Agnes Walker

Multiple chronic diseases and quality of life: patterns emerging from a large national sample, Australia

Objectives: To assess the importance of multiple chronic diseases (co-morbidities) to how people feel about their lives generally. To do this, we studied the associations between co-morbidities and indicators of quality of life and/or psychological distress. Methods: Analysis of unit record cross-sectional data from Australian national surveys for the population aged 20 years or more. Identification of an appropriate indicator of multiple chronic diseases (i.e. co-morbidities). Use of logistic regression techniques to study associations between: (1) co-morbidities and demographic, socio-economic and risk factor variables; and (2) quality of life (general and psychological distress) and demographic, socio-economic and health status indicators. Results: Older people, obese persons, women, persons with low socio-economic status and those living alone had significantly greater probability of having three or more chronic illnesses than did other people aged 20+ years (p<0.0001). Also, people with co-morbidities and/or with poor self-rated general health, those living alone, people with low educational qualifications and persons with low socio-economic status were more likely to feel dissatisfied, unhappy or terrible about their lives and to have moderate, high or very high psychological distress scores than the rest of the 20+-year-old population (p<0.0001). Conclusions: 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.

Distributional impact of recent changes in private health insurance policies

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 younger ones.

Hospital admissions by socio‐economic status: does the Inverse care law‘ apply to older Australians?

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).

Economic model system of chronic diseases in Australia: A novel approach initially focusing on diabetes and cardiovascular disease

Chronic diseases affect around 80% of older Australians, are main causes of premature death, and account for 70% of health expenditures. The novel features, building and validation of an Australian prototype model-system which simulates interventions that target several chronic diseases are described. Chronic disease progression models are linked to a population-wide microsimulation projection model that accounts for demographic, socio-economic and health characteristics, comorbidities, health expenditures, quality of life. It estimates costs vs. benefits of simulated policy interventions. The outcome is a validated person-level prototype able to simultaneously model diabetes and Cardiovascular Disease (CVD). An illustrative model application is also presented.

Health Status, Health Inequalities and the Ability of Older Australians to Stay in the Labour Force*

This paper assesses the potential labour market impact of possible future trends concerning older Australians - such the lifting of the age of retirement and general improvements in health. Currently in Australia healthier 45-64 year olds are much more likely to have jobs – and thus have higher incomes - than the less healthy in that age group. In 1998, only a negligible proportion of persons aged 65 years or above worked more than 15 hours per week – and these tended to have higher socioeconomic status (SES). First, modifications made to a dynamic microsimulation model - so that the impact of the health of older Australians on their employment status could be studied – are described. Validation of these modifications is also discussed. Second, illustrative scenarios are simulated on the impact that longer working lives may have on individuals and governments. In these scenarios, longer working lives can arise from more favourable labour market conditions facing older Australians aged 65 to 70; greater incentives to stay in the workforce; or general improvements in the health of the population. We found that, if 65-70 year olds had the same employment patterns as 45 to 64 year olds in 1998, they would have benefited from additional earnings (wages or salaries) totalling around

Using An Economic Model Of Diabetes To Evaluate Prevention And Care Strategies In Australia

15 billion (

THE IMPACT OF DEMOGRAPHIC AND OTHER CHANGES ON EXPENDITURE ON PHARMACEUTICAL BENEFITS IN 2020 IN AUSTRALIA

28 billion in 2018). Also, government expenditure on the age pension would have been around

Health inequalities across socio-economic groups: comparing geographic-area-based and individual-based indicators.

2 billion lower (

An economic forecasting microsimulation model of the Australian Pharmaceutical Benefits Scheme

4 billion in 2018). Had it been possible to lift the health status of all Australians to that of the richest 20 per cent of the population, then the earnings of 65-70 year olds in 2018 would have been 4.0% higher than if the 1998 health patterns had prevailed - and government’s savi ngs on the age pension around 3.8% greater. Finally, issues that could in future be studied with further development of the dynamic microsimulation model are discussed.