The effects of increased private health insurance: a review of the evidence

Hindle, Don; McAuley, Ian

doi:10.1071/ah040119

Cited by 17 publications

(17 citation statements)

References 49 publications

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“…This is evident from the differences in profiles of care between the two subpopulations and the findings that showed rural patients were utilising EDs to fill the gaps in the primary healthcare and the specialist services in rural areas. Other evidence shows that increasing private health insurance coverage in Australia has been associated with loss of equity after controlling for other factors 30 31…”

Section: Discussionmentioning

confidence: 99%

Rural–urban differentials in 30-day and 1-year mortality following first-ever heart failure hospitalisation in Western Australia: a population-based study using data linkage

et al. 2014

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ObjectivesWe examined differentials in short-term (30-day mortality) and 1-year mortality (in 30-day survivors) following index (first-ever) hospitalisation for heart failure (HF), between rural and metropolitan patients resident in Western Australia.DesignA population-based cohort study.SettingHospitalised patients in Western Australia, Australia.ParticipantsIndex patients aged 20–84 years with a first-ever hospitalisation for HF between 2000 and 2009 (with no prior admissions for HF in previous 10 years), identified using the Western Australia linked health data.Main outcome measures30-day and 1-year all-cause mortality (in 30-day survivors) following index admission for HF.ResultsOf 17 379 index patients with HF identified, 25.9% (4499) were from rural areas. Rural patients were significantly younger at first HF hospitalisation than metropolitan patients. Aboriginal patients comprised 1.9% of metropolitan and 17.2% of rural patients. Despite some statistical differences, the prevalence of antecedents including ischaemic heart disease, hypertension, diabetes and chronic kidney disease was high (>20%) in both subpopulations. After adjusting for age only, patients from rural areas had a higher risk of 30-day death (OR 1.16 (95% CI 1.01 to 1.33)) and 1-year death in 30-day survivors (HR 1.11 (95% CI 1.01 to 1.23)). These relative risk estimates increased and remained significant after further progressive adjustments for Aboriginality, socioeconomic status, insurance status, emergency presentation, individual comorbidities and revascularisation with OR 1.25 (1.06 to 1.48) for 30-day mortality and HR 1.13 (1.02 to 1.27) for 1-year mortality. The addition of the weighted Charlson index to the 30-day model improved the ‘c’ statistic (under the receiver operating characteristic curve) from 0.656 (using a variation of administrative claims model) to 0.714.ConclusionsRemoteness and variable access to healthcare can cause important disparities in health outcomes. Rural patients with HF in Western Australia have poorer risk-adjusted outcomes compared with metropolitan patients. This finding has important implications for chronic disease management and provision of health services in rural Australia.

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Section: Discussionmentioning

confidence: 99%

Rural–urban differentials in 30-day and 1-year mortality following first-ever heart failure hospitalisation in Western Australia: a population-based study using data linkage

et al. 2014

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“…Therefore, to obtain an unbiased estimate of the effect of LHC, it is necessary to hold constant changes in M d . This can be done by decomposing the 23 Barrett and Conlon (2003); Hindle and McAuley (2004); Ellis and Savage (2005); Doiron et al (2008). 24 As noted above, since the mid-1990s there has been an increase in private insurance coverage for the ''gap'' between the total fee charged by medical specialists and the Medicare scheduled fee.…”

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confidence: 99%

Community Rating, Entry-Age Rating and Adverse Selection in Private Health Insurance in Australia

Buchmueller

2008

Geneva Pap Risk Insur Issues Pract

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“…Both the advocates of NHI and the defenders of PHI have employed these concepts, although the latter have also emphasised the merits of 'choice'. Most of the published academic work on PHI has concentrated on Commonwealth policies and expenditure in terms of the national v. private health funding debate or else has examined specific policy initiatives, such as the Howard government's rebates and 'Lifetime Cover' reforms [14][15][16][17][18] (see pp. 303-306 16 ).…”

Section: The Private Health Funds In the Politics Of Private Health Imentioning

confidence: 99%

Australia's private health insurance industry: structure, competition, regulation and role in a less than 'ideal world'

Shamsullah¹

2011

Aust. Health Review

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Abstract. Australia's private health insurance funds have been prominent participants in the nation's health system for 60 years. Yet there is relatively little public awareness of the distinctive origins of the health funds, the uncharacteristic organisational nature of these commercial enterprises and the peculiarly regulated nature of their industry. The conventional corporate responsibility to shareholders was, until recently, completely irrelevant, and remains marginal to the sector. However, their purported answerability to contributors, styled as 'members', was always doubtful for most health funds. After a long period of remarkable stability in the sector, despite significant shifts in health funding policy, recent years have brought notable changes, with mergers, acquisitions and exits from the industry. The research is based on the detailed study of the private health funds, covering their history, organisational character and industry structure. It argues that the funds have always been divorced from the disciplines of the competitive market and generally have operated complacently within a system of comprehensive regulation and generous subsidy. The prospect of the private health funds enjoying an expanded role under a form of 'social insurance', as suggested by the National Health and Hospitals Reform Commission, is not supported.What is known about the topic? Government policies promoting private health insurance have long been the subject of public debate and have received considerable academic analysis. The health funds have a high profile in the media and with the public, reflecting the extent of private health insurance coverage. What does this paper add? There is relatively little awareness of the unique nature of the private health insurance industry. This paper highlights the distinctive organisational origins of the health funds, the recent changes to the structure of the sector which have complicated their corporate identities and the complex role they play in an extraordinarily regulated private health insurance industry. What are the implications for practitioners? Awareness of the nature of the sector should take us beyond perennial concerns about premium rises and the level of private health insurance coverage to better appreciate the diverse nature of the industry, the constraints under which the funds operate and the potential they may have to deliver 'social insurance'.

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The effects of increased private health insurance: a review of the evidence

Cited by 17 publications

References 49 publications

Rural–urban differentials in 30-day and 1-year mortality following first-ever heart failure hospitalisation in Western Australia: a population-based study using data linkage

Rural–urban differentials in 30-day and 1-year mortality following first-ever heart failure hospitalisation in Western Australia: a population-based study using data linkage

Community Rating, Entry-Age Rating and Adverse Selection in Private Health Insurance in Australia

Australia's private health insurance industry: structure, competition, regulation and role in a less than 'ideal world'

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