The long run impact of child abuse on health care costs and wellbeing in Australia. CHERE Working Paper 2010/10

There are approximately 55,000 substantiated child abuse or neglect cases in Australia each year, according to Australian Institute of Health and Welfare data, 2005-06 to 2008-09 (AIHW2010). In 2008-09, one third of child maltreatment cases related to physical or sexual abuse. Our paper examines the relationship between physical and sexual abuse of children and adult physical and mental health conditions and associated health care costs in Australia. The analysis utilises confidentialised unit record file data from the National Survey of Mental Health and Wellbeing 2007, which includes 8841 persons aged from 16 to 85. The econometric results indicate that Australians with a history of being abused as a child suffer from significantly more physical and mental health conditions as adults and incur higher annual health care costs. In addition, we investigate the associations between child abuse, incarceration and self harm and the intergenerational impact of abuse, to extend the understanding of the long run costs of child abuse in Australia. We conclude that prevention child abuse is expected to generate long term socio-economic benefits.child abuse, mental health, costs, Australia

Out-of-pocket health expenditures in Australia: A semi-parametric analysis, CHERE Working Paper 2006/15

Out-of-pocket health expenditures in Australia are high in international comparisons and have been growing at a faster rate than most other health costs in recent years. This raises concerns about the extent to which out-of-pocket costs have constrained access to health services for low income households. Using data from the ABS Household Expenditure Survey 2003-04, we model the relationships between health expenditure shares and equivalised total expenditure for categories of out-of-pocket health expenditures and analyse the extent of protection given by concession cards. To allow for flexibility in the relationship we adopt a semi-parametric estimation technique following Yatchew (1997). We find mixed evidence for the protection health concession cards give against high out-of-pocket health expenditures. Despite higher levels of subsidy, households with concession cards have higher total health expenditure shares than other households. Surprisingly, the major drivers of the difference are not categories of expenditure where cards offer little or no protection, such as dental services and non-prescription medicines, but prescriptions costs, where concession cards guarantee a subsidy, and specialist consultations, where bulk billing rates would be expected to be higher for cardholders. This is the first detailed distributional analysis of household health expenditures in Australia.Out-of-pocket costs, international comparisons, Australia

Hospital in the Home in NSW, CHERE Project Report No 16

Hospital in the home, NSW

When is an ounce of prevention worth a pound of cure: The case of cardiovascular disease?

Objective: To provide decision makers with a tool to inform resource allocation decisions at the local level, using cardiovascular disease prevention as an example. Method: Evidence from the international literature was extrapolated to estimate the health and financial impacts in Central Sydney Area Health Service (CSAHS) of three different prevention programs; smoking cessation; blood pressure reduction and cholesterol lowering. The cost-effectiveness analysis framework was reconfigured to 1) estimate the risk of CVD in the community using local risk factor data, 2) estimate the number of CVD events prevented through investment in preventive programs and 3) estimate the local financial flow-on effects of prevention on acute care services. The model developed here estimates an upper bound of what local decision makers could spend on preventive programs whilst remaining consistent with their willingness to pay for one additional life-year gained. Results: The model predicted that over a five-year period the cumulative impact of the three programs has the potential to save 1245 life-years in people aged 40-79 years living in CSAHS. If decision-makers are willing to invest in cost-saving preventive programs only, the model estimates that they can spend up $12 per person in the target group per year. However, if they are willing to spend$70,000 per life-year gained, this amount rises to $201. Conclusions: Modelling the impact of preventive activities on the acute care health system enables us to estimate the amount that can be spent on preventive programs. The model is flexible in terms of its ability to examine these impacts in a variety of settings and therefore has the potential to be a useful resource planning tool.Resource allocation, cardiovascular disease, health promotion, Australia

Revisiting horizontal inequity of health care use in Australia

Despite the universal health insurance system in Australia, there is inequity in use of needed healthcare services, and it varies across states. Increasing reliance on private funding and fragmented provision of healthcare services might make the Australian system challenging to deliver equitable healthcare

Primary Health Care in Australia: towards a more sustainable and equitable health care system

Numerous editions of the Australian Government’s Intergenerational Report have consistently shown that health care is the fastest growing component of the Commonwealth Government’s outlays. Over the next forty years, the federal government’s expenditure on health is expected to almost double in terms of share of GDP. Not surprisingly, one of the central aims for policy advisers is to make the health care system more sustainable. Policy advisers in Australia, and internationally, are placing greater importance on the role of primary care to deliver a more sustainable health care system. A well-functioning primary care system is widely regarded as an essential element of a high performing health care system 1. The recently announced Medical Homes trial is a good example of the way the Australian government is seeking to reform primary care and place it at the centre of the health care system. In part, such reforms are driven by the promise of better management of chronic diseases at earlier stages of disease in order to prevent further declines in health status, unnecessary hospitalisations and escalating health care costs. With sustainability at the forefront of the policy debate, there is an urgent need to develop a better understanding of the drivers of health expenditure growth, and in particular the relationship between the role and functioning of primary care and other health care sectors. However, health care reforms aimed at making the system more financially sustainable do so at the cost of fairness. The proposed mandatory co-payments for general practice consultations announced in the 2014 Federal Budget are a good example of this. On the one hand, the government was making the argument that the proposal would make Medicare expenditure more sustainable, but opponents argued that this would reduce access to general practitioners, particularly among low income people and the elderly. The ensuing debate was hotly contested, ideologically driven and largely absent of hard evidence. Indeed, due to the controversial nature of the 2014 co-payments, the government eventually abandoned its planned reforms altogether. One of the essential problems for Government is that the role primary care can play in making the Australian health care system more efficient and equitable is often unclear. This report highlights the key results of one of the major work themes undertaken as part of the Centre for Research Excellence on the Financing and Economics (REFinE) of Primary Health Care. It reports on a number of projects that have developed our understanding of the drivers of health care use and expenditure. There are two themes to this report that seek to deliver a better understanding of, Drivers of health care costs and use (Part A) Access and equity in Australia’s health care system (Part B) In developing this understanding, it examines the interrelationships between primary care and other sectors of the Australian health care system, including hospital care, specialist care and emergency department care. In particular, it will address the relationship between primary health care and the short and medium term use of other health care services, particularly the substitution between general practice and specialist care; and between general practice and emergency department and admitted hospital care. It will report on our investigations of the distribution of health expenditures and determine to what extent health expenditures are associated with patient demographics, socioeconomic and health status. This report draws on a number of papers that have been developed as part of the work undertaken at the Centre for Research Excellence on the Financing and Economics of Primary Care (REFinE). Most of these papers have been published, others are in the final stages of development. Collectively, these provide a greater understanding of the cost trajectories of people with chronic diseases.The research reported in this paper is a project of the Australian Primary Health Care Research Institute which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research Evaluation and Development Strategy

Economic evaluation of cystic fibrosis screening: A Review of the literature, CHERE Working Paper 2006/6

Objectives: To critically examine the economic evidence on Cystic Fibrosis (CF) screening and to understand issues relating to the transferability of findings to the Australian context for policy decisions. Methods: A systematic literature search identified 25 economic studies with empirical results on CF published between 1990 and 2005. These articles were then assessed against international benchmarks on conducting and reporting of economic evaluations, focusing on the transferability of the evidence to the local setting. Results: Six studies described only costs, 12 were cost-effectiveness studies, 6 were cost-benefit studies and one had a combined design (cost utility, cost benefit and cost effectiveness). Most of the cost-effectiveness studies compared screening versus ?no-screening? but the screening programs under consideration differed markedly. Four considered neonatal screening, three prenatal screening, three pre-conception and carrier screening, and one considered all types of screening programs. The outcome measures also varied considerably between studies. One study included a quality adjusted life year measure. Cost?benefit measures mostly included economic savings ? evaded lifetime medical costs of avoiding CF child birth. Conclusion: The variability in study design, model inputs and reporting of economic evaluations of CF carrier screening raises issues on the applicability and transferability of such evidence to the Australian context.Cystic fibrosis, economic evaluation

The use of breast screening services in NSW: Are we moving towards greater equity? [Draft - not for quotation or citation], CHERE Working Paper 2007/7

Introduction: Since 1991 State and Federal Governments, under the auspices of BreastScreen Australia, have been providing mammography services free at the point of delivery to women aged 40 and over. One of the stated aims of the program is to provide equitable access to all women in the target group. Methods: Data on self-reported utilisation of breast screening services came from the 1997/98 and 2002/04 NSW Health Surveys. Probit regression analysis was used to examine the relationship between income and breast screening behaviour of women in NSW aged 50 to 69. Results: The results for 2002 and 2004 show that income has a positive and significant impact on the likelihood that a woman chooses to screen for breast cancer at regular intervals. The role of income was consistent across most regions. Women born overseas have a lower likelihood of screening regularly. Results from the pooled dataset show that the income gradient appears to be steeper in 2002/04 compared to 1997/98. Conclusions: These results indicate that the current program has not ensured equitable take-up of mammography services and that further research and investment is needed to meet program objectives.breast screening, Australia