Factors associated with health service utilisation in rural Victoria: a multilevel analysis informed by Andersen’s behavioral model

Abstract Background Access to health services in rural areas can be hampered by a variety of factors contributing to reduced utilisation and poorer health outcomes. Andersen’s behavioral model was developed to understand how people utilise health services by assessing associations with predisposing factors, needs factors and enabling factors. The aims of this study were to determine the relative contribution of these factors to utilisation of general practice, medical specialists and dental services in a rural area and also to identify the nature of barriers to health service access. Methods A cross-sectional survey design was used. Households were randomly selected from local government lists. Respondents were asked about their health, use of health services, barriers to health service access and demographic details by trained research assistants. Multilevel regression analysis informed by the Andersen model was used to identify factors associated with health service utilisation, and impact of access barriers on utilisation as per Yeatt’s expansion. Results Household respondents ( n = 2680) provided data about their health and service utilisation. General practice utilisation was lower for males than females (OR 0.57 [0.40, 0.8]). The use of specialists was lower for those without Year 12 educational attainment than those with Year 12 (OR 0.81 [0.66, 0.996]), for those born overseas compared with those born in Australia (OR 0.67 [0.51, 0.88]) or residing in small towns compared with those residing in the regional centre (OR 0.82 [0.67, 0.99]). Dental use was lower for males than females (OR 0.71 [0.50, 0.996]) and those not employed compared with employed people (OR 0.51 ([0.35, 0.76]). Respondents reported barriers to general health service access including cost, distance and waiting time, but these barriers were not associated with reduced utilisation. Access barriers to dental care included cost and no perceived need, and these were associated with reduced utilisation. Conclusions A variety of healthcare service barriers were identified, but largely did not preclude utilisation of medical services in this rural area, suggesting that barriers may delay, inconvenience or complicate the patient journey. However, barriers to dental care, including its cost and perceived need, did restrict use.