If I was Health Minister (heaven forbid as I wouldn’t have the stamina, political nous, or tolerance for playing the media game), I would insist that the following question was applied to every piece of policy advice or recommendation.
Will this further increase the inequities in access to good health and to health services? Or will it help close these gaps?
It doesn’t seem such an unreasonable ask when we have so much evidence that those who are most likely to have health problems are least likely to have access to useful health care.
A study published in the latest Australian and NZ Journal of Public Health provides yet more ammunition for this line of questioning.
Researchers from the ANU and University of Newcastle used data from a 2004 survey of 10,905 women aged 53 to 58 to examine the relationship between socioeconomic status and health service use.
Given that poorer and more disadvantaged groups are generally more likely to have chronic diseases and other health problems, you might expect them to use health services more often.
Not so. While GP use was roughly the same between the wealthier and the poorer, the better off women were more likely to report having used dental services, specialists, allied health practitioners, and alternative health providers.
The researchers say their findings support experts who have questioned the private health insurance rebate, and suggest that it is adding to inequities by enabling wealthier women to access allied health services, often important in the management of chronic diseases, that poorer women without insurance could not afford.
“The pattern of findings suggests that inequalities in care are to some extent shaped by the health care system itself, where out-of-pocket costs and private care influence access,” the researchers said.
“International findings are in line with these conclusions – inequity in ambulatory medical and dental care in universal systems is found to be greatest in countries where private health insurance and direct private payments play some role in access to services.”
The researchers note that their findings don’t prove that poorer women are being under-treated as their study could not rule out the possibility that advantaged women are being over-serviced. “Nevertheless,” they said, “this in itself could still be considered inequitable in that health expenditure is not being distributed according to need.”
The researchers conclude that their findings “suggest unfairness and inefficiency in the allocation of services as those who are sickest and hence potentially have the greatest capacity to benefit from health care, are not those most likely to receive it.”
Meanwhile, the Australian Healthcare and Hospitals Association has just issued this release, putting pressure on the AMA to join its stance opposing the private health insurance rebate.
It says: “The private health insurance rebate is a grossly inefficient means of supporting private health care and would deliver much greater gains to the community if spent directly on health services and infrastructure. AHHA calls on all health groups to unite in advocating for the re-direction of the private health insurance rebate funds into public hospitals and community-based care.”
Now wouldn’t that be something – imagine if the closing the gaps question was asked, not only by Health Ministers, but by powerbrokers like the AMA…what a difference that might make.