Knowledge Synthesis: Healthcare delivery to those most in need

Australia’s mixed public and private model of health care delivery means that medical care is often delivered inversely to need, with those most in need receiving the least or least effective care. We looked at the use of chlamydia testing in young people, dental care in women of different ages, and preventive health checks by general practitioners for women in mid-life and across all this research, our findings indicate that sufficient government reimbursement to cover the cost of the health care may be an enabler for care being delivered to the right women. In contrast, where levels of reimbursement are insufficient, inequities of access are evident. 

Dental Care

Regular visits to the dentist improve oral health; however, there is currently no publicly funded universal dental insurance scheme in Australia, with most adults self-funding all (or at least some) of the costs incurred by visiting a private dentist.  We looked at the use of dental care in the 1973-78, 1946-51 and 1921-26 cohorts of ALSWH. While there is already substantial evidence of the sizeable socioeconomic inequities in access to dental care, we established that these inequities exist in women of all ages.

General Practitioner Preventive Health Checks 

In contrast, among women in mid-life who were eligible for a range of preventive health checks provided by general practitioners, we found preventive health checks were more commonly done in women with risk factors for chronic disease, lower education levels and more GP visits. Only 1% of women were charged out-of-pocket costs.  The Medicare rebate to GPs for preventive health checks may be an adequate incentive for GPs to provide this care.  

Chlamydia Testing 

In a third paper, we looked at the characteristics of young women who were undergoing chlamydia testing and found that women with a history of chlamydia infection, those who were not in a relationship, and those who reported alcohol and cannabis use were the most likely to undergo a chlamydia test in our study. 

The Royal Australian College of General Practitioners recommends opportunistically offering screening for chlamydia infection in sexually active young people aged 15-29 years. Testing is available free of charge in a variety of settings, including general practices and sexual health clinics. Our results are encouraging as they indicate that the women in our study are aware of the implications of their risky behaviour and either seek out testing with their general practitioner or are responsive to suggestions by their GP to have a test.

NewsGP 
Adequate rebates lead to optimal care: Study https://www1.racgp.org.au/newsgp/professional/adequate-rebates-lead-to-optimal-care-study  

Insight+ 
Preventative health checks reading women who need it most https://insightplus.mja.com.au/2023/36/preventive-health-checks-reaching-women-who-need-it-most/

1. Wilson LF, Xu Z, Doust J, Mishra GD, Dobson AJ. Associations of socioeconomic and health factors with dental non-attendance: A comparison of three cohorts of women. Community Dent Oral Epidemiol. 2023 Jun;51(3):452-461
2. Wilson LF, Dobson AJ, Doust J, Mishra GD. Socioeconomic, behavioural and health factors associated with chlamydia testing in sexually active young women: an Australian observational cohort study. Sex Health. 2022 Apr;19(2):112-121.
3. Wilson LF, Dobson AJ, Mishra GD, Doust J. Preventive health checks in mid-life women in Australian general practice. Medical Journal of Australia [Accepted for publication 27 July 2023]