Injured Workers' Experiences of General Practitioner Care Across Dual Healthcare Funding Systems: A Qualitative Study in an Australian Workers' Compensation Context.

Abstract

Background: Injured workers often navigate healthcare services funded by multiple payers with distinct eligibility and funding rules. In Australia, general practitioner (GP) care is subsidised through the publicly funded health insurance system (Medicare). Injured workers may also access care funded by the workers' compensation system for work-related conditions. Consequently, injured workers may be required to navigate two healthcare funding systems simultaneously. This study examined injured workers' experiences of GP care across both systems to inform improved patient care and system reform.

Methods: Twelve participants with work-related musculoskeletal injuries were recruited. Data were analysed using reflexive thematic analysis, following an inductive approach to coding and identifying key themes.

Results: Three themes were identified: (1) "Navigating dual care funding systems", where participants described challenges accessing care across workers' compensation and Medicare; (2) "Workers' compensation systemic strains on care", where systemic pressures within workers' compensation affected workers' access to and GPs' delivery of care; and (3) "GPs' management of workers' compensation-related tasks", where care experiences varied depending on how individual GPs approached workers' compensation-related tasks.

Conclusion: Workers described significant challenges arising from system fragmentation, administrative demands, and variability in GPs 'willingness to engage with the workers' compensation process. These experiences shaped access, continuity, and quality of care received. Workers preferred whole-person care, often changing GPs when their regular GP refused to engage with the workers' compensation system. Strengthening coordination between funding systems, streamlining administrative processes, and improving GP training could improve the care experiences. These findings highlight the system-level reforms prioritising patient experience.