The decline in bulk-billing and increase in out-of-pocket costs for general practice consultations in rural areas of Australia, 1995–2001

To the Editor: Young and Dobson1 have confirmed what has been long suspected by many rural doctors and patients — that women (and patients in general) in rural areas are paying higher out-of-pocket costs for general practice consultations than those in urban areas.

I wonder whether the authors have considered analysing the data by State and Territory, as the structure of a State healthcare system often has a significant impact on healthcare costs to individuals. I am also interested to know whether total costs of healthcare (including on-costs, referrals, specialist fees, hospital and investigative care) were analysed. There is a long held view that rural doctors have a more holistic approach to patient care than their urban colleagues, who are more inclined to recommend unnecessary investigations and specialist referrals. It would be fascinating to know whether urban women would actually be more "out-of-pocket" than rural women if total contact with the healthcare system (not just general practice consultations) was taken into account.