Health care utilisation and out-of-pocket expenditure associated with back pain: a nationally representative survey of Australian women

Background: Back pain impacts on a significant proportion of the Australian population over the life course and has high prevalence rates among women, particularly in older age. Back pain care is characterised by multiple practitioner and selfprescribed treatment options, and the out-of-pocket costs associated with consultations and self-prescribed treatments have not been examined to date. Objective: To analyse the extent of health care practitioner consultations and self-prescribed treatment for back pain care among Australian women, and to assess the self-reported costs associated with such usage. Methods: Survey of 1,310 women (response rate 80.9%) who reported seeking help for back pain from the '1946-51 cohort' of the Australian Longitudinal Study on Women's Health. Women were asked about their use of health care practitioners and self-prescribed treatments for back pain and the costs associated with such usage. Results: In the past year 76.4% consulted a complementary and alternative practitioner, 56% an allied health practitioner and 59.2% a GP/medical specialist. Overall, women consulted with, on average, 3.0 (SD = 2.0) different health care practitioners, and had, on average, 12.2 (SD = 9.7) discrete health care practitioner consultations for back pain. Average self-reported out-of-pocket expenditure on practitioners and self-prescribed treatments for back pain care per annum was AU$873.10. Conclusions: Multiple provider usage for various but distinct purposes (i.e. pain/mobility versus anxiety/stress) points to the need for further research into patient motivations and experiences of back pain care in order to improve and enhance access to and continuity of care. Our results suggest that the cost of back pain care represents a significant burden, and may ultimately limit women's access to multiple providers. We extrapolate that for Australian working-age women, total out-of-pocket expenditure on back pain care per annum is in excess of AU$1.4billion, thus indicating the prominence of back pain as a major economic, social and health burden

A Common Pitch and The Management of Corporate Relations: Interpretation, Ethics and Managerialism

This paper examines how good management can repair fractured relationships within organisations, addressing problems that if left unattended will threaten the future existence of many of these companies. It analyses why there is a mood for change in management thinking, and what direction that change can take. Part of the challenge is how managers can best satisfy the objectives of corporate social responsibility initiatives, and repair organisational and fractured community relationships. A possible role for management is to examine alternative ways of thinking about the potential benefits for the organisation that can be achieved by enhancing employee relationships. In this regard, this paper offers strategies to examine management’s adverse affects on workers’ life-plans. The art of interpretation is used to expose how bureaucratic logic ignores workers’ rights and potentially damages the corporation’s longevity. Interpretation, as opposed to procedure, suggests that organisations are not simply profit mechanisms, but active and dynamic civil societies. By better understanding the facilitating processes of administrative and management thinking, it is possible that we can develop alternative strategies that empower individuals to circumvent the negative consequences of instrumental rationality and enable them to act more responsibly in the public interest. Copyright Springer Science+Business Media, Inc. 2007civil society, corporate social responsibility initiatives, hermeneutics, organisational and fractured community relationships,