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Objective. Out-of-pocket (OOP) costs could act as a potential barrier to accessing specialist services, particularly among low-income patients. The aim of this study is to examine the link between OOP costs and socioeconomic inequality in specialist services in Australia. Methods. This study is based on population-level data from the Medicare Benefits Schedule of Australia in 2014-15. Three outcomes of specialist care were used: all visits, visits without OOP costs (bulk-billed services), and visits with OOP costs. Logistic and zero-inflated negative binomial regression models were used to examine the association between outcome variables and area-level socioeconomic status after controlling for age, sex, state of residence, and geographic remoteness. The concentration index was used to quantify the extent of inequality. Results. Our results indicate that the distribution of specialist visits favoured the people living in wealthier areas of Australia. There was a pro-rich inequality in specialist visits associated with OOP costs. However, the distribution of the visits incurring zero OOP cost was slightly favourable to the people living in lower socioeconomic areas. The pro-poor distribution of visits with zero OOP cost was insufficient to offset the pro-rich distribution among the visits with OOP costs. Conclusions. OOP costs for specialist care might partly undermine the equity principle of Medicare in Australia. This presents a challenge to the government on how best to influence the rate and distribution of specialists' services.

Objective. To elucidate the policy implications of recent trends in the funding of radiotherapy services between 2009-10 and 2021-22. Method. We use national aggregate claims data to determine time trends in the fees, benefits and out-of-pocket (OOP) costs of radiotherapy and nuclear therapeutic medicine claims funded through the Medicare Benefits Schedule (MBS) program. All dollar figures are expressed in constant 2021 Australian dollars. Results. Radiotherapy and nuclear therapeutic medicine MBS claims increased by 78% whereas MBS funding increased by 137% between 2009-10 and 2021-22. The main driver of Medicare funding growth has been the Extended Medicare Safety Net, which has increased by 404%. Over the 13 year observation period, the percentage of bulk-billed claims peaked in 20i7-18 at 76.1% but fell to 69.8% in 2021-22. For non-bulk billed services, average OOP costs per claim increased from $20.40 in 2009-10 to $69.78 in 2021-22. Conclusion. Despite increased Medicare funding, patients face increasing financial barriers to access radiation oncology services. Policies with regard to funding radiotherapy services should be reviewed to ensure that services are easily accessible and affordable for all those needing treatment and at a reasonable cost to Government.

Background: The accessibility to affordable primary healthcare services contributes to population health and health equity. A key aspect to accessibility is the geographical distribution of primary healthcare services. Limited studies have assessed the nationwide spatial distribution of bulk billing-only medical practices or ‘no-fee’ services. The aim of this study was to provide a nationwide approximation of bulk billing-only services and evaluate the socio-demographic status and population characteristics in relation to the distribution of bulk billing-only GP services. Methods: The methodology in this study used Geographic Information System (GIS) technology to map the locations of all bulk bulking-only medical practices collected in mid-2020 and linked this with population data. The population data and practice locations were analysed at the level of Statistical Areas Level 2 (SA2) regions and used the most recent Census data. Results: The study sample included (n = 2095) bulk billing-only medical practice locations. The nationwide average Population-to-Practice (PtP) ratio was 1 practice to 8529 people for regions with access to bulk billing-only practice, and 57.4% of the Australian population lives within an SA2 that has access to at least one bulk billing-only medical practices. No significant associations were identified between practice distribution and area socio-economic status. Conclusion: The study identified areas with low access to affordable GP services, with many SA2 regions having no access to bulk billing-only practices. Findings also indicate that there was no association between area socio-economic status and the distribution of bulk billing-only services.

To determine: 1) the mean, median and range of fees for initial and subsequent private outpatient consultations with a general paediatrician in Australia; 2) any variation in fees and bulk billing rates between states/territories; and 3) volume of outpatient general paediatric specialist consultations relative to child population. Analysis of Medicare claims data from the years 2011 and 2014 for initial consultations (items 110 and 132), subsequent consultations (items 116 and 133), and autism or pervasive developmental disorder (PDD) initial consultation (item 135) with a general paediatrician. Fees for initial and subsequent general paediatric outpatient consultations varied within, and between, states and territories. Fees increased slightly from 2011 to 2014, after accounting for inflation. The volume of consultations relative to child population varied markedly across states and territories, as did bulk billing rates. Use of item codes for patients with multiple morbidities (132 and 133) increased significantly from 2011 to 2014. Autism/PDD consultation service use (item 135) and fees remained relatively stable. There was variation in service use, fees and bulk billing within, and between, states and territories, and across time and consultation types. Future studies should assess the impact of such variation on access to paediatric services and the relationship, if any, to variation in state investment in public paediatric outpatient services.

Sydney GP Dr Jodhi Menon has remained a fierce advocate of GPs' independence from government since he first contributed to Australian Doctor's pages in 1984. The Sydney GP turned his back on the vocational register, and continues to bill privately. Here, he reflects on the past 25 years.

The Commonwealth Government is currently undertaking a review of various issues in the health sector. A recently published study by John Deeble has analysed expenditures, utilisation, workforce issues etc. under Australia's current health insurance arrangements (Medicare) for the provision of medical services remunerated on a fee-for-service basis.This study has highlighted increased utilisation of services as a major \"management issue\".It is demonstrated here that the data on which these conclusions are based are deficient in several respects.By analysis of other data it is indicated that the picture of fee-for-service medical practice under Medicare presented by Deeble is out of focus in several important dimensions.More specifically, the high utilisation rates have been obtained by \"adjusting\" data and ignoring substitution behaviour between services provided by outpatient departments at public hospitals and services provided on a fee-for-service basis. Also the Deeble analysis has ignored institutional changes that involve \"transfers\" of health expenditures from one government entity to another.This study shows that on the basis of empirical data, Deeble has considerably overestimated the growth of per capita utilisation of medical services in Australia since the introduction of Medicare. It also casts doubt on the need for \"reform\".

A 2001 versus 1991 longitudinal assessment of shipper-to-shipper perceptions, carrier-to-carrier perceptions, and shipper-to-carrier perceptions indicates that carrier understanding of shipper needs may be improving. The shipper-to-shipper analysis revealed that in 2001 shippers were even more concerned with information access, consistent carrier performance, solid customer relations, and the availability of desired services. The carrier-to-carrier analysis indicates that in 2001 carriers appreciated the increasing importance of such factors, as well as the value of providing rate leadership. In 2001, statistically significant differences resulted between shipper and carrier mean ratings for eleven of the thirty-six selection criteria, an improvement from nineteen of thirty-five significant differences in 1991. Basically, carriers must key on offering more flexible rates, providing desired services, and developing a Web-enhanced EDI.

The decision criteria shippers use to select and evaluate motor carriers have been the subject of much research. Most studies of the carrier selection process were conducted prior to deregulation, although a number of studies have been conducted since the Motor Carrier Act of 1980. A total of 166 attributes were included as 99 questions in an 8-page questionnaire directed to shippers utilizing general commodities LTL motor carriers. With 316 respondents, the attributes were rated by importance by shippers when selecting and evaluating LTL motor carriers. Sixteen of the 18 most important attributes were service related. Study findings revealed that shippers placed far greater emphasis on the quality of service delivered by carriers than low rates. The fact that the majority of LTL motor carriers do not perform at levels required by customers highlights the need for firms to benchmark against customer requirements of performance and not just competitors.

Much has been said and written about electronic data interchange (EDI) during the past decade, yet industry and carrier management seem to understand little about the relative importance of EDI. EDI is available in the transportation industry and offers viable strategic opportunities for shippers and receivers. The application of most value to a firm depends on its operational and marketing needs. In the accounting and finance areas, electronic freight billing offers the greatest potential. In the areas of shipping and billing, electronic bill of lading exchange provides tremendous advantages. Shipment location messages offer many opportunities for enhancing customer service and materials management. Each EDI application should be reviewed to determine how it can help the firm. The challenge to industry is to work smarter, more productively, and more effectively to meet customer demands and the threat of competition. EDI offers solutions for each of these challenges.