Objectives: The aim was to identify and explain
trends and cut points in payment classification
(privately insured or otherwise) for episodes of
hospitalisation in Western Australia.
Methods: Hospital morbidity data from 1980 to
2001 were used to produce trend lines of the proportion
of hospital separations in each payment category
in each year in age and clinical subgroups.
Results: The most significant changes in payment
classification over time were found in all groups
between 1980 and 1984, corresponding to a period
when free public hospital care in Australia was
abolished (Sep 1981 to Feb 1984). The trend
associated with this policy change rebounded significantly
just before the introduction of Medicare in
1984. These observations were consistent over all
age groups except in the oldest group (70+ years).
This trend was more pronounced for the surgical
subgroup compared with other broad clinical categories.
More recently, a trend towards increasing
public episodes was reversed from 2000 following
introduction of incentives for private health cover
and sanctions against deferred uptake in younger
people.
Conclusion: The public appeared to adopt a shortterm
crisis reaction to major policy change but then
reversed towards past patterns of behaviour. The
implications for policy makers include the need to
understand the underlying culture of the population;
to realise that attitudes become fixed as people age;
and to recognise the difference in the effectiveness
of incentive- and deterrent-based policies.