less likely to visit specialist drug services however. Group differences between high risk opioid users who visit specialist drug services and those who do not appear to exist in relation to suicidality. Further research is needed in to delivering abstinence focussed or harm reduction based interventions via emergency services or inpatient hospital settings, and in understanding differences in suicidality between drug service attenders and non-attenders.

scholarly journals Comorbidity and healthcare use for individuals with CVD in the Ireland: a cross-sectional, population-based study

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e025305 ◽  
Author(s):  
Karyn Morrissey
Keyword(s):  
Health Service ◽  
Service Use ◽  
Household Survey ◽  
Population Based ◽  
Health Service Use ◽  
Cross Sectional Survey ◽  
Service Usage ◽  
Cross Sectional ◽  
National Household Survey ◽  
Nationally Representative

ObjectiveThis study explores the factors associated with health service use for individuals with cardiovascular disease (CVD) and comorbidity in the Ireland.DesignPopulation-based cross-sectional survey.SettingNationally representative health and health service use survey from the 2010 Quarterly National Household Survey was analysed.Primary outcome measuresFour outcome variables were examined: no CVD, CVD only, CVD with CVD-related comorbidities and CVD with non-CVD-related comorbidity.ResultsOf the 791 individuals reporting doctor-diagnosed CVD, 77% had a second morbidity. Using type of healthcare coverage as a proxy for socioeconomic status, both CVD-related and non CVD-related comorbidity increases the use of health service usage substantially for individuals with CVD, particularly general practitioner services (8.47, CI 4.49 to 15.96 and 5.20, CI 2.10 to 12.84) and inpatient public hospital care (3.64, CI 2.93 to 4.51 and 3.00, CI 2.11 to 4.26).ConclusionThis study indicated that even when demographic and socioeconomic factors are controlled for, comorbidity significantly increases the risk of accessing health services for individuals with CVD.

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