Acupuncture in Australian General Practice: Trends in Reimbursed Acupuncture Services from 1995 to 2011

Abstract

Objectives To ascertain the extent of and trends in the use of acupuncture in Australian general practice and the characteristics of patients receiving publicly subsidised acupuncture services from general practitioners (GPs). Design Secondary analysis of national patient Medicare data for claims by all non-specialist medical practitioners for Medicare Benefits Schedule items for an attendance where acupuncture was performed by a medical practitioner from 1995 to 2011. Main Outcome Measures Use of acupuncture by GPs, patients’ sex and age and the socioeconomic disadvantage index of GP's practice. Results There has been a 47.7% decline in the number of acupuncture claims by GPs per 100 000 population in the period from 1995 to 2011. Acupuncture claims were made by 3.4% of GPs in 2011. Women were almost twice as likely to receive acupuncture from a GP as men, and patients in urban areas were more than twice as likely to receive acupuncture from a GP as patients in rural areas. Acupuncture claims were highest in areas that were socioeconomically advantaged. Conclusions Claims for reimbursement for acupuncture by GPs have declined significantly in Australian general practice even though the use of acupuncture by the Australian public has increased. This may be due to increased use of referrals or use of non-medical practitioners, barriers to acupuncture practice in general practice or non-specific factors affecting reimbursement for non-vocationally registered GPs.

Acupuncture Referrals in Rural Primary Healthcare: A Survey of General Practitioners in Rural and Regional New South Wales, Australia

“…5 However, the high level of professional relationships and referral with acupuncturists among GPs may also be related to longstanding (since 1984) and formal referral and reimbursement arrangements that exist for acupuncture services in the Australian public healthcare system, when performed by medical practitioners. 10 The established nature of acupuncture in Australian general practice may also explain why this treatment has high levels of support, relative to other CAM professions, among the general practice community in this study. However, given the longstanding decline in the number of medical practitioners performing acupuncture in Australian general practice, 10 and the rise of the emergent Chinese medicine and acupuncture professions in Australia, 26 it is also likely that there is also a significant interface between general practice and non-medical acupuncturists.…”

“…10 The established nature of acupuncture in Australian general practice may also explain why this treatment has high levels of support, relative to other CAM professions, among the general practice community in this study. However, given the longstanding decline in the number of medical practitioners performing acupuncture in Australian general practice, 10 and the rise of the emergent Chinese medicine and acupuncture professions in Australia, 26 it is also likely that there is also a significant interface between general practice and non-medical acupuncturists. Although our study results suggest that acupuncture was largely accepted by the majority of the Australian rural and regional GP community, nearly 1/10th of GPs in this study maintained that they would never refer patients to acupuncture under any circumstances.…”

“…9 Furthermore, acupuncture consultations-when performed by a medical practitioner-have been eligible for public subsidies (Medicare) since 1984. 10 In this sense acupuncture is unique among CAM therapies in Australia in that it has significant levels of use by nonmedical CAM practitioners as well as medical providers. The non-medical practise of acupuncture in Australia is not limited to those trained in Chinese medicine, and there is also significant acupuncture practise among other practitioner groups not traditionally associated with the practise in Australia, including chiropractors, naturopaths, osteopaths and physiotherapists.…”

“…Analysis of Australian health insurance reimbursement data has also suggested that medical practitioners in rural areas are less likely to provide reimbursed acupuncture services than medical practitioners in urban areas, though pockets of high rural service provision do exist. 10 Similarly, non-medical acupuncturists make up a significant part of the CAM primary care workforce in rural and regional New South Wales, though there was significant variation between areas, with acupuncturists ranging from between 4% and 42% of total CAM providers in individual rural Divisions of General Practice. 5 The high level of integration of acupuncture in the Australian healthcare sector, relative to other CAM professions and therapies, has significant implications for general practice and healthcare delivery in rural and regional Australia, especially when viewed in the context of high use of these therapies in non-urban areas.…”

“…17 Additionally, despite high levels of support for acupuncture among the Australian GP population and rising acupuncture use among the Australian population, publicly reimbursed acupuncture services by GPs have steadily declined over the previous two decades. 10 Recent research has also uncovered increased use of CAM by rural populations when compared to urban populations, in Australia and internationally. 18 The presence of geographical variations in acupuncture use are less clear, with the previous Australian analyses not identifying significant difference in acupuncture use among middle-aged women from rural or urban areas.…”