Centre for Health Research

An Investigation of the Geographic Variation in Primary Health Care

Aims:

This study is a collaboration between the University of Western Sydney (UWS) and the Australian National University (ANU), and is part of a larger project, named GRAPHC (Geographic and Resource Analysis in Primary Health Care), that is being conducted at ANU. Our goal is to provide decision-makers with a comprehensive picture of the patterns and determinants of geographic variation in primary healthcare need, utilisation and cost within NSW. Our research will help decision-makers to formulate evidence-based resource allocation policies aimed at improving  the delivery of primary healthcare as well as reducing health disparities.

Research areas:

The project comprises three phases. First, we will use Geographic Information Systems (GIS) to define the Primary Care Services Areas (PCSAs), which are areas that reflect the flow of patients from their neighbourhoods of residence to their choice of primary healthcare. This will allow us to investigate, for example, how often people cross Medicare Local boundaries to access primary healthcare.

The PCSAs will be an important unit of analysis entering the second phase of the project, in which we will investigate the geographical variation of primary healthcare need, use and cost. We will identify determinants of these geographical variations by modelling the contributions of factors that can be grouped as ‘individual’ (e.g. age, gender) or ‘contextual’ (e.g. availability of primary healthcare).

Third, we will evaluate potential recommendations on the allocation of healthcare resources. Building on our analysis in phase two, we will identify determinants of geographical variation in need, use and cost of primary healthcare that could be potentially modifiable via spatial resource allocation. Simulation methods will be used to investigate the consequences of altering some of these determinants on narrowing health inequalities and enhancing the efficiency of the primary healthcare system.

Data and methods:

This project will use The 45 and Up Study linked to Medicare Benefits Schedule (MBS), Pharmaceutical Benefits Scheme (PBS), records of hospital and emergency department admissions, cancer registrations, and mortality data. Data linkage is performed by the Centre for Health Record Linkage (CHeReL).

A prominent role in the econometric analysis will be played by multilevel modelling. Multilevel modelling takes in account the fact that groups of individuals share some unmeasured exposures that may influence the outcome of interest. For example people living in the same geographical location will have a similar range of options for accessing primary healthcare.

Collaboration:

University of Western Sydney

Thomas  Astell-Burt
Xiaoqi Feng
Federico Girosi
Louisa Jorm

Australian National University

Danielle Butler
Kirsty Douglas
Paul Konings
Soumya Mazumdar
Ian  McRae

For more information:

Please contact Federico Girosi, Centre for Health Research, UWS - email: f.girosi@uws.edu.au