The Rise and Fall in Out-of-Pocket Costs in Australia: An Analysis of the<i>Strengthening Medicare</i>Reforms

Wong, Chun Yee; Greene, Jennifer C.; Dolja‐Gore, Xenia; Gool, Kees van

doi:10.1002/hec.3376

Cited by 14 publications

(10 citation statements)

References 18 publications

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“…In response to the spiralling costs facing the Australian state to financing this system, ongoing health care reform has led to an interrogation of the amount being paid out-of-pocket by individuals [26]. Previous research in this area has looked at out-of-pocket expenditure at a single point in time [6, 35], or focused upon expenditure by a single sub-population [21, 32]. However, it has been noted that the basis of the Medicare system – to provide universal health care – is being undermined by increasing out-of-pocket costs [20].…”

Section: Introductionmentioning

confidence: 99%

Out-of-pocket healthcare expenditure in Australia: trends, inequalities and the impact on household living standards in a high-income country with a universal health care system

2019

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BackgroundPoor health increases the likelihood of experiencing poverty by reducing a person’s ability to work and imparting costs associated with receiving medical treatment. Universal health care is a means of protecting against the impoverishing impact of high healthcare costs. This study aims to document the recent trends in the amount paid by Australian households out-of-pocket for healthcare, identify any inequalities in the distribution of this expenditure, and to describe the impact that healthcare costs have on household living standards in a high-income country with a long established universal health care system. We undertook this analysis using a longitudinal, nationally representative dataset – the Household Income and Labour Dynamics in Australia Survey, using data collected annually from 2006 to 2014. Out of pocket payments covered those paid to health practitioners, for medication and in private health insurance premiums; catastrophic expenditure was defined as spending 10% or more of household income on healthcare.ResultsAverage total household expenditure on healthcare items remained relatively stable between 2006 and 2014 after adjusting for inflation, changing from $3133 to $3199. However, after adjusting for age, self-reported health status, and year, those in the lowest income group (decile one) had 15 times the odds (95% CI, 11.7–20.8) of having catastrophic health expenditure compared to those in the highest income group (decile ten). The percentage of people in income decile 2 and 3 who had catastrophic health expenditure also increased from 13% to 19% and 7% to 13% respectively.ConclusionsOngoing monitoring of out of pocket healthcare expenditure is an essential part of assessing health system performance, even in countries with universal health care.

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Section: Introductionmentioning

confidence: 99%

Out-of-pocket healthcare expenditure in Australia: trends, inequalities and the impact on household living standards in a high-income country with a universal health care system

2019

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“…This present study contributes to two strands of health literature. A large body of work has explored the determinants of OOP health expenditures, highlighting the association between OOP spending and age [13]; obesity [14]; health insurance coverage [10,15]; and healthcare reforms such as Medicare Part D implementation [8,16–18]. Many studies also emphasize the important role of chronic illnesses.…”

Section: Introductionmentioning

confidence: 99%

Out-of-pocket health spending among Medicare beneficiaries: Which chronic diseases are most costly?

Fong

2019

PLoS ONE

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BackgroundLittle is known about the impact of different types of chronic diseases on older adults’ out-of-pocket healthcare spending and whether certain diseases trigger higher spending needs than others.MethodsWe use data from the 2014 Health and Retirement Study representing a weighted population of 35,939,270 Medicare beneficiaries aged 65+. Generalized linear models are applied to estimate the effect of different chronic diseases on total out-of-pocket expenditure, adjusted for demographics, socio-economic status, physical health, and other factors. We also decompose total spending by expenditure categories (inpatient, non-inpatient, and prescription drug spending). Sensitivity analysis is performed using a younger sample of older adults aged 50–64.ResultsCardiovascular disease, diabetes, hypertension and cancer, induce significantly higher adjusted out-of-pocket spending among older adults than other conditions. These results hold regardless how the spending differences are assessed (absolute or percentage terms). For Medicare beneficiaries, cardiovascular disease is associated with an excess out-of-pocket spending of $317 per year, followed by diabetes ($237), hypertension ($150), and cancer ($144). Prescription drug spending is singularly the most important driver of additional expenses for cardiovascular disease, diabetes and hypertension, while non-inpatient services spending accounts for the bulk of increased spending among those with cancer.ConclusionsOur finding that major noncommunicable diseases impact individuals’ out-of-pocket medical spending differentially–and that service drivers of increased spending may be heterogeneous across disease types–suggest that health professionals and policymakers should recognize that certain chronic diseases exert greater financial toll on the elderly. Interventions to promote more cost efficient healthcare services and consumer choices can help older adults better cope with these expensive long-lasting conditions and reduce the overall burden of noncommunicable diseases.

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“…This kind of incentive was implemented in 2005 for general practice consultations, with a noticeable impact on the OOP costs. 31 Similar financial incentives could be designed for specialist consultations, although more research is required on the level of the incentives that would maximise behaviour change among specialists and minimise unintended consequences on Government expenditure and other (eg higher income) patients.…”

Section: Discussionmentioning

confidence: 99%

The link between out-of-pocket costs and inequality in specialist care in Australia

2022

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Objective Out-of-pocket (OOP) costs could act as a potential barrier to accessing specialist services, particularly among low-income patients. The aim of this study is to examine the link between OOP costs and socioeconomic inequality in specialist services in Australia. Methods This study is based on population-level data from the Medicare Benefits Schedule of Australia in 2014–15. Three outcomes of specialist care were used: all visits, visits without OOP costs (bulk-billed services), and visits with OOP costs. Logistic and zero-inflated negative binomial regression models were used to examine the association between outcome variables and area-level socioeconomic status after controlling for age, sex, state of residence, and geographic remoteness. The concentration index was used to quantify the extent of inequality. Results Our results indicate that the distribution of specialist visits favoured the people living in wealthier areas of Australia. There was a pro-rich inequality in specialist visits associated with OOP costs. However, the distribution of the visits incurring zero OOP cost was slightly favourable to the people living in lower socioeconomic areas. The pro-poor distribution of visits with zero OOP cost was insufficient to offset the pro-rich distribution among the visits with OOP costs. Conclusions OOP costs for specialist care might partly undermine the equity principle of Medicare in Australia. This presents a challenge to the government on how best to influence the rate and distribution of specialists’ services.

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The Rise and Fall in Out-of-Pocket Costs in Australia: An Analysis of theStrengthening MedicareReforms

Cited by 14 publications

References 18 publications

Out-of-pocket healthcare expenditure in Australia: trends, inequalities and the impact on household living standards in a high-income country with a universal health care system

Out-of-pocket healthcare expenditure in Australia: trends, inequalities and the impact on household living standards in a high-income country with a universal health care system

Out-of-pocket health spending among Medicare beneficiaries: Which chronic diseases are most costly?

The link between out-of-pocket costs and inequality in specialist care in Australia

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