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Horizontal inequity in the utilisation of healthcare services in Australia

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  • Pulok, Mohammad Habibullah
  • van Gool, Kees
  • Hall, Jane

Abstract

The Australian universal healthcare system aims to ensure affordable and equitable use of healthcare services based on individual health needs. This paper presents empirical evidence on the extent of horizontal inequity (HI) in healthcare services (unequal utilisation by income for equal need) in Australia during the period of promoting reliance on private healthcare financing. Using data from the most recent Australian National Health Survey of 2011−12 and 2014−15, we examined and measured the extent of HI in eight indicators of out-of-hospital services and hospital-related care. Contrary to earlier studies, our results show a small but pro-rich inequity in the probability of general practitioner visits. Inequity in the distribution of specialist and dentist visits was in favour of richer people, a result that is commonly found in other developed countries and is also consistent with existing Australian evidence. Hospital-related care was equitably distributed compared to the pro-poor pattern found in earlier studies. Despite the universal health insurance system in Australia, there was inequity in the utilisation of needed healthcare services. Our evidence is relevant to similar health systems as governments move to higher out-of-pocket payments and other private sources to reduce pressure on public healthcare expenditure.

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  • Pulok, Mohammad Habibullah & van Gool, Kees & Hall, Jane, 2020. "Horizontal inequity in the utilisation of healthcare services in Australia," Health Policy, Elsevier, vol. 124(11), pages 1263-1271.
    • Handle: RePEc:eee:hepoli:v:124:y:2020:i:11:p:1263-1271
    DOI: 10.1016/j.healthpol.2020.08.012
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    1. Johar, Meliyanni & Jones, Glenn & Keane, Micheal P. & Savage, Elizabeth & Stavrunova, Olena, 2013. "Discrimination in a universal health system: Explaining socioeconomic waiting time gaps," Journal of Health Economics, Elsevier, vol. 32(1), pages 181-194.
    2. Erreygers, Guido, 2009. "Correcting the Concentration Index: A reply to Wagstaff," Journal of Health Economics, Elsevier, vol. 28(2), pages 521-524, March.
    3. Mohammad Habibullah Pulok & Kees Gool & Mohammad Hajizadeh & Sara Allin & Jane Hall, 2020. "Measuring horizontal inequity in healthcare utilisation: a review of methodological developments and debates," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(2), pages 171-180, March.
    4. Lu, Jui-fen R. & Leung, Gabriel M. & Kwon, Soonman & Tin, Keith Y.K. & Van Doorslaer, Eddy & O'Donnell, Owen, 2007. "Horizontal equity in health care utilization evidence from three high-income Asian economies," Social Science & Medicine, Elsevier, vol. 64(1), pages 199-212, January.
    5. García-Gómez, Pilar & Hernández-Quevedo, Cristina & Jiménez-Rubio, Dolores & Oliva-Moreno, Juan, 2015. "Inequity in long-term care use and unmet need: Two sides of the same coin," Journal of Health Economics, Elsevier, vol. 39(C), pages 147-158.
    6. Kim Dalziel & Jinhu Li & Anthony Scott & Philip Clarke, 2018. "Accuracy of patient recall for self‐reported doctor visits: Is shorter recall better?," Health Economics, John Wiley & Sons, Ltd., vol. 27(11), pages 1684-1698, November.
    7. Wong, Chun Yee & Hall, Jane, 2018. "Does patients’ experience of general practice affect the use of emergency departments? Evidence from Australia," Health Policy, Elsevier, vol. 122(2), pages 126-133.
    8. Mohammad Hajizadeh & Luke Brian Connelly & James Robert Gerard Butler, 2014. "Health Policy and Equity of Health Care Financing in Australia: 1973–2010," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 60(2), pages 298-322, June.
    9. Emily J. Callander & Haylee Fox & Daniel Lindsay, 2019. "Out-of-pocket healthcare expenditure in Australia: trends, inequalities and the impact on household living standards in a high-income country with a universal health care system," Health Economics Review, Springer, vol. 9(1), pages 1-8, December.
    10. Eddy van Doorslaer & Xander Koolman & Andrew M. Jones, 2004. "Explaining income‐related inequalities in doctor utilisation in Europe," Health Economics, John Wiley & Sons, Ltd., vol. 13(7), pages 629-647, July.
    11. Stephen Goodall & Anthony Scott, 2008. "Is Hospital Treatment in Australia Inequitable? Evidence from the HILDA Survey," Melbourne Institute Working Paper Series wp2008n05, Melbourne Institute of Applied Economic and Social Research, The University of Melbourne.
    12. Marion Devaux & Michael de Looper, 2012. "Income-Related Inequalities in Health Service Utilisation in 19 OECD Countries, 2008-2009," OECD Health Working Papers 58, OECD Publishing.
    13. Bago d'Uva, Teresa & Jones, Andrew M. & van Doorslaer, Eddy, 2009. "Measurement of horizontal inequity in health care utilisation using European panel data," Journal of Health Economics, Elsevier, vol. 28(2), pages 280-289, March.
    14. FLEURBAEY, Marc & SCHOKKAERT, Erik, 2011. "Equity in health and health care," LIDAM Discussion Papers CORE 2011026, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).
    15. Adam Wagstaff & Eddy van Doorslaer, 2000. "Measuring and Testing for Inequity in the Delivery of Health Care," Journal of Human Resources, University of Wisconsin Press, vol. 35(4), pages 716-733.
    16. Marion Devaux, 2015. "Income-related inequalities and inequities in health care services utilisation in 18 selected OECD countries," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(1), pages 21-33, January.
    17. Fleurbaey, Marc & Schokkaert, Erik, 2009. "Unfair inequalities in health and health care," Journal of Health Economics, Elsevier, vol. 28(1), pages 73-90, January.
    18. Edmund Maurice FitzGerald & Michelle Cunich & Philip Miles Clarke, 2011. "Changes in Inequalities of Access to Dental Care in Australia 1977–2005," Australian Economic Review, The University of Melbourne, Melbourne Institute of Applied Economic and Social Research, vol. 44(2), pages 153-166, June.
    19. Dolores Jiménez‐Rubio & Peter C. Smith & Eddy Van Doorslaer, 2008. "Equity in health and health care in a decentralised context: evidence from Canada," Health Economics, John Wiley & Sons, Ltd., vol. 17(3), pages 377-392, March.
    20. Mohammad Hajizadeh & Luke Brian Connelly & James Robert Gerard Butler, 2012. "Health policy and horizontal inequities of health-care utilization in Australia: 1983--2005," Applied Economics Letters, Taylor & Francis Journals, vol. 19(18), pages 1765-1775, December.
    21. Wagstaff, Adam & van Doorslaer, Eddy, 2000. "Chapter 34 Equity in health care finance and delivery," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 34, pages 1803-1862, Elsevier.
    22. Meliyanni Johar & Chunzhou Mu & Kees Van Gool & Chun Yee Wong, 2017. "Bleeding Hearts, Profiteers, or Both: Specialist Physician Fees in an Unregulated Market," Health Economics, John Wiley & Sons, Ltd., vol. 26(4), pages 528-535, April.
    23. Pulok, Mohammad Habibullah & van Gool, Kees & Hall, Jane, 2020. "Inequity in physician visits: the case of the unregulated fee market in Australia," Social Science & Medicine, Elsevier, vol. 255(C).
    24. Joachim Frick & Nicolas Ziebarth, 2013. "Welfare-related health inequality: does the choice of measure matter?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(3), pages 431-442, June.
    25. Adam Wagstaff, 2005. "The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality," Health Economics, John Wiley & Sons, Ltd., vol. 14(4), pages 429-432, April.
    26. Hua, Xinyang & Erreygers, Guido & Chalmers, John & Laba, Tracey-Lea & Clarke, Philip, 2017. "Using administrative data to look at changes in the level and distribution of out-of-pocket medical expenditure: An example using Medicare data from Australia," Health Policy, Elsevier, vol. 121(4), pages 426-433.
    27. Erreygers, Guido, 2009. "Can a single indicator measure both attainment and shortfall inequality?," Journal of Health Economics, Elsevier, vol. 28(4), pages 885-893, July.
    28. Grignon, Michel & Hurley, Jeremiah & Wang, Li & Allin, Sara, 2010. "Inequity in a market-based health system: Evidence from Canada's dental sector," Health Policy, Elsevier, vol. 98(1), pages 81-90, November.
    29. Kjellsson, Gustav & Gerdtham, Ulf-G., 2013. "On correcting the concentration index for binary variables," Journal of Health Economics, Elsevier, vol. 32(3), pages 659-670.
    30. Hugh Gravelle, 2003. "Measuring income related inequality in health: standardisation and the partial concentration index," Health Economics, John Wiley & Sons, Ltd., vol. 12(10), pages 803-819, October.
    31. Hai Zhong, 2010. "On decomposing the inequality and inequity change in health care utilization: change in means, or change in the distributions?," International Journal of Health Economics and Management, Springer, vol. 10(4), pages 369-386, December.
    32. Dalziel, Kim M. & Huang, Li & Hiscock, Harriet & Clarke, Philip M., 2018. "Born equal? The distribution of government Medicare spending for children," Social Science & Medicine, Elsevier, vol. 208(C), pages 50-54.
    33. Duckett, Stephen, 2018. "Expanding the breadth of Medicare: learning from Australia," Health Economics, Policy and Law, Cambridge University Press, vol. 13(3-4), pages 344-368, July.
    34. Erreygers, Guido, 2009. "Correcting the Concentration Index," Journal of Health Economics, Elsevier, vol. 28(2), pages 504-515, March.
    35. Chun Yee Wong & Jessica Greene & Xenia Dolja‐Gore & Kees van Gool, 2017. "The Rise and Fall in Out‐of‐Pocket Costs in Australia: An Analysis of the Strengthening Medicare Reforms," Health Economics, John Wiley & Sons, Ltd., vol. 26(8), pages 962-979, August.
    36. Chen, Zhuo & Roy, Kakoli, 2009. "Calculating concentration index with repetitive values of indicators of economic welfare," Journal of Health Economics, Elsevier, vol. 28(1), pages 169-175, January.
    37. Martin Siegel & Andreas Mielck & Werner Maier, 2015. "Individual Income, Area Deprivation, and Health: Do Income‐Related Health Inequalities Vary by Small Area Deprivation?," Health Economics, John Wiley & Sons, Ltd., vol. 24(11), pages 1523-1530, November.
    38. Wagstaff, Adam & van Doorslaer, Eddy & Paci, Pierella, 1991. "On the measurement of horizontal inequity in the delivery of health care," Journal of Health Economics, Elsevier, vol. 10(2), pages 169-205, July.
    39. Culyer, A. J. & Wagstaff, Adam, 1993. "Equity and equality in health and health care," Journal of Health Economics, Elsevier, vol. 12(4), pages 431-457, December.
    40. Van de Poel, Ellen & Van Doorslaer, Eddy & O’Donnell, Owen, 2012. "Measurement of inequity in health care with heterogeneous response of use to need," Journal of Health Economics, Elsevier, vol. 31(4), pages 676-689.
    41. Van Doorslaer, Eddy & Clarke, Philip & Savage, Elizabeth & Hall, Jane, 2008. "Horizontal inequities in Australia's mixed public/private health care system," Health Policy, Elsevier, vol. 86(1), pages 97-108, April.
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    3. Laura Hirello & Mohammad Habibullah Pulok & Mohammad Hajizadeh, 2022. "Equity in healthcare utilization in Canada’s publicly funded health system: 2000–2014," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(9), pages 1519-1533, December.
    4. Md Irteja Islam & Gail M Ormsby & Enamul Kabir & Rasheda Khanam, 2021. "Estimating income-related and area-based inequalities in mental health among nationally representative adolescents in Australia: The concentration index approach," PLOS ONE, Public Library of Science, vol. 16(9), pages 1-14, September.
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    6. Pulok, Mohammad Habibullah & Hajizadeh, Mohammad, 2022. "Equity in the use of physician services in Canada's universal health system: A longitudinal analysis of older adults," Social Science & Medicine, Elsevier, vol. 307(C).

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