Long-term out of pocket expenditure of people with cancer: comparing health service cost and use for indigenous and non-indigenous people with cancer in Australia
Abstract Background Indigenous Australians diagnosed with cancer have poorer survival compared to non-Indigenous Australians. We aim to: 1) identify differences by Indigenous status in out-of-pocket expenditure for the first three-years post-diagnosis; 2) identify differences in the quantity and cos...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2019-02-01
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| Series: | International Journal for Equity in Health |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12939-019-0931-4 |
| _version_ | 1818978685777084416 |
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| author | Emily Callander Nicole Bates Daniel Lindsay Sarah Larkins Stephanie M. Topp Joan Cunningham Sabe Sabesan Gail Garvey |
| author_facet | Emily Callander Nicole Bates Daniel Lindsay Sarah Larkins Stephanie M. Topp Joan Cunningham Sabe Sabesan Gail Garvey |
| author_sort | Emily Callander |
| collection | DOAJ |
| description | Abstract Background Indigenous Australians diagnosed with cancer have poorer survival compared to non-Indigenous Australians. We aim to: 1) identify differences by Indigenous status in out-of-pocket expenditure for the first three-years post-diagnosis; 2) identify differences in the quantity and cost of healthcare services accessed; and 3) estimate the number of additional services required if access was equal between Indigenous and non-Indigenous people with cancer. Methods We used CancerCostMod, a model using linked administrative data. The base population was all persons diagnosed with cancer in Queensland, Australia (01JUL2011 to 30JUN2012) (n = 25,553). Each individual record was then linked to their Admitted Patient Data Collection, Emergency Data Information System, Medicare Benefits Schedule (MBS), and Pharmaceutical Benefits Scheme (PBS) records (01JUL2011 to 30JUN2015). We then weighted the population to be representative of the Australian population (approximately 123,900 Australians, 1.7% Indigenous Australians). The patient co-payment charged for each MBS service and PBS prescription was summed for each month from date of diagnosis to 36-months post-diagnosis. We then limited our model to MBS items to identify the quantity and type of healthcare services accessed during the first three-years. Results On average Indigenous people with cancer had less than half the out-of-pocket expenditure for each 12-month period (0–12 months: mean $401 Indigenous vs $1074 non-Indigenous; 13–24 months: mean $200 vs $484; and 25–36 months: mean $181 vs $441). A stepwise generalised linear model of out-of-pocket expenditure found that Indigenous status was a significant predictor of out of pocket expenditure. We found that Indigenous people with cancer on average accessed 236 services per person, however, this would increase to 309 services per person if Indigenous people had the same rate of service use as non-Indigenous people. Conclusions Indigenous people with cancer had lower out-of-pocket expenditure, but also accessed fewer Medicare services compared to their non-Indigenous counterparts. Indigenous people with cancer were less likely to access specialist attendances, pathology tests, and diagnostic imaging through MBS, and more likely to access primary health care, such as services provided by general practitioners. |
| first_indexed | 2024-12-20T16:47:34Z |
| format | Article |
| id | doaj.art-c0343e7c468b46a0ad3b0b1fc51264af |
| institution | Directory Open Access Journal |
| issn | 1475-9276 |
| language | English |
| last_indexed | 2024-12-20T16:47:34Z |
| publishDate | 2019-02-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal for Equity in Health |
| spelling | doaj.art-c0343e7c468b46a0ad3b0b1fc51264af2022-12-21T19:32:53ZengBMCInternational Journal for Equity in Health1475-92762019-02-0118111110.1186/s12939-019-0931-4Long-term out of pocket expenditure of people with cancer: comparing health service cost and use for indigenous and non-indigenous people with cancer in AustraliaEmily Callander0Nicole Bates1Daniel Lindsay2Sarah Larkins3Stephanie M. Topp4Joan Cunningham5Sabe Sabesan6Gail Garvey7School of Medicine, Griffith UniversityAustralian Institute of Tropical Health and Medicine (AITHM), James Cook UniversityCollege of Public Health, Medical and Veterinary Sciences (CPHMVS), James Cook UniversityCollege of Medicine and Dentistry (CMD), James Cook UniversityCollege of Public Health, Medical and Veterinary Sciences (CPHMVS), James Cook UniversityMenzies School of Health Research, Charles Darwin UniversityCollege of Medicine and Dentistry (CMD), James Cook UniversityMenzies School of Health Research, Charles Darwin UniversityAbstract Background Indigenous Australians diagnosed with cancer have poorer survival compared to non-Indigenous Australians. We aim to: 1) identify differences by Indigenous status in out-of-pocket expenditure for the first three-years post-diagnosis; 2) identify differences in the quantity and cost of healthcare services accessed; and 3) estimate the number of additional services required if access was equal between Indigenous and non-Indigenous people with cancer. Methods We used CancerCostMod, a model using linked administrative data. The base population was all persons diagnosed with cancer in Queensland, Australia (01JUL2011 to 30JUN2012) (n = 25,553). Each individual record was then linked to their Admitted Patient Data Collection, Emergency Data Information System, Medicare Benefits Schedule (MBS), and Pharmaceutical Benefits Scheme (PBS) records (01JUL2011 to 30JUN2015). We then weighted the population to be representative of the Australian population (approximately 123,900 Australians, 1.7% Indigenous Australians). The patient co-payment charged for each MBS service and PBS prescription was summed for each month from date of diagnosis to 36-months post-diagnosis. We then limited our model to MBS items to identify the quantity and type of healthcare services accessed during the first three-years. Results On average Indigenous people with cancer had less than half the out-of-pocket expenditure for each 12-month period (0–12 months: mean $401 Indigenous vs $1074 non-Indigenous; 13–24 months: mean $200 vs $484; and 25–36 months: mean $181 vs $441). A stepwise generalised linear model of out-of-pocket expenditure found that Indigenous status was a significant predictor of out of pocket expenditure. We found that Indigenous people with cancer on average accessed 236 services per person, however, this would increase to 309 services per person if Indigenous people had the same rate of service use as non-Indigenous people. Conclusions Indigenous people with cancer had lower out-of-pocket expenditure, but also accessed fewer Medicare services compared to their non-Indigenous counterparts. Indigenous people with cancer were less likely to access specialist attendances, pathology tests, and diagnostic imaging through MBS, and more likely to access primary health care, such as services provided by general practitioners.http://link.springer.com/article/10.1186/s12939-019-0931-4CostRuralitySocioeconomicIndigenous |
| spellingShingle | Emily Callander Nicole Bates Daniel Lindsay Sarah Larkins Stephanie M. Topp Joan Cunningham Sabe Sabesan Gail Garvey Long-term out of pocket expenditure of people with cancer: comparing health service cost and use for indigenous and non-indigenous people with cancer in Australia International Journal for Equity in Health Cost Rurality Socioeconomic Indigenous |
| title | Long-term out of pocket expenditure of people with cancer: comparing health service cost and use for indigenous and non-indigenous people with cancer in Australia |
| title_full | Long-term out of pocket expenditure of people with cancer: comparing health service cost and use for indigenous and non-indigenous people with cancer in Australia |
| title_fullStr | Long-term out of pocket expenditure of people with cancer: comparing health service cost and use for indigenous and non-indigenous people with cancer in Australia |
| title_full_unstemmed | Long-term out of pocket expenditure of people with cancer: comparing health service cost and use for indigenous and non-indigenous people with cancer in Australia |
| title_short | Long-term out of pocket expenditure of people with cancer: comparing health service cost and use for indigenous and non-indigenous people with cancer in Australia |
| title_sort | long term out of pocket expenditure of people with cancer comparing health service cost and use for indigenous and non indigenous people with cancer in australia |
| topic | Cost Rurality Socioeconomic Indigenous |
| url | http://link.springer.com/article/10.1186/s12939-019-0931-4 |
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