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Preventative health checks for women in mid-life are being provided to those who are most in need, contrasting with trends where those who are more disadvantaged tend to receive less primary health care.
New research has found general practitioners (GPs) are proactively providing preventive health checks to women in mid-life who need it most, possibly due to sufficient Medicare rebates.
The research, published in the Medical Journal of Australia, analysed data from the Australian Longitudinal Study on Women’s Health (ALSWH) to determine whether preventive health checks were being carried out on women in mid-life with the greatest need, as often people who are most in need are the ones who receive the least care.
“We wanted to know if the patients getting preventive health checks were those who needed them most and if a patient’s economic position might be a barrier to access,” Professor Jenny Doust said, the study’s senior researcher and clinical professorial research fellow of The University of Queensland.
The types of preventive health checks generally available for women aged between 40 and 49 years are checks for those at risk of type 2 diabetes and chronic disease, as well as a heart health check.
The research found that women were more likely to have had health checks if they had risk factors for chronic disease, which was in contrast to previous research which found that fewer GP services are provided to people with unhealthy lifestyles.
The new findings were mirrored in a recent study looking at the uptake of health checks for Aboriginal and Torres Strait Islander people, which found these went to those who had the greatest health care needs.
“Our work shows that, in Australian primary care, people who need preventive care the most are more likely to receive it,” Professor Doust said.
“We often hear about the inverse care law, that is the ability to access health care varies inversely with need.
“There is some previous evidence of the inverse care law in Australian general practice, with people who have unhealthy behaviours using fewer GP services and those living in disadvantaged areas having shorter GP consultation times.
“Our study shows that the inverse care law doesn’t seem to apply here.”
The research authors believe one explanation might be that the Medicare rebate paid to GPs for preventive health is at a sufficiently high level for GPs to be incentivised to provide this care.
The fact that fewer women in the study underwent heart health checks suggests the rebate for this service may be inadequate compared with the rebate for health checks for diabetes and chronic disease.
“It is hard to design health care funding so that people who need care receive it, without also incentivising overservicing to those who can afford to pay more,” Professor Doust said.
“Partly, we rely on health care providers being motivated to provide equitable care.”
“Our study suggests GPs are doing that.”
Read the research in the Medical Journal of Australia.
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To ensure public funds are well spent, is there convincing evidence these preventive checks are worth doing? Evidence for opportunistic risk assessment is well known. If the evidence for a dedicated health check for non-Indigenous populations has grown since earlier RCT research showing these health checks made no difference, this would be good to know. Everyone wants high value health care.