John Glover

The impact of co-payment increases on dispensings of government-subsidised medicines in Australia

Patient co‐payments for medicines subsidised under the Australian Pharmaceutical Benefits Scheme (PBS) increased by 24% in January 2005. We investigated whether this increase and two related co‐payment changes were associated with changes in dispensings of selected subsidised medicines in Australia.

Metropolitan income inequality and working-age mortality: A cross-sectional analysis using comparable data from five countries

The relationship between income inequality and mortality has come into question as of late from many within-country studies. This article examines the relationship between income inequality and working-age mortality for metropolitan areas (MAs) in Australia, Canada, Great Britain, Sweden, and the United States to provide a fuller understanding of national contexts that produce associations between inequality and mortality. An ecological cross-sectional analysis of income inequality (as measured by median share of income) and working-age (25–64) mortality by using census and vital statistics data for 528 MAs (population >50,000) from five countries in 1990–1991 was used. When data from all countries were pooled, there was a significant relationship between income inequality and mortality in the 528 MAs studied. A hypothetical increase in the share of income to the poorest half of households of 1% was associated with a decline in working-age mortality of over 21 deaths per 100,000. Within each country, however, a significant relationship between inequality and mortality was evident only for MAs in the United States and Great Britain. These two countries had the highest average levels of income inequality and the largest populations of the five countries studied. Although a strong ecological association was found between income inequality and mortality across the 528 MAs, an association between income inequality and mortality was evident only in within-country analyses for the two most unequal countries: the United States and Great Britain. The absence of an effect of metropolitan-scale income inequality on mortality in the more egalitarian countries of Canada. Australia, and Sweden is suggestive of national-scale policies in these countries that buffer hypothetical effects of income inequality as a determinant of population health in industrialized economies.

Determinants of self-reported medicine underuse due to cost: a comparison of seven countries

Objectives To compare the predictors of self-reported medicine underuse due to cost across countries with different pharmaceutical subsidy systems and co-payments. Methods We analysed data from a 2007 survey of adults in Australia, Canada, Germany, the Netherlands, New Zealand (NZ), the United Kingdom (UK) and the United States (US). The predictors of underuse were calculated separately for each country using multivariate poisson regression. Results Reports of underuse due to cost varied from 3% in the Netherlands to 20% in the US. In Australia, Canada, NZ, the UK and the US, cost-related underuse was predicted by high out-of-pocket costs (RR range 2.0-4.6), below average income (RR range 1.9-3.1), and younger age (RR range 3.9-16.4). In all countries except Australia and the UK, history of depression was associated with cost-related underuse (RR range 1.2- 4.1). In Australia, Canada, Germany, the UK and the US lack of patient involvement in treatment decisions was associated with cost-related underuse (RR range 1.2-1.4). In Australia, Canada and NZ, indigenous persons more commonly reported underuse due to cost (RR range 2.1-2.9). Conclusions Cost-related underuse of medicines was least commonly reported in countries with the lowest out-of-pocket costs, the Netherlands and the UK. Countries with reduced co-payments or cost ceilings for low income patients showed the least disparity in rates of underuse between income groups. Despite differences in health insurance systems in these countries, age, ethnicity, depression, and involvement with treatment decisions were consistently predictive of underuse. There are opportunities for policy makers and clinicians to support medicine use in vulnerable groups.

Increased patient co‐payments and changes in PBS‐subsidised prescription medicines dispensed in Western Australia

Objective: To determine whether a 24% increase in patient co‐payments in January 2005 and two related co‐payment changes for medicines subsidised under the Australian Pharmaceutical Benefits Scheme (PBS) were associated with changes in dispensings in Western Australia (WA).

Unpacking analyses relying on area-based data: are the assumptions supportable?

BackgroundIn the absence in the major Australian administrative health record collections of a direct measure of the socioeconomic status of the individual about whom the event is recorded, analysis of the association between the health status, use of health services and socioeconomic status of the population relies an area-based measure of socioeconomic status.This paper explores the reliability of the area of address (at the levels typically available in administrative data collections) as a proxy measure for socioeconomic disadvantage. The Western Australian Data Linkage System was used to show the extent to which hospital inpatient separation rates for residents of Perth vary by socioeconomic status of area of residence, when calculated at various levels of aggregation of area, from smallest (Census Collection District) to largest (postcode areas and Statistical Local Areas). Results are also provided of the reliability, over time, of the address as a measure of socioeconomic status.ResultsThere is a strong association between the socioeconomic status of the usual address of hospital inpatients at the smallest level in Perth, and weaker associations when the data are aggregated to larger areas. The analysis also shows that a higher proportion of people from the most disadvantaged areas are admitted to hospital than from the most well-off areas (13% more), and that these areas have more separations overall (47% more), as a result of larger numbers of multiple admissions.Of people admitted to hospital more than once in a five year period, four out of five had not moved address by the time of their second episode. Of those who moved, the most movement was within, or between, areas of similar socioeconomic status, with people from the most well off areas being the least likely to have moved.ConclusionPostcode level and SLA level data provide a reliable, although understated, indication of socioeconomic disadvantage of area. The majority of Perth residents admitted to hospital in Western Australia had the same address when admitted again within five years. Of those who moved address, the majority had moved within, or between, areas of similar socioeconomic status.Access to data about individuals from the Western Australian Data Linkage System shows that more people from disadvantaged areas are admitted to a hospital, and that they have more episodes of hospitalisation. Were data to be available across Australia on a similar basis, it would be possible to undertake research of greater policy-relevance than is currently possible with the existing separations-based national database.

Comparative evaluation of indicators for gender equity and health

SummaryObjectives:This paper reports on a comparative evaluation of indicators that are in use, or proposed for use, by leading international organizations to assess their adequacy for the purpose of monitoring key issues related to gender, equity and health.Methods:A comprehensive health information framework was developed on a generic framework by the ISO (2001) to use for the analysis of gender equity within mainstream health systems. A sample of 1 095 indicators used by key international organizations were mapped to this framework and assessed for technical quality and gender sensitivity.Results:The evaluation found deficiencies in the indicators currently in use, from the viewpoint of both technical quality and underlying conceptual bases, as well as in their coverage of the framework, and especially in relation to health system performance.Conclusions:Routine administrative reporting offered large numbers of indicators but these did not allow for monitoring of gender equity and health. The paper concludes that there is merit in developing a core set of leading indicators that can be used for comparisons across peer countries and communities.

Impact of cost of medicines for chronic conditions on low income households in Australia

Objectives: To determine the cost of medicines for selected chronic illnesses and the proportion of discretionary income this would potentially displace for households with different pharmaceutical subsidy entitlements and incomes. Methods: We analysed household income and expenditure data for 9,774 households participating in two Australian surveys in 2009-10. The amount of ‘discretionary’ income available to households after basic living and health care expenditure was modelled for households with high pharmaceutical subsidies: pensioner and non-pensioner concessional (social security entitlements); and households with general pharmaceutical subsidies and low, middle or high incomes. We calculated the proportion of discretionary income that would be needed for medicines if one household member had diabetes or acute coronary syndrome, or if one member also had two co-existing illnesses (gastro-oesophageal reflux disease and depression, or asthma and osteoarthritis). Results: Pensioner and low income households had little discretionary income after basic living and health care expenditure (AUD

From the city to the bush: increases in patient co-payments for medicines have impacted on medicine use across Australia

92 and

The geographic distribution of private health insurance in Australia in 2001

164/week, respectively). Medicines for the specified illnesses ranged from

Australia and New Zealand, Health Systems of

11-