Health Workforce

Describing the numbers of health workers is potentially fraught.

The most reliable data is likely from AIHW, which relies on annual surveys (for which the response rate is now high) linked to registration data.

MBS data provides a good count of those health professionals billing Medicare. But many do not, and some professions who typically would, may not do so in some rural and remote areas (eg if salaried)

However, because work arrangements have the potential to be more complicated in rural and especially in remote areas, our level of confidence in (especially) the AIHW GP numbers decreases as remoteness increases. In particular, in the survey, medical practitioners are only able to describe themselves as one “type” of medical practitioner (eg as a GP), while hours worked in “other” locations is either not recorded in the survey, or is not allocated to those other areas during the writing of the AIHW reports.

The COAG Reform Council has also published the prevalence of GPs (but not other medical practitioners) and their FTE by remoteness, but based on Medicare data, rather than AIHW survey. GP prevalence based on Medicare data shows a dramatically different distribution of GPs –any work done in other settings (eg hospitals or Aboriginal Health Services) would, in many cases be excluded from the calculation of FTE, and the count of GPs will include individuals who have, for example, worked only a week in remote areas, as well as individuals who work full time in these areas.

Reporting of medical practitioner prevalence (and that of other health professionals) is also complicated by the fact that “need for medical service” tends to be greater in rural and especially remote areas, while there is frequently a need for the rural or remote area medical practitioner to have a broader scope of practice (eg be able to do work which would otherwise be done by a specialist or an allied health worker) as well as the need for rural GPs to be more frequently “on call”.

None of the health professional prevalences of which we are aware have been adjusted for any of these factors. Such adjustment would result in statistics showing even greater disparity/lesser access in rural and especially remote areas

Inter-regional comparisons do not currently take into account the greater need for medical services by people living in rural and remote areas, nor the need for broader scope of practice by medical practitioners in these areas. Consequently, similar numbers of Drs or FTEs per 100,000 population in different areas does not mean that access to medical services is similar in those areas, indeed, a higher prevalence of medical practitioners in areas with poorer health or in areas where medical practitioners are isolated, would be necessary to ensure that access to medical services was similar in these areas and Major cities.

 

Table 26: Medical workforce, 2012 and 2013

 

MC

IR

OR

R/VR

 

 

MC

IR

OR

R

VR

 

FTE per 100,000 population (2013)

Medical practitioners (AIHW 2013)

405

275

250

249

 

 GPs

106

110

112

135

 

 Hospital non specialists

53

36

32

42

 

 Specialists

155

80

58

31

 

 Specialists in training

81

43

42

30

 

 Other clinicians

10

6

6

11

 

 Non clinicians

21

7

9

8

 

 

FTE per 100,000 population (2012)

Medical practitioners (AIHW 2012)

418

276

263

255

 

 GPs

108

118

123

134

 

 Hospital non specialists

52

38

37

48

 

 Specialists

153

79

58

33

 

 Specialists in training

74

28

30

18

 

 Other clinicians

9

5

6

10

 

 Non clinicians

22

9

10

12

 

 

Drs per 100,000 population (2012)

Medical practitioners (AIHW 2012)

398

257

234

222

 

 GPs

114

115

114

117

 

 Hospital non specialists

46

34

31

41

 

 Specialists

139

70

50

27

 

 Specialists in training

62

23

26

16

 

 Other clinicians

10

5

5

8

 

 Non clinicians

23

10

10

11

 

 

 

 

 

 

 

GPs (MBS 2012-13)

GPs based on 2012-13 MBS data

GPs per 100,000 population

124

154

152

234

272

GP FTEs per 100,000 population

81

88

75

67

49

 

 

 

 

 

 

GPs (SCRGPS 2013-14 )

 

 

 

 

 

GP FTWE (Full-time workload equivalent)

102

101

91

70

57

Note: Numbers of medical practitioners per 100,000 population in 2012, is derived by NRHA based on the published FTE and the hours worked in each area by each “type” of medical practitioner.
There was insufficient information in the 2013 AIHW publication to calculate the number of GPs per 100,000 population.
Sources:
2012 AIHW data from AIHW 2014.Medical Workforce 2012.National health workforce series no. 8. Cat. no. HWL 54. Canberra: AIHW. http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129546076
2013 AIHW data from http://www.aihw.gov.au/workforce/medical/additional/
MBS data from National Healthcare Agreement Healthcare in Australia 2012–13: Five years of performance Statistical supplement Report to the Council of Australian Governments 30 April 2014
http://pandora.nla.gov.au/pan/146265/20140703-0935/www.coagreformcouncil.gov.au/reports.html
SCRGPS data based on MBS statistics  http://www.pc.gov.au/research/ongoing/report-on-government-services/2015/health

The hours worked on average by rural medical practitioners is higher than for those in Major cities. For example while Major cities GPs work 38 hours per week on average, those in Inner regional areas work 41 hours compared with 46 hours in Remote/Very remote areas (in 2012).

 

Table 27: Nursing, dentistry, pharmacy and other allied health workforce 2012

 

MC

IR

OR

R

VR

 

FTE per 100,000 population

Nurses and midwives (AIHW 2012)

1134

1085

1071

1241

1303

 Enrolled nurses

164

239

251

233

177

 Registered nurses

970

847

821

1007

1126

Midwives

129

136

149

191

244

Dental professionals (AIHW 2012)

MC

IR

OR

R/VR

 

 Dentists

64

42

36

22

 

 Dental hygienists

5.8

2.7

2.8

1.7

 

 Dental therapists

3.4

4.3

5.6

4.5

 

 Dental prosthetists

5.6

6.4

3.2

0.5

 

 Oral health therapists

2.6

2.8

2.6

1.4

 

Other Allied Health (AIHW 2012)

 

 

 

 

 

Pharmacists

95

75

72

56

 

Psychologists

99

57

45

34

 

Podiatrists

16

14

10

5

 

Physiotherapists

91

56

48

44

 

Optometrists

19

15

10

6

 

Occupational therapists

48

40

27

17

 

Medical radiation practitioners

49

35

21

13

 

Chiropractors

17

15

11

7

 

Chinese medicine practitioners

17

6

4

2

 

Osteopaths

8

5

np

np

 

Aboriginal health workers

0

0.2

3.6

29.7

 

Notes: FTE represents “Full time equivalent”. Numbers in remote and Very remote areas should be treated with caution, as work settings, arrangements (eg sharing and FIFO) can be quite different in these areas compared with Major cities and regional areas.
Sources: 
Nursing and midwifery:AIHW 2013. Nursing and midwifery workforce 2012.National Health Workforce Series no. 6. Cat. no. HWL 52. Canberra: AIHW.httpHYPERLINK "http://www.aihw.gov.au/publication-detail/?id=60129545333"://www.aihw.gov.au/publication-detail/?id=60129545333
Dental:AIHW 2014. Dental workforce 2012.National health workforce series no. 7. Cat. no. HWL 53. Canberra: AIHW.httpHYPERLINK "http://www.aihw.gov.au/publication-detail/?id=60129545961"://www.aihw.gov.au/publication-detail/?id=60129545961
Allied Health: AIHW 2013. Allied health workforce 2012.National health workforce series no. 5. Cat. no. HWL 51. Canberra: AIHW.
http://www.aihw.gov.au/publication-detail/?id=60129544591

The prevalence of allied health workers declines significantly with remoteness, as it does for the dental work force.
Compared with Major cities, the prevalence of nurses is lower in regional areas, but higher in remote areas, but is less dramatically different than for the other professions.

Potential sources of information

AIHW health workforce series
http://www.aihw.gov.au/workforce-publications/

Healthworkforce Australia series
http://www.hwa.gov.au/resources/publications1996, 2001 and 2006 data from Census in 

Selected Health Occupations: Australia, 2006   ABS Cat No 4819.0
http://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/4819.0Main Features12006?opendocument&tabname=Summary&prodno=4819.0&issue=2006&num=&view

 

Mental health services

Good source of data is MHSA http://mhsa.aihw.gov.au/home/

 

Table 28: Australian Government Medicare expenditure on mental health-related services per capita, by provider type, remoteness area, 2012–13

 

MC

IR

OR

R

VR

 

Per capita expenditure ($)

Psychiatrist

17.08

8.51

4.16

2.41

1.60

General practitioner

9.49

9.50

6.44

3.38

1.76

Clinical psychologist

10.76

7.06

3.44

1.90

0.78

Other psychologist

9.53

9.37

5.24

1.80

1.00

Other allied health

0.96

1.06

0.80

0.18

0.08

All providers

47.83

35.50

20.08

9.67

5.21

Source: http://mhsa.aihw.gov.au/home/
Note: expenditure is expressed in 2011-12 dollars.

Per capita Medicare expenditure on mental health in IR, OR, R and VR areas is 74%, 42%, 20% and 11% that in Major cities

 

Mental health workforce

Table 29: Mental health workforce FTE per 100,000 population, 2012

 

MC

IR

OR

R/VR

 

FTE per 100,000 population

Psychiatrists

16

6

4

5

Mental health nurses

85

79

52

48

Psychologists

98

57

45

34

Source: http://mhsa.aihw.gov.au/home/

In 2012, psychiatrist, mental health nurse and psychologist FTEs were respectively, 33%, 82% and 54% as prevalent in regional areas, and 29%,56% and 35% as prevalent in remote areas as in Major cities.

References for further information on mental health workforce:

http://mhsa.aihw.gov.au/home/
http://www.aihw.gov.au/publication-detail/?id=60129544591
http://www.hwa.gov.au/sites/default/files/HWA_Australia-Health-Workforce-Series_Psychologists%20in%20focus_vF_LR.pdf

 

MBS expenditure -primary care (non-referred services)

Table 30: Non-referred MBS expenditure 2012-13

 

MC

IR

OR

R

VR

Non referred services billed to Medicare

92,228,861

24,527,659

10,739,691

1,295,930

609,430

Population

15,992,076

4,162,976

2,047,681

318,814

206,707

Services per Australian per year

5.8

5.9

5.2

4.1

2.9

Benefits paid

 $4,228,006,152

 $1,120,805,509

 $491,588,905

 $61,996,017

 $31,913,392

Fees charged

 $4,690,021,141

 $1,258,634,791

 $552,086,200

 $69,876,456

 $34,683,269

Total out of pocket paid

 $462,014,989

 $137,829,282

 $60,497,295

 $7,880,439

 $2,769,877

Total out of pocket per person per year

 $28.89

 $33.11

 $29.54

 $24.72

 $13.40

Average out of pocket per service

 $5.01

 $5.62

 $5.63

 $6.08

 $4.55

Bulk billed services

                  76,795,121

                  19,528,815

                    8,646,183

                    1,054,125

                        527,533

Non bulk billed services

                  15,433,740

                    4,998,844

                    2,093,508

                        241,805

                          81,897

Average out of pocket cost to non bulk billed person for each service

 $29.94

 $27.57

 $28.90

 $32.59

 $33.82

Bulk billing rate

83.3%

79.6%

80.5%

81.3%

86.6%

Source: https://www.health.gov.au/internet/main/publishing.nsf/Content/Medicare+Statistics-1. Population data from http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/3218.02012-13?OpenDocument

  • Rate of non-referred (aka GP type) MBS services was around 6 per year in MC and IR areas, 4, 4 and 3 per year in OR, R and VR areas.
  • Average out of pocket cost per service was $5 in MCs, $5.6 in regional areas, $6 in remote areas, and $4.5 in VR areas
  • The average out of pocket cost for non bulk-billed services was $30 in MCs, $27.6 in IR, $28.9 in OR, $32.6 in R and $33.8 in VR
  • Bulk billing rates were lower in regional and remote areas (around 80%), but higher in Very remote areas (just under 87%), compared with MC rates of just over 83%.

PBS expenditure

PBS expenditure is slightly higher per capita in regional Australia than in Major cities, largely because there are proportionally more people eligible for PBS (ie health card holders, pensioners etc) in regional areas. The rate of access of health card holders to PBS in regional and remote areas is usually not reported, but when it is, comparisons show lower rates of access to PBS for health card holders in regional and remote areas.

Government pays a PBS component when:

  • A health card holder purchases medication costing more than $6.10 (the card holder pays up to 6.10, PBS pays the rest).
  • When a non card holder purchases medication costing more than $37.70( the general patient pays up to 37.70, PBS pays the rest)

If, the proportion of the population in each area holding a health card was the same, then a simple comparison based on the total PBS expenditure in each area divided by the population in each area might be valid. However, in 2013, health card holders are about 30% more prevalent in regional areas than in Major cities (see page 22), and consequently meaningful comparisons need to take this into account see below) .

 

Table 31: PBS expenditure adjusted to account for differences in the proportion of the population who are concession card holders, 2006-07

 

MC

IR

OR

R

VR

Australia

General expenditure ($millions)

$1,210

$302

$142

 

 

$1,683

Card expenditure ($millions)

$3,256

$1,125

$ 487

 

 

$4,934

Population (millions) 2006-07

14.299

4.121

1.980

0.316

0.166

20,883

% of pop card holders (ABS )

30%

45%

44%

44%

44%

35%

General population (millions)

9.952

2.283

1.111

0.177

0.934

13.532

Card holding population (millions)

4.347

1.838

0.869

0.139

0.731

7.351

Gen. per cap. expenditure (adjusted)

$122

$132

$128

$128

$128

$124

Card per cap. expenditure (adjusted)

$749

$612

$560

$560

$560

$671

Per capita overspend gen. pop

$0

$11

$7

$7

$7

$3

Per capita overspend card pop

$0

-$137

-$189

-$189

-$189

-$78

Total overspend gen. pop ($millions)

$0

$25

$7

$1

$1

$34

Total overspend card pop  ($millions)

$0

-$312

-$210

-$33

-$18

-$573

Total overspend

$0

-$288

-$202

-$32

-$17

-$539

Source: http://www.ruralhealth.org.au/sites/default/files/documents/nrha-policy-document/position/pos-full-complementary-report-27-feb-11.pdf

Table 31 above, based on AIHW data for 2006-07, shows that while there appears to be a slight PBS overspend for the general population in regional and possibly remote areas, there is a strong underspend for health card holders in regional and remote areas.  As far as we are aware, no more recent data describing expenditure for card and non card holders is publically available.

If the 2006-07 data in the table above is reworked using the more recent (and less variable) estimates of health card holder prevalence from PHIDU (see page 22), then the annual PBS underspend in rural areas declines from $540million to $260 million.

 

Barriers to healthcare

Percentage of people 15+ who experienced a barrier to accessing healthcare when needed: MC 4.8%, IR 6.3%, OR/rem 9.9% (percentages appear to be crude). Source: ABS General Health Survey 2014.http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4159.0Main+Features12014?OpenDocument