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The inverse care law revisited: impact of disadvantaged location on accessing longer GP consultation times

John S Furler, Patty Chondros, Doris Y L Young, Elizabeth Harris, P Gawaine Powell Davies and Mark F Harris
Med J Aust 2002; 177 (2): 80-83.

Summary

Objective: To compare the rate of provision of longer consultations per head of population across practice locations categorised by socioeconomic status.

Design: Retrospective analysis of Medicare data for all consultations for all general practitioners in Australia for the 1998–99 and 1999–2000 financial years, grouped by postcode of practice location. Postcodes were categorised by the Socio-Economic Indexes for Areas, Index of Relative Socio-Economic Disadvantage score.

Main outcome measures: Number of consultations and number of brief, standard, long and prolonged consultations per capita in each postcode grouping.

Results: The absolute number of long plus prolonged consultations showed no trend across postcode groups, but the rate ratio per person was significantly higher in more advantaged postcode areas. This represents an example of care provision in inverse relationship to need.

Discussion: Despite higher rates of chronic disease and lower rates of preventive care uptake, patients in low socioeconomic status areas receive longer GP consultations at a lower rate than patients in more advantaged areas. Possible strategies to overcome this inverse care provision include increased numbers of GPs in disadvantaged communities, removal of financial disincentives to longer consultations, and strengthening health promotion and community health services in disadvantaged areas.

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  • John S Furler1
  • Patty Chondros2
  • Doris Y L Young3
  • Elizabeth Harris4
  • P Gawaine Powell Davies5
  • Mark F Harris6

  • 1 Department of General Practice, University of Melbourne, Carlton, VIC.
  • 2 Centre for Health Equity Research, Training and Evaluation, South West Sydney Area Health Service, Liverpool, NSW.
  • 3 School of Community Medicine, University of NSW, Sydney, NSW.

Correspondence: j.furler@unimelb.edu.au

Acknowledgements: 

The project was supported by a grant from the General Practice Branch, Commonwealth Department of Health and Ageing. Data were provided by the General Practice Branch, Department of Health and Ageing. Thanks to Professor Brian McAvoy for comments on an early draft.

Competing interests:

None identified.

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