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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

Author

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  • Emily J. Callander

    (School of Medicine, Griffith University – Gold Coast campus)

  • Haylee Fox

    (School of Medicine, Griffith University – Gold Coast campus)

  • Daniel Lindsay

    (College of Public Health, Medical and Veterinary Science, James Cook University)

Abstract

Background Poor health increases the likelihood of experiencing poverty by reducing a person’s ability to work and imparting costs associated with receiving medical treatment. Universal health care is a means of protecting against the impoverishing impact of high healthcare costs. This study aims to document the recent trends in the amount paid by Australian households out-of-pocket for healthcare, identify any inequalities in the distribution of this expenditure, and to describe the impact that healthcare costs have on household living standards in a high-income country with a long established universal health care system. We undertook this analysis using a longitudinal, nationally representative dataset – the Household Income and Labour Dynamics in Australia Survey, using data collected annually from 2006 to 2014. Out of pocket payments covered those paid to health practitioners, for medication and in private health insurance premiums; catastrophic expenditure was defined as spending 10% or more of household income on healthcare. Results Average total household expenditure on healthcare items remained relatively stable between 2006 and 2014 after adjusting for inflation, changing from $3133 to $3199. However, after adjusting for age, self-reported health status, and year, those in the lowest income group (decile one) had 15 times the odds (95% CI, 11.7–20.8) of having catastrophic health expenditure compared to those in the highest income group (decile ten). The percentage of people in income decile 2 and 3 who had catastrophic health expenditure also increased from 13% to 19% and 7% to 13% respectively. Conclusions Ongoing monitoring of out of pocket healthcare expenditure is an essential part of assessing health system performance, even in countries with universal health care.

Suggested Citation

  • 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.
    • Handle: RePEc:spr:hecrev:v:9:y:2019:i:1:d:10.1186_s13561-019-0227-9
    DOI: 10.1186/s13561-019-0227-9
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    References listed on IDEAS

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    Cited by:

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    2. 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.
    3. Sabanovic, Hana & La Brooy, Camille & Méndez, Susan J. & Yong, Jongsay & Scott, Anthony & Elshaug, Adam G. & Prang, Khic-Houy, 2023. "“It's not a one operation fits all”: A qualitative study exploring fee setting and participation in price transparency initiatives amongst medical specialists in the Australian private healthcare sect," Social Science & Medicine, Elsevier, vol. 339(C).
    4. Nguyen, John, 2023. "The impact of private health insurance on household savings : Evidence from Australia," Warwick-Monash Economics Student Papers 48, Warwick Monash Economics Student Papers.
    5. Junpeng Li & Puneet Vatsa & Wanglin Ma, 2024. "Flush toilet use and its impact on health and non‐health expenditures," Journal of International Development, John Wiley & Sons, Ltd., vol. 36(4), pages 2022-2046, May.
    6. Bailey Yee & Nisa Mohan & Fiona McKenzie & Mona Jeffreys, 2024. "What Interventions Work to Reduce Cost Barriers to Primary Healthcare in High-Income Countries? A Systematic Review," IJERPH, MDPI, vol. 21(8), pages 1-28, August.
    7. Jay Dev Dubey, 2021. "Measuring Income Elasticity of Healthcare-Seeking Behavior in India: A Conditional Quantile Regression Approach," Journal of Quantitative Economics, Springer;The Indian Econometric Society (TIES), vol. 19(4), pages 767-793, December.
    8. Callander, Emily J. & Shand, Antonia & Nassar, Natasha, 2021. "Inequality in out of pocket fees, government funding and utilisation of maternal health services in Australia," Health Policy, Elsevier, vol. 125(6), pages 701-708.
    9. Timothy Ludlow & Jonas Fooken & Christiern Rose & Kam Ki Tang, 2024. "Out-of-pocket expenditure, need, utilisation, and private health insurance in the Australian healthcare system," International Journal of Health Economics and Management, Springer, vol. 24(1), pages 33-56, March.

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