Over the past three decades health spending and hospital use increased more for the elderly than for persons under age sixty-five. Medicare spending for the oldest old (age eighty-five and older) increased faster than for persons ages sixty-five to seventy-four, but that increase was due entirely to greater postacute care use. Health care trends are consistent with the idea that Medicare has improved the health of the elderly. Greater spending increases for the elderly may reflect legislative developments such as the passage of Medicare and its continued fee-for-service nature and the failure to pass universal coverage, as well as changes in the health care delivery system such as the rapid growth in managed care enrollment among persons under age sixty-five.

The objective ofthis study was to assess the impact of Enhanced Primary Care service utilisation on subsequent GP service regularity and frequency. The study involved a retrospective population-based longitudinal cohort using linked administrative health records of hospital and primary care services for people over the age of 65 years. Multinomial logistic regression modelling was used to evaluate changes in the relative likelihood of increased primary care service regularity and frequency in exposed and unexposed individuals adjusting for age, sex and recent chronic disease hospitalisation history. Enhanced Primary Care services significantly and substantially increased the relative likelihood of increased regularity with no corresponding higher likelihood of increased frequency of GP contact. Increased regularity was more likely with increasing age except for the oldest age group (90+ years). Some chronic disease histories (e.g. diabetes) showed a higher likelihood of improved regularity while others were less likely to produce an increased regularity (e.g. hypertension). The study suggests a capacity for modification of physician and patient behaviour using incentivised services within the current fee-for-service system in Australia.

Objectives: To explore the interaction of computed tomography (CT) use, dose and radiation risk of Australian Medicare-funded CT scanning and the impact on cancer incidence and mortality.Methods: This retrospective cohort study used records of Medicare subsidised CT scans in Australia (2006Australia ( /07 to 2011 and Australian CT dosimetry. The annual number, rate and adjusted likelihood of CT were determined for gender, age and examination type. Incident cancer and cancer-related mortality attributable to CT in Australia were estimated using lifetime attributable risk coefficients, dosimetry and scan numbers. Results:The number of CT scans increased by 36% from 2006/07 to 2011/12. Only patients aged 0-4 years did not present an increase in CT scanning rates. Females were 11% more likely to be scanned than males. Head, abdomen/pelvis and spine CT scans were the most likely areas scanned. Females were attributed 61% of both incident cancers and cancer-related mortality from 55% of scans performed. Patients aged 15-44 years were attributed 37% of incident cancers and 30% of cancer-related mortality from 26% of CT scans. Conclusions:CT in Australia is increasing, including in groups at higher risk from ionising radiation. This presents a complex set of risk/benefit considerations for clinicians and policy makers.

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