Increasingly inequitable distribution of general practitioners in Australia, 1986-96

Abstract

Objective: To document trends in the distribution of general practitioners (GPs) in Australia between 1966 and 1996. adjusted for community need. Methods: Data on the location of GPs, population size and crude mortality in statistical divisions (SO) were obtained from the Australlan Bureau of Statistics Census of Population and Housing in 1986 and 1996. From these data, we calculated measures of distribution equality (number of people sharing each GP in each SO) and distribution equity (number of people sharing each GP divided by the crude mortality rate; the Robin Hood Index), and analysed temporal changes in the distribution of G Ps. Results: Nationally, the number of people sharing each GP feU 11 % from 1,038 in 1986 to 921 in 1996. However, in 41 of 57 SOs (72%, poO.Ol) the number of people sharing a GP actually increased over this time, and the average Robin Hood Index across SOs fell from 0.943 to 0.783 (.0-0.004), indicating increasingly inequitable distribution. Comparing the Robin Hood Index values of all SOs ranked in pairs, the value fell in 53 of 57 (93%, pdl.OO 1) paired SOs over the decade. These patterns demonstrate increasing inequity over the decade. The number of people sharing each GP was consistently and substantially lower in the capital city SOs and the Robin Hood Index values were consistently and substantially higher (over~ served) compared with country SOs. Conclusions: Despite there being more G Ps per capita in Australia, their distribution became increasingly unequal and inequitable between 1986 acd 1996, such that rural and remole areas became increasingly poorly served.