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Angeles MR, Crosland P, Hensher M. Challenges for Medicare and universal health care in Australia since 2000. Med J Aust 2023; 218:322-329. [PMID: 36739106 DOI: 10.5694/mja2.51844] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/14/2022] [Accepted: 12/05/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To identify the financing and policy challenges for Medicare and universal health care in Australia, as well as opportunities for whole-of-system strengthening. STUDY DESIGN Review of publications on Medicare, the Pharmaceutical Benefits Scheme, and the universal health care system in Australia published 1 January 2000 - 14 August 2021 that reported quantitative or qualitative research or data analyses, and of opinion articles, debates, commentaries, editorials, perspectives, and news reports on the Australian health care system published 1 January 2015 - 14 August 2021. Program-, intervention- or provider-specific articles, and publications regarding groups not fully covered by Medicare (eg, asylum seekers, prisoners) were excluded. DATA SOURCES MEDLINE Complete, the Health Policy Reference Centre, and Global Health databases (all via EBSCO); the Analysis & Policy Observatory, the Australian Indigenous HealthInfoNet, the Australian Public Affairs Information Service, Google, Google Scholar, and the Organisation for Economic Co-operation and Development (OECD) websites. RESULTS The problems covered by the 76 articles included in our review could be grouped under seven major themes: fragmentation of health care and lack of integrated health financing, access of Aboriginal and Torres Strait Islander people to health services and essential medications, reform proposals for the Pharmaceutical Benefits Scheme, the burden of out-of-pocket costs, inequity, public subsidies for private health insurance, and other challenges for the Australian universal health care system. CONCLUSIONS A number of challenges threaten the sustainability and equity of the universal health care system in Australia. As the piecemeal reforms of the past twenty years have been inadequate for meeting these challenges, more effective, coordinated approaches are needed to improve and secure the universality of public health care in Australia.
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Affiliation(s)
| | - Paul Crosland
- Brain and Mind Centre, the University of Sydney, Sydney, NSW
| | - Martin Hensher
- Menzies Institute for Medical Research, the University of Tasmania, Hobart, TAS
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2
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Rosenberg S, Park SH, Hickie I. Paying the price – out-of-pocket payments for mental health care in Australia. AUST HEALTH REV 2022; 46:660-666. [PMID: 36288722 DOI: 10.1071/ah22154] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/30/2022] [Indexed: 12/13/2022]
Abstract
Objective This study set out to present data on out-of-pocket payments for Medicare mental health services provided by general practitioners (GP), psychiatrists, clinical psychologists and other psychologists, to explore how much is spent on out-of-pocket payments for mental health; if any trends could be seen; and what variations exist across regions. Methods We performed secondary analysis of publicly available data on Medicare-subsidised GP, allied health and specialist health care across Australia. We merged and interrogated data covering the period 2013-19 and 2019-21 to create a data set covering eight full years of Medicare mental health services, arranged by profession and by region. Results Out-of-pocket payments for mental health care in Australia have been rising consistently over the period 2013-21, at a considerably faster rate than overall expenditure on mental health care. There is wide variation in out-of-pocket payments depending on where you live. Conclusions The impact of out-of-pocket payments on community access to mental health care is growing. This has implications, especially in poorer communities, for access to care. This should be an important consideration taken as the Australian Government considers next steps in national mental health reform, including the Better Access Program, currently under evaluation.
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Affiliation(s)
- Sebastian Rosenberg
- Brain and Mind Centre, University of Sydney, 94 Mallett Street, Camperdown, NSW 2050, Australia
| | - Shin Ho Park
- Brain and Mind Centre, University of Sydney, 94 Mallett Street, Camperdown, NSW 2050, Australia
| | - Ian Hickie
- Brain and Mind Centre, University of Sydney, 94 Mallett Street, Camperdown, NSW 2050, Australia
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McIntyre E, Oorschot T, Steel A, Leach MJ, Adams J, Harnett J. Conventional and complementary health care use and out-of-pocket expenses among Australians with a self-reported mental health diagnosis: a cross-sectional survey. BMC Health Serv Res 2021; 21:1266. [PMID: 34814916 PMCID: PMC8611990 DOI: 10.1186/s12913-021-07162-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 10/01/2021] [Indexed: 11/10/2022] Open
Abstract
Background Mental health disorders are a global health concern. In Australia, numerous national reports have found that the current mental healthcare system does not adequately meet the needs of Australians with mental illness. Consequently, a greater understanding of how people with a mental health disorder are using the broader healthcare system is needed. The aim of this paper is to explore conventional and complementary health care use and expenditure among Australian adults reporting a mental health disorder diagnosis. Methods A cross-sectional online survey of 2,019 Australian adults examined socio-demographic characteristics, complementary and conventional health care use and the health status of participants. Results 32 % (n = 641) of the total sample (N = 2019) reported a mental health disorder in the previous 3 years. Of these, 96 % reported consulting a general practitioner, 90.6 % reported using prescription medicines, 42.4 % consulted a complementary medicine practitioner, 56.9 % used a complementary medicine product and 23 % used a complementary medicine practice. The estimated 12-month out-of-pocket health care expenditure among Australians with a mental health disorder was AUD$ 4,568,267,421 (US$ 3,398,293,672) for conventional health care practitioners and medicines, and AUD$ 1,183,752,486 (US$ 880,729,891) for complementary medicine practitioners, products and practices. Older people (50–59 and 60 and over) were less likely to consult a CM practitioner (OR = 0.538, 95% CI [0.373, 0.775]; OR = 0.398, 95% CI [0.273, 0.581] respectively) or a psychologist/counsellor (OR = 0.394, 95% CI [0.243, 0.639]; OR = 0.267, 95% CI [0.160, 0.447] respectively). People either looking for work or not in the workforce were less likely to visit a CM practitioner (OR = 0.298, 95% CI [0.194, 0.458]; OR = 0.476, 95% CI [0.353, 0.642], respectively). Conclusions A substantial proportion of Australian adults living with a mental health disorder pay for both complementary and conventional health care directly out-of-pocket. This finding suggests improved coordination of healthcare services is needed for individuals living with a mental health disorder. Research examining the redesign of primary health care provision should also consider whether complementary medicine practitioners and/or integrative health care service delivery models could play a role in addressing risks associated with complementary medicine use and the unmet needs of people living with a mental health disorder.
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Affiliation(s)
- Erica McIntyre
- Australian Research Centre in Complementary and Integrative Medicine, School of Public Health, Faculty of Health, University of Technology Sydney, 2007, Ultimo, NSW, Australia. .,Institute for Sustainable Futures, University of Technology Sydney, PO Box 123, 2007, Ultimo, NSW, Australia.
| | - Tracey Oorschot
- Australian Research Centre in Complementary and Integrative Medicine, School of Public Health, Faculty of Health, University of Technology Sydney, 2007, Ultimo, NSW, Australia
| | - Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine, School of Public Health, Faculty of Health, University of Technology Sydney, 2007, Ultimo, NSW, Australia
| | - Matthew J Leach
- Australian Research Centre in Complementary and Integrative Medicine, School of Public Health, Faculty of Health, University of Technology Sydney, 2007, Ultimo, NSW, Australia.,National Centre for Naturopathic Medicine, Southern Cross University, NSW, 2480, Lismore, Australia
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine, School of Public Health, Faculty of Health, University of Technology Sydney, 2007, Ultimo, NSW, Australia
| | - Joanna Harnett
- Australian Research Centre in Complementary and Integrative Medicine, School of Public Health, Faculty of Health, University of Technology Sydney, 2007, Ultimo, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney School of Pharmacy, 2006, Sydney, NSW, Australia
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Callander EJ, Shand A, Nassar N. Inequality in out of pocket fees, government funding and utilisation of maternal health services in Australia. Health Policy 2021; 125:701-708. [PMID: 33931227 DOI: 10.1016/j.healthpol.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 01/17/2021] [Accepted: 04/13/2021] [Indexed: 10/21/2022]
Abstract
This study aimed to assess the distribution of service utilisation, out-of-pocket fees and government funding for maternal health care in Australia by socioeconomic group. A large linked administrative dataset was utilised. Women were grouped into socioeconomic quintiles using an area-based measure of socioeconomic status. Descriptive statistics were used to quantify the distribution of number of services, out of pocket fees, and government funding by socioeconomic quintile. Needs-adjusted concentration indices (CINA) were utilised to quantify inequity. The mean out of pocket fees for women of least socioeconomic advantage was $1,026 and for women of most socioeconomic advantage the mean was $2,432 (CINA 0.093, 95% CI: 0.088 - 0.098). However, use of many services were higher for women of most socioeconomic advantage: private obstetrician (CINA: 0.035, 95% CI: 0.032 - 0.038), other specialist services (CINA: 0.089, 95%CI: 0.083 - 0.094), and diagnostic and pathology tests (CINA: 0.027, 95%CI: 0.025 - 0.030). Federal government funding through Medicare was distributed towards women of most socioeconomic advantage (CINA: 0.036, 95%CI: 0.033 - 0.039); whereas government public hospital funding was skewed towards women of least socioeconomic advantage (CINA: -0.05, 95%CI: -0.057 - -0.046). Future policy changes in Australia's healthcare system need to ensure that women of least socioeconomic advantage have adequate access to maternity and early childhood care, and out of pocket fees are not an access barrier.
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Affiliation(s)
- Emily J Callander
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.
| | - Antonia Shand
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia; Royal Hospital for Women, New South Wales, Australia
| | - Natasha Nassar
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia; Menzies Centre for Health Policy, Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales Australia
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5
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Callander EJ, Topp S, Fox H, Corscadden L. Out-of-pocket expenditure on health care by Australian mothers: Lessons for maternal universal health coverage from a long-established system. Birth 2020; 47:49-56. [PMID: 31612550 DOI: 10.1111/birt.12457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/11/2019] [Accepted: 09/11/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Designing effective universal health care systems has challenges, including the use of patient co-payments and the role of the public and private systems. This study sought to quantify the total amount of out-of-pocket fees incurred by women who gave birth in private and public hospitals within Australia-a country with universal health coverage-and assess the impact that variation in birth type has on out-of-pocket fees. METHODS Data came from a linked administrative data set of all women who gave birth in the Australian state Queensland between July 1, 2012, and June 30, 2015, plus their resultant children. Propensity score matching was used to create two similar cohorts of women who gave birth in private and public hospitals. RESULTS The mean total out-of-pocket fees for care from conception to the child's first birthday was $2813 (±2683 standard deviation) and $623 (±1202) for women who gave birth in private and public hospitals, respectively. Total fees were higher in both public and private hospitals for women who had a cesarean birth ($716 [±1419] and $3010 [±2988]) than for women who had a vaginal birth without instruments ($556 [±1044] and $2560 [±2284]). DISCUSSION Australia's strong policy incentives for women to take out private health insurance are leaving women with large out-of-pocket costs. This should hold important lessons for other countries implementing a universal health care system, to ensure that using a combination of public and private practitioners does not undermine the intention of universal care.
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Affiliation(s)
| | - Stephanie Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Qld, Australia
| | - Haylee Fox
- School of Medicine, Griffith University, Southport, Qld, Australia
| | - Lisa Corscadden
- New South Wales Bureau of Health Information, Chatswood, NSW, Australia
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Callander E, Bates N, Lindsay D, Larkins S, Preston R, Topp SM, Cunningham J, Garvey G. The patient co-payment and opportunity costs of accessing healthcare for Indigenous Australians with cancer: A whole of population data linkage study. Asia Pac J Clin Oncol 2019; 15:309-315. [PMID: 31313475 DOI: 10.1111/ajco.13180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 05/27/2019] [Indexed: 11/26/2022]
Abstract
AIM To quantify the direct out-of-pocket patient co-payments and time opportunity costs (length of hospital stay) incurred by Indigenous and non-Indigenous persons diagnosed with cancer during the first year postdiagnosis. METHODS CancerCostMod was used, which is a model of cancer costs based upon a whole-of-population data linkage. The base population was a census of all persons diagnosed with cancer in Queensland, Australia between 1 July 2011 and 30 June 2012 (n = 25,553). Individual records were linked to corresponding Queensland Health Admitted Patient Data Collection, Emergency Data Information System, Medicare Benefits Schedule, and Pharmaceutical Benefits Scheme records between 1 July 2011 and 30 June 2015. Queensland data were weighted to be representative of the Australian population (approximately 123,900 Australians, 1.7% Indigenous Australians). RESULTS After adjusting for age, sex, rurality, area-based deprivation, and cancer group, Indigenous Australians accrued significantly less in postdiagnosis patient co-payments at 0-6 months (61% less) and 7-12 months (63% less). Indigenous Australians also had significantly fewer postdiagnosis hospitalizations at 0-6 months (21% fewer) and 7-12 months (27% fewer). CONCLUSION There is growing concern regarding the financial burden of cancer to the patient. The time spent away from family and their community may also have an important time opportunity cost, which may affect a person's decision to undertake or continue treatment. This is the first study in Australia to identify the financial cost of co-payments for Indigenous people with cancer, as well as the number and length of hospitalizations as drivers of time opportunity costs.
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Affiliation(s)
- Emily Callander
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Nicole Bates
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Daniel Lindsay
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Robyn Preston
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Joan Cunningham
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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Ward B, Lane R, McDonald J, Powell-Davies G, Fuller J, Dennis S, Kearns R, Russell G. Context matters for primary health care access: a multi-method comparative study of contextual influences on health service access arrangements across models of primary health care. Int J Equity Health 2018; 17:78. [PMID: 29903017 PMCID: PMC6003144 DOI: 10.1186/s12939-018-0788-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 05/29/2018] [Indexed: 01/01/2023] Open
Abstract
Background Equitable access to primary health care (PHC) is an important component of integrated chronic disease management. Whilst context is known to influence access to PHC, it is poorly researched. The aim of this study was to determine the contextual influences associated with access arrangements in four Australian models of integrated PHC. Methods A multi-method comparative case study design. Purposive sampling identified four models of PHC across six sites in two Australian states. Complexity theory informed the choice of contextual factors that influenced access arrangements, which were analysed across five dimensions: availability and accommodation, affordability, acceptability, appropriateness and approachability. Semi-structured interviews, document/website analysis and non-participant observation were used to collect data from clinicians, administrative staff and other key stakeholders. Within and cross-case thematic analysis identified interactions between context and access across sites. Results Overall, financial viability, objectives of the PHC model and relationships with the local hospital network (LHN) underpinned access arrangements. Local supply of general practitioners and financial viability were strong influences on availability of after-hours services. Influences on affordability were difficult to determine because all models had nil/low out-of-pocket costs for general practitioner services. The biggest influence on acceptability was the goal/objectives of the PHC model. Appropriateness and to a lesser degree affordability arrangements were influenced by the relationship with the LHN. The provision of regular outreach services was strongly influenced by perceived population need, referral networks and model objectives. Conclusions These findings provide valuable insights for policy makers charged with improving access arrangements in PHC services. A financially sustainable service underpins attempts to improve access that meets the needs of the service population. Smaller services may lack infrastructure and capacity, suggesting there may be a minimum size for enhancing access. Access arrangements may be facilitated by aligning the objectives between PHC, LHN and other stakeholder models. While some access arrangements are relatively easy to modify, improving resource intensive (e.g. acceptability) access arrangements for vulnerable and/or chronic disease populations will require federal and state policy levers with input from primary health networks and LHNs.
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Affiliation(s)
- Bernadette Ward
- School of Rural Health, Monash University, PO Box 666, Bendigo, VIC, Australia.
| | - Riki Lane
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Clayton, Australia
| | - Julie McDonald
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Gawaine Powell-Davies
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Jeff Fuller
- College of Nursing & Health Sciences, Flinders University, South, Bedford Park, South Australia
| | - Sarah Dennis
- Faculty of Health Sciences, The University of Sydney, Lidcombe, Australia.,South Western Sydney Local Health District, Ingham Institute of Applied Medical Research, Liverpool, Australia
| | - Rachael Kearns
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Grant Russell
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Clayton, Australia
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O'Loughlin M, Harriss L, Thompson F, McDermott R, Mills J. Exploring factors that influence adult presentation to an emergency department in regional Queensland: A linked, cross-sectional, patient perspective study. Emerg Med Australas 2018; 31:67-75. [DOI: 10.1111/1742-6723.13094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 03/28/2018] [Accepted: 04/04/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Mary O'Loughlin
- Australian Institute of Tropical Health and Medicine, Centre for Chronic Disease Prevention, College of Public Health, Medical and Veterinary Sciences; James Cook University; Cairns Queensland Australia
| | - Linton Harriss
- Australian Institute of Tropical Health and Medicine, Centre for Chronic Disease Prevention, College of Public Health, Medical and Veterinary Sciences; James Cook University; Cairns Queensland Australia
| | - Fintan Thompson
- Australian Institute of Tropical Health and Medicine, Centre for Chronic Disease Prevention, College of Public Health, Medical and Veterinary Sciences; James Cook University; Cairns Queensland Australia
| | - Robyn McDermott
- Australian Institute of Tropical Health and Medicine, Centre for Chronic Disease Prevention, College of Public Health, Medical and Veterinary Sciences; James Cook University; Cairns Queensland Australia
- School of Health Sciences; University of South Australia; Adelaide South Australia Australia
| | - Jane Mills
- College of Health; Massey University; Wellington New Zealand
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Callander E, Fox H. Changes in out-of-pocket charges associated with obstetric care provided under Medicare in Australia. Aust N Z J Obstet Gynaecol 2018; 58:362-365. [DOI: 10.1111/ajo.12760] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 11/21/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Emily Callander
- Australian Institute of Tropical Health and Medicine; James Cook University; Townsville Queensland Australia
| | - Haylee Fox
- Australian Institute of Tropical Health and Medicine; James Cook University; Townsville Queensland Australia
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