Multiple chronic diseases were found to have a considerable negative impact on quality of life, not only in terms of how people felt about their lives generally, but also in terms of the extent of their psychological distress.

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The health benefits and costs of a national diabetes screening and prevention scenario are estimated among Australians ages 45-74. The Australian Diabetes Cost-Benefit Model is used to compare baseline and scenario outcomes from 2000 to 2010. Those newly diagnosed in 2000 receive intensive care, resulting in lower complication rates. People "at high risk" of developing diabetes are offered lifestyle intervention, reducing the numbers developing diabetes. A total of 115,000 people became "newly diagnosed." Among those deemed at high risk, 53,000 avoided developing diabetes by 2010. Average yearly intervention and incremental treatment cost was AU$179 million, with a cost per disability-adjusted life-year of AU$50,000.

The impacts of changes to private health insurance (PHI) policies introduced since 1999 -in particular the 30% PHI rebate and the Lifetime Health Cover -have been much debated. We present historical analyses of the impacts in terms of the proportion of Australians having hospital insurance cover under different PHI policies, by age, gender and socioeconomic status, and project these to 2010 using a new Private Health Insurance coverage model.The combined effect of the 30% rebate and Lifetime Health Cover was to increase PHI membership from just over 30% in 1998 to just under 50% by the end of 2000, due mainly to more people taking out PHI cover from among the richest 20% of the population. Among the poorest 40% the impact was minimal. Model projections suggested that, had the new PHI policies not been introduced, then the proportion of Australians with PHI would have declined to around 20% by 2010, compared with 40% if the current arrangements remained in place. Also, analysis of 2001 survey data regarding choices to use a public or a private hospital indicated that higher income groups with or without PHI were the more likely to have used a private hospital than lower income groups. Among those with PHI, older people were more likely to have used a private hospital than ALTHOUGH IN RECENT DECADES the health of populations in developed countries like Australia improved considerably, the related expenditures tended to outpace economic growth. This resulted in nations searching for ways to contain costs, most typically in the hospital sector, such as the passing on of a larger share of the costs to individuals. 1,2 Examples of this latter approach are the Federal government' s recently introduced policies to increase the take-up of private health insurance (PHI). Basically, the policies are the 30% private health insurance rebate, Lifetime Health Cover and the Medicare Levy Surcharge (Appendix A). When the 30% rebate was introduced, one stated aim was to ease the burden on Medicare, in particular on public hospitals.A recent inquiry 3 examined the issue of whether these policies had achieved their aim of easing the burden on public hospitals. While researchers What is known about the topic? Recent changes in private health insurance (PHI) policies were motivated partly by concern about the continuing decline in the number of people purchasing PHI. The changes have been effective in reversing the decline in the short term and have led to strong increases in coverage among younger people. What does this paper add?Modelling of the impact of policy settings indicates that removal of the 30% rebate would cause a small drop in proportion covered compared to the impact of removal of life-time cover in combination with the rebate. Under all scenarios, the model indicates continuing long-term decline in the proportion of the population purchasing PHI. Under current policies, the proportion covered would decline to 40% by 2010. What are the implications?Removal of the 30% rebate would have a considerably lesser impa...

Objective: To investigate whether the ‘inverse care law’ applies to New South Wales (NSW) hospital admissions ‐ especially to older people with high socio‐economic status (SES). Design: Cross‐sectional study analysing inequalities in public and private hospital admission rates by SES, defined in terms of age, sex and family income/size at the small geographic area level. Setting: Admissions to NSW public and private hospitals in 1999–2000 (1.8 million admissions against a NSW population of 6.4 million). Methodology: Inequalities in hospitalisation rates were expressed as rate ratios across the most and least disadvantaged 20% of the NSW population. Results: Public hospital admission rates for people aged 0–60 years were 24–35% higher for the most disadvantaged 20% of the NSW population than for the least disadvantaged 20%. For 70+ year‐olds the direction of this difference was reversed ‐ being 14% lower for the most disadvantaged 20% of the population (5% higher for public patients). For private hospitals this reversal prevailed for all age groups (23–49% lower). For all hospitals it was 16% and 27% lower for 60–69 and 70+ year‐olds respectively, with higher admission rates for top SES 60+ year‐olds most pronounced for renal dialysis, chemotherapy, colonoscopies and other diagnostic scopes, rehabilitation and follow‐up, and cataract operations. Conclusion: While the ‘inverse care law’ did apply to 60+ year‐olds, it did not apply either to younger NSW hospital users or to public patients in public hospitals. Implications: Awareness of these SES‐level differentials should result in greater equality of access to hospital services, especially by older people.