Inequality in out of pocket fees, government funding and utilisation of maternal health services in Australia

Callander, Emily; Shand, Antonia; Nassar, Natasha

doi:10.1016/j.healthpol.2021.04.009

Cited by 4 publications

(4 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…30 In previous studies exploring service utilization and pregnancy costs, most of them focused on services provided at a certain stage of the maternal care continuum, 31 evaluated the association between the service utilization rate and health outcomes, 32 or explored factors associated with maternal healthcare service use. [33][34][35] This study added value by aggregating the maternal health service use and costs at the population level and throughout the course of pregnancy. We specifically explored all types of healthcare utilization, not just obstetric or midwifery care, identifying the range of other services accessed by women and babies.…”

Section: Discussionmentioning

confidence: 99%

“…From 2010 to 2020, the average maternal age increased from 30.0 years to 30.9, while the proportion of older mothers (aged 35 or over) has increased from 23% to 25.5%. 12 Compared with younger mothers (aged [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34], older mothers are more at risk for pre-existing medical conditions that can affect the current pregnancy (e.g., hypertension), pregnancy complications (e.g., gestational diabetes), cesarean birth (which entail longer postnatal hospital stays relative to vaginal birth), and adverse outcomes for babies (e.g., stillbirth, preterm birth [less than 37 weeks of gestation], and low birthweight [less than 2500 g]). 13,14 These increased risks are associated with the usage of additional health services for mothers and babies (e.g., antenatal admission), compared with routine maternity care.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Unlocking big data to understand health services usage and government funding during pregnancy and early childhood, evidence in Australia

Zhang

Callander

2023

Birth

View full text Add to dashboard Cite

BackgroundMaternity care is a high‐volume and high‐cost area of health care, which entails various types of service use throughout the course of the pregnancy. Thus, the aim of this study was to explore the most common reasons and related costs of health services used by women and babies from pregnancy to 12‐month postbirth.MethodsWe used linked administrative data from one state of Australia, which contained all births in Queensland between 01/07/2017 and 30/06/2018. Descriptive analyses were used to identify the 10 most frequent reasons and related costs for accessing inpatient, outpatient, emergency department, and Medicare services. These are reported separately for women and babies in different periods.ResultsWe included 58,394 births in our data set. The results have highlighted that there was relatively uniform use of inpatient, outpatient, and Medicare services by women and babies, with the 10 most common services accounting for more than half of the total services accessed. However, the emergency department service use was more diverse. Medicare services accounted for the greatest volume (79.21%) of service events but only 10.21% of the overall funding, compared with inpatient services, which accounted for less volume (3.62%) but the highest amount of overall funding (75.19%).ConclusionStudy findings provide empirical evidence about the full spectrum of services used by birthing families and their babies, and could assist health providers and managers to understand the services women and infants actually access during pregnancy, birth, and postbirth.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Unlocking big data to understand health services usage and government funding during pregnancy and early childhood, evidence in Australia

Zhang

Callander

2023

Birth

View full text Add to dashboard Cite

show abstract

“…24 Increasing the volume of outpatient specialist care through public hospitals might be an additional option to improving equity. Although there is a skew towards higher socio-economic status in access to Medicare services, [21][22][23]25 public hospitals achieve greater equity in the provision of care than private hospitals. 25,26 However, public hospitals play a vital role contributing to equity in health access once conditions arise; they do not cover primary and preventive care.…”

Section: Systems-level Options For Changementioning

confidence: 99%

Out‐of‐pocket fees for health care in Australia: implications for equity

Callander

2023

Medical Journal of Australia

View full text Add to dashboard Cite

“…Thus, the indicator may have weakened construct validity, or ability to capture the concept of free care for maternal health services [14]. In addition, there may be a tendency for the poor, illiterate, and less advantaged to be unfairly charged, moving away from rather than toward equity in UHC for maternal health [20][21][22].…”

Section: Introductionmentioning

confidence: 99%

Validating the implementation of an indicator reporting policies and laws on free public maternal health-related services in the era of universal health coverage: A multi-country cross-sectional study

Odikro,

Kenu,

Adanu

et al. 2024

PLoS ONE

View full text Add to dashboard Cite

Background The concept of universal health coverage (UHC) encompasses both access to essential health services and freedom from financial harm. The World Health Organization’s Maternal Newborn Child and Adolescent Health (MNCAH) Policy Survey collects data on policies that have the potential to reduce maternal morbidity and mortality. The indicator, “Are the following health services provided free of charge at point-of-use in the public sector for women of reproductive age?”, captures the free provision of 13 key categories of maternal health-related services, to measure the success of UHC implementation with respect to maternal health. However, it is unknown whether it provides a valid measure of the provision of free care. Therefore, this study compared free maternal healthcare laws and policies against actual practice in three countries. Methods and findings We conducted a cross-sectional study in four districts/provinces in Argentina, Ghana, and India. We performed desk reviews to identify free care laws and policies at the country level and compared those with reports at the global level. We conducted exit interviews with women aged 15–49 years who used a component service or their accompanying persons, as well as with facility chief financial officers or billing administrators, to determine if women had out-of-pocket expenditures associated with accessing services. For designated free services, prevalence of expenditures at the service level for women and reports by financial officers of women ever having expenditures associated with services designated as free were computed. These three sources of data (desk review, surveys of women and administrators) were triangulated, and chi-square analysis was conducted to determine if charges were levied differentially by standard equity stratifiers. Designation of services as free matched what was reported in the MNCAH Policy Survey for Argentina and Ghana. In India, insecticide-treated bed nets and testing and treatment for syphilis were only designated as free for selected populations, differing from the WHO MNCAH Policy Survey. Among 1046, 923, and 1102 women and accompanying persons who were interviewed in Argentina, Ghana, and India, respectively, the highest prevalence of associated expenditures among women who received a component service in each setting was for cesarean section in Argentina (26%, 24/92); family planning in Ghana (78.4%, 69/88); and postnatal maternal care in India (94.4%, 85/90). The highest prevalence of women ever having out of pocket expenditures associated with accessing any free service reported by financial officers was 9.1% (2/22) in Argentina, 64.1% (93/145) in Ghana, and 29.7% (47/158) in India. Across the three countries, self-reports of out of pocket expenditures were significantly associated with district/province and educational status of women. Additionally, wealth quintile in Argentina and age in India were significantly associated with women reporting out of pocket expenditures. Conclusions Free care laws were largely accurately reported in the global MNCAH policy database. Notably, we found that women absorbed both direct and indirect costs and made both formal and informal payments for services designated as free. Therefore, the policy indicator does not provide a valid reflection of UHC in the three settings.

show abstract

Inequality in out of pocket fees, government funding and utilisation of maternal health services in Australia

Cited by 4 publications

References 31 publications

Unlocking big data to understand health services usage and government funding during pregnancy and early childhood, evidence in Australia

Unlocking big data to understand health services usage and government funding during pregnancy and early childhood, evidence in Australia

Out‐of‐pocket fees for health care in Australia: implications for equity

Validating the implementation of an indicator reporting policies and laws on free public maternal health-related services in the era of universal health coverage: A multi-country cross-sectional study

Contact Info

Product

Resources

About