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/[email protected]/Latestproducts/4819.0Main Features12006?opendocument&tabname=Summary&prodno=4819.0&issue=2006&num=&view

 

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/[email protected]/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.