Economic impact of informal caring for a person with arthritis in Australia from 2015 to 2030: a microsimulation approach using national survey data

OBJECTIVES

To estimate the economic burden of informal caregivers not in the labour force (NILF) due to caring for a person with arthritis in Australia, with projections of these costs from 2015 to 2030.

DESIGN

Static microsimulation modelling using national survey data.

SETTING

Australia nationwide survey.

PARTICIPANTS

Participants include respondents to the Survey of Disability, Ageing and Carers who are informal carers of a person who has arthritis as their main chronic condition and non-carers.

OUTCOME MEASURES

Estimating the economic impact and national aggregated costs of informal carers NILF to care for a person with arthritis and projecting these costs from 2015 to 2030 in 5-year intervals.

RESULTS

On a per-person basis, when adjusted for age, sex and highest education attained, the difference in average weekly total income between informal carers and non-carers employed in the labour force is $A1051 (95% CI: $A927 to $A1204) in 2015 and projected to increase by up to 22% by 2030. When aggregated, the total national annual loss of income to informal carers NILF is estimated at $A388.2 million (95% CI: $A324.3 to $A461.9 million) in 2015, increasing to $A576.9 million (95% CI: $A489.2 to $A681.8 million) by 2030. The national annual tax revenue lost to the government of the informal carers NILF is estimated at $A99 million (95% CI: $A77.9 to $A126.4 million) in 2015 and is projected to increase 49% by 2030.

CONCLUSION

Informal carers NILF are economically worse off than employed non-carers, and the aggregated national annual costs are substantial. The future economic impact of informal carers NILF to care for a person with arthritis in Australia is projected to increase, with the estimated differences in income between informal carers and employed non-carers increasing by 22% from 2015 to 2030.

Effectiveness of a New Service Delivery Model for Management of Knee Osteoarthritis in Primary Care: A Cluster Randomized Controlled Trial

OBJECTIVE

To evaluate the effectiveness and health costs of a new primary care service delivery model (the Optimising Primary Care Management of Knee Osteoarthritis [PARTNER] model) to improve health outcomes for patients with knee osteoarthritis (OA) compared to usual care.

METHODS

This study was a 2-arm, cluster, superiority, randomized controlled trial with randomization at the general practice level, undertaken in Victoria and New South Wales, Australia. We aimed to recruit 44 practices and 572 patients age ≥45 years with knee pain for >3 months. Professional development opportunities on best practice OA care were provided to intervention group general practitioners (GPs). All recruited patients had an initial GP visit to confirm knee OA diagnosis. Control patients continued usual GP care, and intervention patients were referred to a centralized care support team (CST) for 12-months. Via telehealth, the CST provided OA education and an agreed OA action plan focused on muscle strengthening, physical activity, and weight management. Primary outcomes were patient self-reported change in knee pain (Numerical Rating Scale [range 0-10; higher score = worse]) and physical function (Knee Injury and Osteoarthritis Outcome Score activities of daily living subscale [range 0-100; higher score = better] at 12 months. Health care cost outcomes included costs of medical visits and prescription medications over the 12-month period.

RESULTS

Recruitment targets were not reached. A total of 38 practices and 217 patients were recruited. The intervention improved pain by 0.8 of 10 points (95% confidence interval [95% CI] 0.2, 1.4) and function by 6.5 of 100 points (95% CI 2.3, 10.7), more than usual care at 12 months. Total costs of medical visits and prescriptions were $3,940 (Australian) for the intervention group versus $4,161 for usual care. This difference was not statistically significant.

CONCLUSION

The PARTNER model improved knee pain and function more than usual GP care. The magnitude of improvement is unlikely to be clinically meaningful for pain but is uncertain for function.

Health, social and economic implications of adolescent risk behaviours/states: protocol for Raine Study Gen2 cohort data linkage study

BACKGROUND

Risk-taking behaviours are a major contributor to youth morbidity and mortality. Vulnerability to these negative outcomes is constructed from individual behaviour including risk-taking, and from social context, ecological determinants, early life experience, developmental capacity and mental health, contributing to a state of higher risk. However, although risk-taking is part of normal adolescent development, there is no systematic way to distinguish young people with a high probability of serious adverse outcomes, hindering the capacity to screen and intervene. This study aims to explore the association between risk behaviours/states in adolescence and negative health, social and economic outcomes through young adulthood.

METHODS

The Raine Study is a prospective cohort study which recruited pregnant women in 1989-91, in Perth, Western Australia. The offspring cohort (N = 2,868) was followed up at regular intervals from 1 to 27 years of age. These data will be linked to State government health and welfare administrative data. We will empirically examine relationships across multiple domains of risk (for example, substance use, sexual behaviour, driving) with health and social outcomes (for instance, road-crash injury, educational underachievement). Microsimulation models will measure the impact of risk-taking on educational attainment and labour force outcomes.

DISCUSSION

Comprehensive preventive child health programmes and policy prioritise a healthy start to life. This is the first linkage study focusing on adolescence to adopt a multi-domain approach, and to integrate health economic modelling. This approach captures a more complete picture of health and social impacts of risk behaviour/​states in adolescence and young adulthood.

An Analysis of Hospital Costs for Childhood Cancer Care

BACKGROUND

This study used a linked dataset consisting of all childhood cancers recorded over the course of 10 years in New South Wales (NSW), Australia, to evaluate the hospital and emergency department costs (from a payer perspective) and resources used by patients with childhood cancer. We also analyzed determinants responsible for high-frequency hospital admissions, hospital length of stay (LoS), and hospital costs.

METHODS

We analyzed linked data at the individual patient level for a retrospective cohort of 2,966 patients with cancer aged <18 years with a diagnosis date between 2001 and 2012 from the NSW Central Cancer Registry, Australia. We reported costs and use of hospitalization and emergency department presentation 1 year before the date of diagnosis, 1 year after diagnosis, and 2 to 5 years after diagnosis. We also examined the association between cancer types and hospital admission and hospital costs from the payer perspective. Patient characteristics associated with the frequency of hospital admissions, hospital LoS, and hospital costs were also determined using a generalized linear model.

RESULTS

Most hospital admission costs occurred in the first year after diagnosis, accounting for >70% of hospital costs within 5 years after diagnosis. The estimated median annual cost of hospitalization in the first year after diagnosis was A$88,964 (interquartile range [IQR], A$34,399-A$163,968) for patients diagnosed at age 0 to 14 years and A$23,384 (IQR, A$5,585-A$91,565) for those diagnosed at age 15 to 17 years. Higher frequency of hospital admissions, hospital LoS, and hospital costs were significantly associated with younger age at cancer diagnosis, cancer metastases, and living in remote/disadvantaged socioeconomic areas.

CONCLUSIONS

Our study represents one of the first in Australia to include detailed hospitalization cost information for all childhood cancer cases. This study highlights the high hospital use by pediatric patients and the importance of early diagnosis. Our findings also demonstrate the health inequities experienced by patients from remote areas and the lowest socioeconomic areas.

Protocol for the process and feasibility evaluations of a new model of primary care service delivery for managing pain and function in patients with knee osteoarthritis (PARTNER) using a mixed methods approach

INTRODUCTION

This protocol outlines the rationale, design and methods for the process and feasibility evaluations of the primary care management on knee pain and function in patients with knee osteoarthritis (PARTNER) study. PARTNER is a randomised controlled trial to evaluate a new model of service delivery (the PARTNER model) against 'usual care'. PARTNER is designed to encourage greater uptake of key evidence-based non-surgical treatments for knee osteoarthritis (OA) in primary care. The intervention supports general practitioners (GPs) to gain an understanding of the best management options available through online professional development. Their patients receive telephone advice and support for OA management by a centralised, multidisciplinary 'Care Support Team'. We will conduct concurrent process and feasibility evaluations to understand the implementation of this new complex health intervention, identify issues for consideration when interpreting the effectiveness outcomes and develop recommendations for future implementation, cost effectiveness and scalability.

METHODS AND ANALYSIS

The UK Medical Research Council Framework for undertaking a process evaluation of complex interventions and the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) frameworks inform the design of these evaluations. We use a mixed-methods approach including analysis of survey data, administrative records, consultation records and semistructured interviews with GPs and their enrolled patients. The analysis will examine fidelity and dose of the intervention, observations of trial setup and implementation and the quality of the care provided. We will also examine details of 'usual care'. The semistructured interviews will be analysed using thematic and content analysis to draw out themes around implementation and acceptability of the model.

ETHICS AND DISSEMINATION

The primary and substudy protocols have been approved by the Human Research Ethics Committee of The University of Sydney (2016/959 and 2019/503). Our findings will be disseminated to national and international partners and stakeholders, who will also assist with wider dissemination of our results across all levels of healthcare. Specific findings will be disseminated via peer-reviewed journals and conferences, and via training for healthcare professionals delivering OA management programmes. This evaluation is crucial to explaining the PARTNER study results, and will be used to determine the feasibility of rolling-out the intervention in an Australian healthcare context.

TRIAL REGISTRATION NUMBER

ACTRN12617001595303; Pre-results.

The productivity gains associated with a junk food tax and their impact on cost-effectiveness

Objective

To estimate the productivity impacts of a policy intervention on the prevention of premature mortality due to obesity.

Methods

A simulation model of the Australian population over the period from 2003 to 2030 was developed to estimate productivity gains associated with premature deaths averted due to an obesity prevention intervention that applied a 10% tax on unhealthy foods. Outcome measures were the total working years gained, and the present value of lifetime income (PVLI) gained. Impacts were modelled over the period from 2003 to 2030. Costs are reported in 2018 Australian dollars and a 3% discount rate was applied to all future benefits.

Results

Premature deaths averted due to a junk food tax accounted for over 8,000 additional working years and a $307 million increase in PVLI. Deaths averted in men between the ages of 40 to 59, and deaths averted from ischaemic heart disease, were responsible for the largest gains.

Conclusions

The productivity gains associated with a junk food tax are substantial, accounting for almost twice the value of the estimated savings to the health care system. The results we have presented provide evidence that the adoption of a societal perspective, when compared to a health sector perspective, provides a more comprehensive estimate of the cost-effectiveness of a junk food tax.

Correction to: Effectiveness of a new model of primary care management on knee pain and function in patients with knee osteoarthritis: Protocol for THE PARTNER STUDY

After the publication of this protocol [1], our collaborator Prima Health solutions advised us of their intent to withdraw from the study.

Effectiveness of a new model of primary care management on knee pain and function in patients with knee osteoarthritis: Protocol for THE PARTNER STUDY

BACKGROUND

To increase the uptake of key clinical recommendations for non-surgical management of knee osteoarthritis (OA) and improve patient outcomes, we developed a new model of service delivery (PARTNER model) and an intervention to implement the model in the Australian primary care setting. We will evaluate the effectiveness and cost-effectiveness of this model compared to usual general practice care.

METHODS

We will conduct a mixed-methods study, including a two-arm, cluster randomised controlled trial, with quantitative, qualitative and economic evaluations. We will recruit 44 general practices and 572 patients with knee OA in urban and regional practices in Victoria and New South Wales. The interventions will target both general practitioners (GPs) and their patients at the practice level. Practices will be randomised at a 1:1 ratio. Patients will be recruited if they are aged ≥45 years and have experienced knee pain ≥4/10 on a numerical rating scale for more than three months. Outcomes are self-reported, patient-level validated measures with the primary outcomes being change in pain and function at 12 months. Secondary outcomes will be assessed at 6 and 12 months. The implementation intervention will support and provide education to intervention group GPs to deliver effective management for patients with knee OA using tailored online training and electronic medical record support. Participants with knee OA will have an initial GP visit to confirm their diagnosis and receive management according to GP intervention or control group allocation. As part of the intervention group GP management, participants with knee OA will be referred to a centralised multidisciplinary service: the PARTNER Care Support Team (CST). The CST will be trained in behaviour change support and evidence-based knee OA management. They will work with patients to develop a collaborative action plan focussed on key self-management behaviours, and communicate with the patients' GPs. Patients receiving care by intervention group GPs will receive tailored OA educational materials, a leg muscle strengthening program, and access to a weight-loss program as appropriate and agreed. GPs in the control group will receive no additional training and their patients will receive usual care.

DISCUSSION

This project aims to address a major evidence-to-practice gap in primary care management of OA by evaluating a new service delivery model implemented with an intervention targeting GP practice behaviours to improve the health of people with knee OA.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry: ACTRN12617001595303 , date of registration 1/12/2017.

Psychological distress increases the risk of falling into poverty amongst older Australians: the overlooked costs-of-illness

Background

This paper aimed to identify whether high psychological distress is associated with an increased risk of income and multidimensional poverty amongst older adults in Australia.

Methods

We undertook longitudinal analysis of the nationally representative Household Income and Labour Dynamics in Australian (HILDA) survey using modified Poisson regression models to estimate the relative risk of falling into income poverty and multidimensional poverty between 2010 and 2012 for males and females, adjusting for age, employment status, place of residence, marital status and housing tenure; and Population Attributable Risk methodology to estimate the proportion of poverty directly attributable to psychological distress, measured by the Kessler 10 scale.

Results

For males, having high psychological distress increased the risk of falling into income poverty by 1.68 (95% CI: 1.02 to 2.75) and the risk of falling into multidimensional poverty by 3.40 (95% CI: 1.91 to 6.04). For females, there was no significant difference in the risk of falling into income poverty between those with high and low psychological distress (p = 0.1008), however having high psychological distress increased the risk of falling into multidimensional poverty by 2.15 (95% CI: 1.30 to 3.55). Between 2009 and 2012, 8.0% of income poverty cases for people aged 65 and over (95% CI: 7.8% to 8.4%), and 19.5% of multidimensional poverty cases for people aged 65 and over (95% CI: 19.2% to 19.9%) can be attributed to high psychological distress.

Conclusions

The elevated risk of falling into income and multidimensional poverty has been an overlooked cost of poor mental health.

Prioritising the application of genomic medicine

The clinical translation of genomic sequencing is hampered by the limited information available to guide investment into those areas where genomics is well placed to deliver improved health and economic outcomes. To date, genomic medicine has achieved its greatest successes through applications to diseases that have a high genotype–phenotype correlation and high penetrance, with a near certainty that the individual will develop the condition in the presence of the genotype. It has been anticipated that genomics will play an important role in promoting population health by targeting at-risk individuals and reducing the incidence of highly prevalent, costly, complex diseases, with potential applications across screening, prevention, and treatment decisions. However, where primary or secondary prevention requires behavioural changes, there is currently very little evidence to support reduction in disease incidence. A better understanding of the relationship between genomic variation and complex diseases will be necessary before effective genomic risk identification and management of the risk of complex diseases in healthy individuals can be carried out in clinical practice. Our recommended approach is that priority for genomic testing should focus on diseases where there is strong genotype–phenotype correlation, high or certain penetrance, the effects of the disease are serious and near-term, there is the potential for prevention and/or treatment, and the net costs incurred are acceptable for the health gains achieved.

The Productivity Costs of Premature Mortality Due to Cancer in Australia: Evidence from a Microsimulation Model

Aim

To estimate the productivity costs of premature mortality due to cancer in Australia, in aggregate and for the 26 most prevalent cancer sites.

Methods

A human capital approach was adopted to estimate the long term impacts of Australian cancer deaths in 2003. Using population mortality data, the labour force participation and the present value of lifetime income (PVLI) forgone due to premature mortality was estimated based on individual characteristics at the time of death including age, sex and socioeconomic status. Outcomes were modelled to the year 2030 using economic data from a national microsimulation model. A discount rate of 3% was applied and costs were reported in 2016 Australian dollars.

Results

Premature deaths from cancer in 2003 resulted in 88,000 working years lost and a cost of $4.2 billion in the PVLI forgone. Costs were close to three times higher in males than females due to the higher number of premature deaths in men, combined with higher levels of workforce participation and income. Lung, colorectal and brain cancers accounted for the highest proportion of costs, while testicular cancer was the most costly cancer site per death.

Conclusions

The productivity costs of premature mortality due to cancer are significant. These results provide an economic measure of the cancer burden which may assist decision makers in allocating scare resources amongst competing priorities.

Type 2 diabetes mellitus and the risk of falling into poverty: an observational study

BACKGROUND

Diabetes is known to be associated with low income; however, no longitudinal studies have documented whether developing type 2 diabetes mellitus (T2DM) is a risk factor for later falling into poverty. This paper aims to determine whether Australians who are diagnosed with type 2 diabetes have an elevated risk of falling into income poverty or multidimensional poverty.

METHODS

Data from a nationally representative, longitudinal survey conducted annually since 2001 are utilized. It identifies adults aged 21 years and over who were diagnosed with type 2 diabetes between 2007 and 2009 and compares their risk of falling into income poverty and multidimensional poverty between 2007 and 2012 relative to those who had never been diagnosed with type 2 diabetes using survival analysis with Cox regression models.

RESULTS

After adjusting for confounding factors, for men who were diagnosed with T2DM, the hazard ratio for falling into income poverty was 1.89 (95% CI: 1.03-3.44) and 2.52 (95% CI: 1.24-5.12) for falling into multidimensional poverty, relative men who had never been diagnosed with T2DM. There was no significant difference in the hazard ratio for falling into income poverty (p = 0.6554) or multidimensional poverty (p = 0.9382) for women who were diagnosed with T2DM compared with women who had never been diagnosed with T2DM.

CONCLUSION

Being diagnosed with type 2 diabetes increases the risk of men falling into poverty. The risk is higher for multidimensional poverty than income poverty. Copyright © 2015 John Wiley & Sons, Ltd.

The risk of falling into poverty after developing heart disease: a survival analysis

Background

Those with a low income are known to have a higher risk of developing heart disease. However, the inverse relationship – falling into income poverty after developing heart disease has not been explored with longitudinal data. This paper aims to determine if those with heart disease have an elevated risk of falling into poverty.

Methods

Survival analysis was conducted using the longitudinal Household Income and Labour Dynamics in Australia survey, between the years 2007 and 2012. The study focused on the Australian population aged 21 years and over in 2007 who were not already in poverty and did not already have heart disease, who were followed from 2007 to 2012. Cox regression models adjusting for age, sex and time-varying co-variates (marital status, home ownership and remoteness of area of residence) were constructed to assess the risk of falling into poverty.

Results

For those aged 20 who developed heart disease, the hazard ratio for falling into income poverty was 9.24 (95 % CI: 8.97–9.51) and for falling into multidimensional poverty the hazard ratio was 14.21 (95 % CI: 13.76–14.68); for those aged 40 the hazard ratio for falling into income poverty was 3.45 (95 % CI: 3.39–3.51) and for multidimensional poverty, 5.20 (95 % CI: 5.11–5.29); and for those aged 60 the hazard ratio for falling into income poverty was 1.29 (95 % CI: 1.28–1.30) and for multidimensional poverty, 1.52 (95 % CI: 1.51–1.54), relative those who never developed heart disease. The risk for both income and multidimensional poverty decreases with age up to the age of 70, over which, those who developed heart disease had a reduced risk of poverty.

Conclusion

For those under the age of 70, developing heart disease is associated with an increased risk of falling into both income poverty and multidimensional poverty.

Arthritis and the Risk of Falling Into Poverty: A Survival Analysis Using Australian Data

OBJECTIVE

Low income is known to be associated with having arthritis. However, no longitudinal studies have documented the relationship between developing arthritis and falling into poverty. The purpose of this study was to evaluate Australians who developed arthritis to determine if they had an elevated risk of falling into poverty.

METHODS

Survival analysis using Cox regression models was applied to nationally representative, longitudinal survey data obtained between January 1, 2007 and December 31, 2012 from Australian adults who were ages 21 years and older in 2007.

RESULTS

The hazard ratio for falling into income poverty was 1.08 (95% confidence interval [95% CI] 1.06-1.09) in women who were diagnosed as having arthritis and 1.15 (95% CI 1.13-1.16) in men who were diagnosed as having arthritis, as compared to those who were never diagnosed as having arthritis. The hazard ratio for falling into multidimensional poverty was 1.15 (95% CI 1.14-1.17) in women who were diagnosed as having arthritis and 1.88 (95% CI 1.85-1.91) in men who were diagnosed as having arthritis.

CONCLUSION

Developing arthritis increases the risk of falling into income poverty and multidimensional poverty. The risk of multidimensional poverty is greater than the risk of income poverty. Given the high prevalence of arthritis, the condition is likely an overlooked driver of poverty.

Pathways into chronic multidimensional poverty amongst older people: a longitudinal study

Background

The use of multidimensional poverty measures is becoming more common for measuring the living standards of older people. However, the pathways into poverty are relatively unknown, nor is it known how this affects the length of time people are in poverty for.

Methods

Using Waves 1 to 12 of the nationally representative Household, Income and Labour Dynamics in Australia (HILDA) survey, longitudinal analysis was undertaken to identify the order that key forms of disadvantage develop – poor health, low income and insufficient education attainment – amongst Australians aged 65 years and over in multidimensional poverty, and the relationship this has with chronic poverty. Path analysis and linear regression models were used.

Results

For all older people with at least a Year 10 level of education attainment earlier mental health was significantly related to later household income (p = 0.001) and wealth (p = 0.017). For all older people with at less than a Year 10 level of education attainment earlier household income was significantly related to later mental health (p = 0.021).

When limited to those in multidimensional poverty who were in income poverty and also had poor health, older people generally fell into income poverty first and then developed poor health.

The order in which income poverty and poor health were developed had a significant influence on the length of time older people with less than a Year 10 level of education attainment were in multidimensional poverty for. Those who developed poor health first then fell into income poverty spend significantly less time in multidimensional poverty (−4.90, p < .0001) than those who fell into income poverty then developed poor health.

Conclusion

Knowing the order that different forms of disadvantage develop, and the influence this has on poverty entrenchment, is of use to policy makers wishing to provide interventions to prevent older people being in long-term multidimensional poverty.

The impact of poverty on self-efficacy: an Australian longitudinal study

BACKGROUND

People with strong feelings of 'self-efficacy', i.e. how much a person feels they have control over their life, perform better in the workplace. However, little is known about negative influences on feelings of self-efficacy. In view of the increasing number of people whose income places them below the poverty line despite being in employment, poverty may negatively influence feelings of self-efficacy and hence workplace productivity.

AIMS

To assess whether falling into poverty lowers self-efficacy.

METHODS

Longitudinal analysis of waves 7 to 11 of the nationally representative Household, Income and Labour Dynamics in Australia (HILDA) survey, using linear regression models.

RESULTS

Those who fell into multidimensional poverty (income poverty plus poor health or insufficient level of education attainment) had significantly lower self-efficacy scores (up to 18% lower (95% CI -31% to -1%, P < 0.05)) than those never in poverty, after accounting for initial self-efficacy score and other confounding factors. Income uniquely accounted for 3% of the variance in self-efficacy scores, physical health for 10%, mental health for 78% and education for 1%.

CONCLUSIONS

Given the known links between self-efficacy and workplace productivity, workers who are below the poverty line may be at risk of poor productivity due to the experience of poverty. In addition to the poor outcomes from the employer's perceptive, this may also lead to a negative spiral for the employee.

Impact of multidimensional poverty on the self-efficacy of older people: Results from an Australian longitudinal study

AIMS

Self-efficacy has numerous benefits for active and healthy aging, including giving the people the ability to make positive changes to their living standards and lifestyles. The present study aims to determine whether falling into multidimensional poverty lowers self-efficacy.

METHODS

Longitudinal analysis of waves 7-11 (2007-2011) of the nationally representative Household, Income and Labor Dynamics in Australia survey using linear regression models. The analysis focused on the Australian population aged 65 years and older. The Freedom Poverty Measure was used to identify those in multidimensional poverty.

RESULTS

Those who fell into multidimensional poverty for 3 or 4 years between 2007 and 2011 had their self-efficacy scores decline by an average of 27 points (SD 21.2). Those who fell into poverty had significantly lower self-efficacy scores in 2011 - up to 57% lower (-66.6%, -45.7% P < 0.0001) after being in multidimensional poverty for 3 or 4 years between 2007 and 2011 than those who were never in poverty.

CONCLUSIONS

Falling into multidimensional poverty lowers the self-efficacy scores of older people. In order to improve the chances of older people making long-term changes to improve their living standards, feelings of self-efficacy should first be assessed and improved. Geriatr Gerontol Int 2017; 17: 308-314.

Multidimensional Poverty and Health Status as a Predictor of Chronic Income Poverty

Longitudinal analysis of Wave 5 to 10 of the nationally representative Household, Income and Labour Dynamics in Australia dataset was undertaken to assess whether multidimensional poverty status can predict chronic income poverty. Of those who were multidimensionally poor (low income plus poor health or poor health and insufficient education attainment) in 2007, and those who were in income poverty only (no other forms of disadvantage) in 2007, a greater proportion of those in multidimensional poverty continued to be in income poverty for the subsequent 5 years through to 2012. People who were multidimensionally poor in 2007 had 2.17 times the odds of being in income poverty each year through to 2012 than those who were in income poverty only in 2005 (95% CI: 1.23-3.83). Multidimensional poverty measures are a useful tool for policymakers to identify target populations for policies aiming to improve equity and reduce chronic disadvantage.

The Potential for Poverty to Lower the Self-Efficacy of Adults With Asthma: An Australian Longitudinal Study

PURPOSE

It is known that strong feelings of self-efficacy are linked with better management of asthma. However, it is not known whether the experience of poverty can detrimentally impact the self-efficacy feelings of asthma patients. This paper aims to determine whether falling into income or multidimensional poverty lowers self-efficacy among people diagnosed with asthma.

METHODS

Longitudinal analysis of Waves 7 to 11 (2007 to 2011) of the nationally representative Household, Income and Labour Dynamics in Australia (HILDA) survey using generalized linear models. The analysis was limited to those who had been diagnosed with asthma. The Freedom Poverty Measure was used to identify those in multidimensional poverty.

RESULTS

People with asthma who fell into income poverty had significantly lower self-efficacy scores-23% lower (95% CI: -35.1 to -9.1), after falling into income poverty for 3 or 4 years between 2007 and 2011 compared to those who were never in income poverty. Those who fell into multidimensional poverty also had significantly lower self-efficacy scores-25% lower (95% CI: -42.8 to -2.0), after being in multidimensional poverty for 3 or 4 years between 2007 and 2011 compared to those who were never in poverty.

CONCLUSIONS

Asthmatics who fall into poverty are likely to experience a decline in their feelings of self-efficacy. The findings of this study show that experiencing poverty should be a flag to identify those who may need extra assistance in managing their condition.

Depression prevention, labour force participation and income of older working aged Australians: A microsimulation economic analysis

OBJECTIVE

Depression has economic consequences not only for the health system, but also for individuals and society. This study aims to quantify the potential economic impact of five-yearly screening for sub-syndromal depression in general practice among Australians aged 45-64 years, followed by a group-based psychological intervention to prevent progression to depression.

METHOD

We used an epidemiological simulation model to estimate reductions in prevalence of depression, and a microsimulation model, Health&WealthMOD2030, to estimate the impact on labour force participation, personal income, savings, taxation revenue and welfare expenditure.

RESULTS

Group therapy is estimated to prevent around 5,200 prevalent cases of depression (2.2%) and add about 520 people to the labour force. Private incomes are projected to increase by $19 million per year, tax revenues by $2.4 million, and transfer payments are reduced by $2.6 million.

CONCLUSION

Group-based psychological intervention to prevent depression could result in considerable economic benefits in addition to its clinical effects.

Effect of asthma on falling into poverty: the overlooked costs of illness

BACKGROUND

Studies on the indirect costs of asthma have taken a narrow view of how the condition affects the living standards of patients by examining only the association with employment and income.

OBJECTIVE

To build on the current cost-of-illness literature and identify whether having asthma is associated with an increased risk of poverty, thus giving a more complete picture of the costs of asthma to individuals and society.

METHODS

Longitudinal analysis of the nationally representative Household Income and Labour Dynamics in Australian survey to estimate the relative risk of income poverty, multidimensional poverty, and long-term multidimensional poverty between 2007 and 2012 and population attributable risk method to estimate the proportion of poverty between 2007 and 2012 directly attributable to asthma.

RESULTS

No significant difference was found in the risk of falling into income poverty between those with and without asthma (P = .07). Having asthma increased the risk of falling into multidimensional poverty by 1.35 (95% confidence interval [CI], 1.01-1.83) and the risk of falling into chronic multidimensional poverty by 2.22 (95% CI, 1.20-4.10). Between 2007 and 2012, a total of 5.2% of income poverty cases (95% CI, 5.1%-5.4%), 7.8% of multidimensional poverty cases (95% CI, 7.7%-8.0%), and 19.6% of chronic multidimensional poverty cases (95% CI, 19.2%-20.0%) can be attributed to asthma.

CONCLUSION

Asthma is associated with an increased risk of falling into poverty. This should be taken into consideration when considering the suitability of different treatment options for patients with asthma.

Back problems, comorbidities, and their association with wealth

BACKGROUND CONTEXT

Studies assessing the economic burden of back problems have given little consideration to the presence of comorbidities.

PURPOSE

To assess the difference in the value of wealth held by Australians who have back problems and varying numbers of chronic comorbidities.

STUDY DESIGN

A cross-sectional study.

PATIENT SAMPLE

Individuals aged 45 to 64 years in 2009: 4,388 with no chronic health conditions, 1,405 with back problems, and 3,018 with other health conditions.

OUTCOME MEASURE

Total wealth (cash, shares, superannuation, investment property, and owner occupied home).

METHODS

Using a microsimulation model (Health&WealthMOD), logistic regression models were used to assess the odds of having any wealth. Linear regression models were used to assess the difference in the value of this wealth.

RESULTS

Those with back problems and two comorbidities had 0.16 (95% confidence interval [CI]: 0.06-0.42) times the odds and those with back problems and three or more comorbidities had 0.20 (95% CI: 0.11-0.38) times the odds of having accumulated some wealth than those with no chronic health conditions. Those with back problems and three or more comorbidities had a median value of total wealth of around $150,000, whereas those with back problems only and back problems and one comorbidity had a median value of total wealth of around $250,500. There was no significant difference in the amount of wealth accumulated by those with back problems and at least one comorbidity and those with other health conditions and the same number of comorbidities. However, those with only one health condition (excluding back problems) had 65% more wealth than those with back problems only (95% CI: 5.1-161.2).

CONCLUSIONS

This study highlights the importance of considering multiple morbidities when discussing the relationship between back problems and economic circumstances.

Multiple chronic health conditions and their link with wealth assets

BACKGROUND

There has been little research on the economic status of those with multiple health conditions, particularly on the relationship between multiple health conditions and wealth. This paper will assess the difference in the value and type of wealth assets held by Australians who have multiple chronic health conditions.

METHODS

Using Health&WealthMOD, a microsimulation model of the 45-64-year-old Australian population in 2009, a counterfactual analysis was undertaken. The actual proportion of people with different numbers of chronic health conditions with any wealth, and the value of this wealth was estimated. This was compared with the counterfactual values had the individuals had no chronic health conditions.

RESULTS

There was no change in the proportion of people with one health condition who actually had any wealth, compared to the counterfactual proportion had they had no chronic health conditions. Ninety-four percent of those with four or more health conditions had some accumulated wealth; however, under the counterfactual, 100% would have had some accumulated wealth. There was little change in the value of non-income-producing assets under the counterfactual, regardless of number of health conditions. Those with four or more chronic health conditions had a mean value of $17 000 in income-producing assets; under the counterfactual, the average would have been $78 000.

CONCLUSION

This study has highlighted the variation in the value of wealth according to number of chronic health conditions, and hence the importance of considering multiple morbidities when discussing the relationship between health and wealth.

The impact of diabetes on the labour force participation and income poverty of workers aged 45-64 years in Australia

Objective

To quantify the poverty status and level of disadvantage experienced by Australians aged 45–64 years who have left the labour force due to diabetes in 2010.

Research Design and Methods

A purpose-built microsimulation model, Health&WealthMOD2030, was used to estimate the poverty status and level of disadvantage of those aged 45–64 years who prematurely retire from the workforce due to diabetes. A multiple regression model was used to identify significant differences in rates of income poverty and the degree of disadvantage between those out of the labour force due to diabetes and those employed full- or part-time with no diabetes.

Results

63.9% of people aged 45–64 years who were out of the labour force due to diabetes were in poverty in 2010. The odds of being in poverty for those with no diabetes and employed full-time (OR of being in poverty 0.02 95%CI: 0.01–0.04) or part-time (OR of being in poverty 0.10 95%CI: 0.05–0.23) are significantly lower than those for persons not in the labour force due to diabetes. Amongst those with diabetes, those who were able to stay in either full- or part-time employment were as much as 97% less likely to be in poverty than those who had to retire early because of the condition. Sensitivity analysis was used to assess impacts of different poverty line thresholds and key socioeconomic predictors of poverty.

Conclusions

This study has shown that having diabetes and not being in the labour force because of this condition significantly increases the chances of living in poverty. Intervening to prevent or delay the onset of diabetes is likely to improve their living standards.

Indirect economic impacts of comorbidities on people with heart disease

BACKGROUND

 Few studies have assessed the effect of multiple health conditions among patients with heart disease, particularly the economic implications of having multiple conditions.

METHODS AND RESULTS

 This study used a microsimulation model, Health&WealthMOD, to assess the effect of comorbidities on the labor force participation of 45-64-year-old Australians with heart disease, and the indirect economic costs to these individuals and government. For most comorbid conditions, there is a significant increase in the chance of an individual being out of the labor force, relative to those with heart disease alone. For example, individuals with heart disease and arthritis have more than 6-fold the odds of being out of the labor force relative to those with heart disease alone (OR 6.64, 95% CI: 2.46-17.95). People with heart disease and ≥1 comorbidities also receive a significantly lower income, pay less in taxation and receive more in government transfer payments than those with heart disease alone.

CONCLUSIONS

 It is important to consider whether an individual with heart disease also has other health conditions, as individuals with comorbidities have inferior financial situations and are a greater burden on government finances than those with only heart disease.  (Circ J 2014; 78: 644-648).

Chronic health conditions and poverty: a cross-sectional study using a multidimensional poverty measure

OBJECTIVES

To identify the chronic health conditions associated with multidimensional poverty.

DESIGN

Cross-sectional study of the nationally representative Survey of Disability, Ageing and Carers, conducted by the Australian Bureau of Statistics.

SETTING

Australian population in 2003.

PARTICIPANTS

35 704 individuals randomly selected from the Australian population by the Australian Bureau of Statistics.

OUTCOME MEASURES

Multidimensional poverty status, costs of disability, short form 6D health utility score, income, education attainment.

RESULTS

Among those who were multidimensionally poor, 75% had a chronic health condition and the most common health conditions were back problems (11% of those in multidimensional poverty had back problems) and arthritis (11%). The conditions with the highest proportion of individuals in multidimensional poverty were depression/mood affecting disorders (26% in multidimensional poverty) and mental and behavioural disorders (22%). Those with depression/mood affecting disorders were nearly seven times (OR 6.60, 95% CI 5.09 to 8.55, p<0.0001) more likely to be multidimensionally poor than those with no health condition. Equivalising for the additional costs of disability increased the proportion of individuals in multidimensional poverty for all conditions and the conditions with the highest proportion of individuals in multidimensional poverty changed.

CONCLUSIONS

Owing to the influence of certain health conditions on poverty status, health interventions have the potential to improve national living standards and poverty rates in a similar way that 'traditional' policy responses such as changes to welfare payment currently do. Using a multidimensional poverty measure reveals the health conditions that should be the focus of such efforts.

Multiple disadvantages among older citizens: what a multidimensional measure of poverty can show

Using the newly created Freedom Poverty Measure, a multidimensional measure of poverty, it can be seen that there were 534,700 individuals who were in freedom poverty, who had either poor health or poor education in addition to having low incomes. This multidimensional disadvantage would not normally be captured by single measures of poverty, such as income poverty measures. Men were significantly less likely to be in freedom poverty than women (OR = 0.63, 95% CI: 0.54-0.74, p < .0001), and the proportion of individuals in freedom poverty increased with age, with those older than 85 being 2.3 times more likely to be in freedom poverty than those aged 65 to 69 years (95% CI: 1.73-3.11, p < .0001). Policy responses to address the marginalization of disadvantaged older people should take a multidisciplinary approach, addressing health inequalities in particular, not just low income.

Multiple chronic health conditions and their link with labour force participation and economic status

Aims

To assess the labour force participation and quantify the economic status of older Australian workers with multiple health conditions.

Background

Many older people suffer from multiple health conditions. While multiple morbidities have been highlighted as an important research topic, there has been limited research in this area to date, particularly on the economic status of those with multiple morbidities.

Methods

Cross sectional analysis of Health&WealthMOD, a microsimulation model of Australians aged 45 to 64 years.

Results

People with one chronic health condition had 0.59 times the odds of being employed compared to those with no condition (OR 0.59, 95% CI: 0.49, 0.71), and those with four or more conditions had 0.14 times the odds of being employed compared to those with no condition (OR 0.14, 95% CI: 0.11, 0.18). People with one condition received a weekly income 32% lower than those with no health condition, paid 49 % less tax, and received 37% more in government transfer payments; those with four or more conditions received a weekly income 94% lower, paid 97% less in tax and received over 2,000% more in government transfer payments per week than those with no condition.

Conclusion

While having a chronic health condition is associated with lower labour force participation and poorer economic status, having multiple conditions compounds the affect – with these people being far less likely to be employed and having drastically lower incomes.

The association between labour force participation and being in income poverty amongst those with mental health problems

OBJECTIVES

Mental health conditions are associated with lower standards of living. This study quantifies the relationship between employment, depression and other mental health conditions and being in income poverty.

METHODS

Cross-sectional analysis was undertaken using the 2003 Survey of Disability, Ageing and Carers data for Australians aged 45-64 years.

RESULTS

Those not in the labour force due to depression and other mental health conditions are significantly more likely (odds ratio (OR) 12.53, 95% CI: 12.20-12.86, p < 0.0001; OR 20.10, 95% CI: 19.67-20.54, p < 0.0001) to be in income poverty than those not in the labour force with no chronic health condition. Amongst those with depression and other mental health conditions, those who were in employment were significantly less likely to be in income poverty than those who have had to retire because of the condition.

CONCLUSION

Due to the association between leaving the workforce due to mental health problems and poverty status, efforts to increase the employment of individuals with mental health conditions, or prevent the onset of the conditions, will likely improve living standards.

The indirect economic impacts of co-morbidities on people with depression

It is known that people with depression often have other co-morbid conditions; however this is rarely acknowledged in studies that access the economic impacts of depression. This paper aims to quantify the association between co-morbid health conditions and labour force status and economic circumstances of people with depression. This study undertakes cross-sectional analysis using a dataset that is representative of the 45-64 year old Australian population with depression. The probability of being out of the labour force increases with increasing number of co-morbidities, and the amount of weekly income received by people with depression decreased with increasing numbers of co-morbidities. Those with depression and three or more co-morbidities were 4.31 times more likely to be out of the labour force (95% CI: 1.74-10.68), and received a weekly private income 88% lower (95% CI: -94%, -75%) than people with depression alone. It is important to consider the co-morbid conditions an individual has when assessing the impact of depression on labour force participation and economic circumstances.

Premature retirement due to ill health and income poverty: a cross-sectional study of older workers

OBJECTIVES

To assess the income-poverty status of Australians who were aged between 45 and 64 years and were out of the labour force due to ill health.

DESIGN

A cross-sectional study using a microsimulation model of the 2009 Australian population (Health&WealthMOD).

SETTING

2009 Australian population.

PARTICIPANTS

9198 people aged between 45 and 64 years surveyed for the 2003 Survey of Disability, Ageing and Carers.

PRIMARY OUTCOME MEASURES

50% of the median equivalised income-unit-income poverty line.

RESULTS

It was found that individuals who had retired early due to other reasons were significantly less likely to be in income poverty than those retired due to ill health (OR 0.43 95% CI 0.33 to 0.51), and there was no significant difference in the likelihood of being in income poverty between these individuals and those unemployed. Being in the same family as someone who is retired due to illness also significantly increases an individual's chance of being in income poverty.

CONCLUSIONS

It can be seen that being retired due to illness impacts both the individual and their family.

The personal and national costs of lost labour force participation due to arthritis: an economic study

BACKGROUND

The costs of arthritis to the individuals and the state are considerable.

METHODS

Cross-sectional analysis of the base population of Health&WealthMOD, a microsimulation model of 45 to 64 year old Australians built on data from the Australian Bureau of Statistics' Survey of Disability, Ageing and Carers and STINMOD, an income and savings microsimulation model.

RESULTS

Individuals aged 45 to 64 years who had retired early due to arthritis had a median value of AU$260 in total weekly income whereas those who were employed full time were likely to average more than five times this. The large national aggregate impact of early retirement due to arthritis includes AU$9.4 billion in lost GDP, attributable to arthritis through its impact on labour force participation.When looking at the ongoing impact of being out of the labour force those who retired from the labour force early due to arthritis were estimated to have a median value of total savings by the time they are 65 of as little as $300 (for males aged 45-54). This is far lower than the median value of savings for those males aged 45-54 who remained in the labour force full time, who would have an estimated $339,100 of savings at age 65.

CONCLUSIONS

The costs of arthritis to the individuals and the state are considerable. The impacts on the state include loss of productivity from reduced workforce participation, lost income taxation revenue, and increased government support payments - in addition to direct health care costs. Individuals bear the economic costs of lost income and the reduction of their savings over the long term.

The relationship between employment and social participation among Australians with a disabling chronic health condition: a cross-sectional analysis

OBJECTIVES

Social interaction may be particularly important for people with chronic health conditions, due to the numerous benefits to an individual's health. This paper aims to determine if labour force participation is a factor that influences individuals with chronic health conditions partaking in social or cultural events.

DESIGN AND SETTING

The study undertakes a cross-sectional analysis of the 2009 Survey of Disability, Ageing and Carers, a nationally representative survey of the Australian population.

PARTICIPANTS

33 376 records of persons aged 25-64years.

OUTCOME MEASURES

Participation in social and community activities.

RESULTS

It was found that after controlling for age, sex, level of highest education, income unit type and severity of disability, people with a chronic health condition that were in the labour force were more than twice as likely to be participating in social or community events (OR 2.54, 95% CI 1.95 to 3.29, p<0.0001), and in cultural events (OR 2.57, 95% CI 2.21 to 3.00, p<0.0001) as their counterparts who were out of the labour force. The results were then repeated, with the addition of income as a confounding variable. People with a chronic health condition that were in the labour force were still a little more than twice as likely to be participating in social or community events (OR 2.25, 95% CI 1.69 to 3.00, p<0.0001), and to be participating in cultural events (OR 2.08, 95% CI 1.76 to 2.45, p<0.0001) as their counterparts who were out of the labour force.

CONCLUSIONS

Participating in the labour force may be an important driver of social participation among those with chronic health conditions, independent of income. People with chronic health conditions who are not in the labour force and do not participate in social or cultural activities may have a compounding disadvantage.

The personal and national costs of early retirement because of spinal disorders: impacts on income, taxes, and government support payments

BACKGROUND CONTEXT

Spinal disorders can reduce an individual's ability to participate in the labor force, and this can lead to considerable impacts on both the individual and the state.

PURPOSE

This study was aimed to quantify the personal cost of lost income and the cost to the state from lost income taxation, increased benefits payments, and lost gross domestic product (GDP) as a result of early retirement because of spinal disorders in Australians aged 45 to 64 years in 2009.

METHODS

This was done using cross-sectional analysis of the base population of Health&WealthMOD, a microsimulation model built on data from the Australian Bureau of Statistics' Survey of Disability, Ageing and Carers, and STINMOD, an income and savings microsimulation model. Linear regression models were used to examine the relationship between spinal disorders, labor force participation, income, taxation, and government support payments.

RESULTS

It was found that individuals aged 45 to 64 years who have retired early because of spinal disorders have significantly lower income (79% less; 95% confidence interval [CI], -84.7, -71.1; p<.0001), pay significantly less taxation (100% less; 95% CI, -100.0, 99.9; p<.0001), and receive significantly more in government support payments (21,000% more; 95% CI, 12,767.0, 35,336.4; p<.0001) than those employed full time with no health condition. Individuals who have retired early because of spinal disorders have a median value of total weekly income of only AU$310, whereas those who are employed full time are likely to receive four times this. This has a large national aggregate impact, with AU$4.8 billion lost in annual individual earnings, AU$622 million in additional welfare payments, AU$497 million lost in taxation revenue for governments, and AU$2.9 billion in lost GDP: all attributable to spinal disorders through their impact on labor force participation.

CONCLUSIONS

Although the individual has to bear the economic costs of lost income in addition to the burden of the condition itself, the state experiences the impacts of loss of productivity from reduced workforce participation, lost income taxation revenue, and increasing government support payments.

Access to general practitioner services amongst underserved Australians: a microsimulation study

BACKGROUND

One group often identified as having low socioeconomic status, those living in remote or rural areas, are often recognised as bearing an unequal burden of illness in society. This paper aims to examine equity of utilisation of general practitioner services in Australia.

METHODS

Using the 2005 National Health Survey undertaken by the Australian Bureau of Statistics, a microsimulation model was developed to determine the distribution of GP services that would occur if all Australians had equal utilisation of health services relative to need.

RESULTS

It was estimated that those who are unemployed would experience a 19% increase in GP services. Persons residing in regional areas would receive about 5.7 million additional GP visits per year if they had the same access to care as Australians residing in major cities. This would be a 18% increase. There would be a 20% increase for inner regional residents and a 14% increase for residents of more remote regional areas. Overall there would be a 5% increase in GP visits nationally if those in regional areas had the same access to care as those in major cities.

CONCLUSION

Parity is an insufficient goal and disadvantaged persons and underserved areas require greater access to health services than the well served metropolitan areas due to their greater poverty and poorer health status. Currently underserved Australians suffer a double disadvantage: poorer health and poorer access to health services.

The impact of diabetes prevention on labour force participation and income of older Australians: an economic study

Background

Globally, diabetes is estimated to affect 246 million people and is increasing. In Australia diabetes has been made a national health priority. While the direct costs of treating diabetes are substantial, and rising, the indirect costs are considered greater. There is evidence that interventions to prevent diabetes are effective, and cost-effective, but the impact on labour force participation and income has not been assessed. In this study we quantify the potential impact of implementing a diabetes prevention program, using screening and either metformin or a lifestyle intervention on individual economic outcomes of pre-diabetic Australians aged 45-64.

Methods

The output of an epidemiological microsimulation model of the reduction in prevalence of diabetes from a lifestyle or metformin intervention, and another microsimulation model, Health&WealthMOD, of health and the associated impacts on labour force participation, personal income, savings, government revenue and expenditure were used to quantify the estimated outcomes of the two interventions.

Results

An additional 753 person years in the labour force would have been achieved from 1993 to 2003 for the male cohort aged 60-64 years in 2003, if a lifestyle intervention had been introduced in 1983; with 890 person years for the equivalent female group. The impact on labour force participation was lower for the metformin intervention, and increased with age for both interventions. The male cohort aged 60-64 years in 2003 would have earned an additional $30 million in income with the metformin intervention, and the equivalent female cohort would have earned an additional $25 million. If the lifestyle intervention was introduced, the same male and female cohorts would have earned an additional $34 million and $28 million respectively from 1993 to 2003. For the individuals involved, on average, males would have earned an additional $44,600 per year and females an additional $31,800 per year, if they had continued to work as a result of preventing diabetes.

Conclusions

In addition to improved health and wellbeing, considerable benefits to individuals, in terms of both additional working years and increased personal income, could be made by introducing either a lifestyle or metformin intervention to prevent diabetes.

Freedom poverty: a new tool to identify the multiple disadvantages affecting those with CVD

BACKGROUND

It is recognised that CVD affects an individual's financial situation, placing them in income poverty. However, recent developments in poverty measurement practice recognises other forms of disadvantage other than low income, such as poor health and insufficient education also affect living standards.

METHODS

Using the Freedom Poverty Measure, the multiple forms of disadvantage experienced by those with no health condition, heart disease, other diseases of the circulatory system, and all other health conditions was assessed using data on the adult Australian population contained in the 2003 Survey of Disability, Ageing and Carers.

RESULTS

24% of those with heart disease and 23% of those with other diseases of the circulatory system were in freedom poverty, suffering from multiple forms of disadvantage. Those with heart disease and those with other diseases of the circulatory system were around three times more likely to be in freedom poverty (OR 3.02, 95% CI: 2.29-3.99, p<.0001; OR 2.78, 95% CI: 1.94-3.98, p<.0001) than those with no health condition.

CONCLUSIONS

Recognising the multiple forms of disadvantage suffered by those with CVD provides a clearer picture of their living standards than just looking at their income alone and the high proportion of individuals with CVD that are suffering from multiple forms of disadvantage should make them a target for policy makers wishing to improve living standards.

How depression and other mental health problems can affect future living standards of those out of the labour force

OBJECTIVES

To estimate the extent to which those who exit the workforce early due to mental health problems have less savings by the time they reach retirement age.

METHODS

Using Health & WealthMOD--a microsimulation model of Australians aged 45-64 years that predicts accumulated savings at age 65, regression models were used to analyse the differences between the projected savings and the retirement incomes of people at age 65 for those currently working with no chronic condition, and people not in the labour force due to mental health problems.

RESULTS

Females who retire early due to depression have a median value of total savings by the time they are 65 of $300. For those with other mental health problems the median figure was $0. This is far lower than the median value of $227,900 for females with no chronic condition who remained employed full-time. Males showed similar differences. Both males and females who were out of the labour force due to depression or other mental health problems had at least 97% (95% CI: -99.9% to -68.7%) less savings and retirement income by age 65 that those who remained employed full-time.

CONCLUSIONS

People who retire from the labour force early due to mental health problems will face long term financial disadvantage compared to people who are able to remain in employment.

Economic impacts of illness in older workers: quantifying the impact of illness on income, tax revenue and government spending

BACKGROUND

Long term illness has far reaching impacts on individuals, and also places a large burden upon government. This paper quantifies the indirect economic impacts of illness related early retirement on individuals and government in Australia in 2009.

METHODS

The output data from a microsimulation model, Health&WealthMOD, was analysed. Health&WealthMOD is representative of the 45 to 64 year old Australian population in 2009. The average weekly total income, total government support payments, and total taxation revenue paid, for individuals who are employment full-time, employed part-time and not in the labour force due to ill health was quantified.

RESULTS

It was found that persons out of the labour force due to illness had significantly lower incomes ($218 per week as opposed to $1167 per week for those employed full-time), received significantly higher transfer payments, and paid significantly less tax than those employed full-time or part-time. This results in an annual national loss of income of over $17 billion, an annual national increase of $1.5 billion in spending on government support payments, and an annual loss of $2.1 billion in taxation revenue.

CONCLUSIONS

Illness related early retirement has significant economic impacts on both the individual and on governments as a result of lost income, lost taxation revenue and increased government support payments. This paper has quantified the extent of these impacts for Australia.

Truncated careers in nuclear medicine technology: increased job control may improve retention

OBJECTIVES

The aim of the study was to gain understanding of why nuclear medicine technologists (NMTs) leave and to compare workforce and service provision trends with diagnostic imaging professionals.

DESIGN AND SETTING

A survey of all NMT professional body members in New South Wales, the Australian Capital Territory and Queensland was conducted. This paper reports on survey findings of those no longer working as a NMT. Analysis of 1996, 2001 and 2006 Australian Census data and Medicare statistics was made for NMTs, sonographers and radiographers.

MAIN OUTCOME MEASURES

The five most influential reasons for leaving nuclear medicine were measured by survey. Census data measured workforce characteristics; size, sex, age. Medicare statistics measured national service provision.

RESULTS

Primarily, limited career pathways and professional plateau influence retention of NMTs, with sonography a common career move. Nuclear medicine technologists are young (44.3% <30 years) compared with radiography (52.3% <40 years) or sonography (52.8% <40 years). From 2001 to 2006, service provision in nuclear medicine grew by 11.8% compared with 36% in ultrasound but the workforce size decreased by 4.9% whereas sonographers increased by 51.1%.

CONCLUSIONS

Increasing the level of job control is the most likely factor in creating a positive change to the NMT job characteristics and improving retention.

The personal and national costs of mental health conditions: impacts on income, taxes, government support payments due to lost labour force participation

BACKGROUND

Mental health conditions have the ability to interrupt an individual's ability to participate in the labour force, and this can have considerable follow on impacts to both the individual and the state.

METHOD

Cross-sectional analysis of the base population of Health&WealthMOD, a microsimulation model built on data from the Australian Bureau of Statistics' Survey of Disability, Ageing and Carers and STINMOD, an income and savings microsimulation model was used to quantify the personal cost of lost income and the cost to the state from lost income taxation, increased benefits payments and lost GDP as a result of early retirement due to mental health conditions in Australians aged 45-64 in 2009.

RESULTS

Individuals aged 45 to 64 years who have retired early due to depression personally have 73% lower income then their full time employed counterparts and those retired early due to other mental health conditions have 78% lower incomes. The national aggregate cost to government due to early retirement from these conditions equated to $278 million (£152.9 million) in lost income taxation revenue, $407 million (£223.9 million) in additional transfer payments and around $1.7 billion in GDP in 2009 alone.

CONCLUSIONS

The costs of mental health conditions to the individuals and the state are considerable. While individuals has to bear the economic costs of lost income in addition to the burden of the conditions itself, the impact on the state is loss of productivity from reduced workforce participation, lost income taxation revenue, and increased government support payments--in addition to direct health care costs.