Out-of-pocket healthcare expenditure and chronic disease – do Australians forgo care because of the cost?

Abstract

Although we do know that out-of-pocket healthcare expenditure is relatively high in Australia, little is known about what health conditions are associated with the highest out-of-pocket expenditure, and whether the cost of healthcare acts as a barrier to care for people with different chronic conditions. Cross-sectional analysis using linear and logistic regression models applied to the Commonwealth Fund international health policy survey of adults aged 18 years and over was conducted in 2013. Adults with asthma, emphysema and chronic obstructive pulmonary disease (COPD) had 109% higher household out-of-pocket healthcare expenditure than did those with no health condition (95% CI: 50-193%); and adults with depression, anxiety and other mental health conditions had 95% higher household out-of-pocket expenditure (95% CI: 33-187%). People with a chronic condition were also more likely to forego care because of cost. People with depression, anxiety and other mental health conditions had 7.65 times higher odds of skipping healthcare (95% CI: 4.13-14.20), and people with asthma, emphysema and chronic obstructive pulmonary disease had 6.16 times higher odds of skipping healthcare (95% CI: 3.30-11.50) than did people with no health condition. People with chronic health conditions in Canada, the United Kingdom, Germany, France, Norway, Sweden and Switzerland were all significantly less likely to skip healthcare because of cost than were people with a condition in Australia. The out-of-pocket cost of healthcare in Australia acts as a barrier to accessing treatment for people with chronic health conditions, with people with mental health conditions being likely to skip care. Attention should be given to the accessibility and affordability of mental health services in Australia.

Impact of out‐of‐pocket costs on patient initiation, adherence and persistence rates for patients treated with anti‐vascular endothelial growth factor medicines

“…Expense is a key driver of patients' decisions to seek, delay or avoid specialist services when they need them, as exemplified in a recent study of utilization of Medicare services:

Across Australia, 7.3% of people aged 15 and over who needed to see a medical specialist delayed or did not see a medical specialist due to cost (which represents an estimated 538 000 people) The 90th percentile threshold for annual out‐of‐pocket costs in this report (2016‐2017) was $601.

…”

“…This observation was evident from 6 months onwards and is supportive of the hypothesis that medical expenses are particularly significant access barriers for diabetics above and beyond those that exist for nAMD patients. It may be that the comorbidity burden of diabetes and its economic consequences influenced this difference …”

Out‐of‐pocket expenditure on health care by Australian mothers: Lessons for maternal universal health coverage from a long‐established system

“…The affordability of out‐of‐pocket fees for health care warrants careful consideration, as these fees or “co‐payments” have the potential to negatively affect patient health by reducing demand for health care and causing patients to forego necessary medical treatment. Indeed, within Australia one in four people with a chronic health condition skip care because of the cost . The classic demand response to high or increasing prices is for consumers to demand fewer services; thus, the out‐of‐pocket fees set by practitioners play a key role in determining the number of services that are actually consumed .…”

“…Indeed, within Australia one in four people with a chronic health condition skip care because of the cost. 9 The classic demand response to high or increasing prices is for consumers to demand fewer services; thus, the out-of-pocket fees set by practitioners play a key role in determining the number of services that are actually consumed. 10,11 The significance and impact of out-ofpocket expenses associated with health care are not limited to Australia.…”

Variation in the fees of medical specialists: problems, causes, solutions

“…Articles in this issue of the MJA 1 , 2 and elsewhere 3 ‐ 5 have reported significant variation in the fees charged by specialist physicians and surgeons. These variations raise questions about excessive health care costs, as well as about barriers to access for patients 2 , 4 , 5…”