Horizontal equity in the Australian healthcare system : exploring the unknowns and updating the knowns

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Australia has a tax-funded universal health insurance system known as Medicare, which aims to ensure universal and equitable use of healthcare services. This thesis assesses the fairness of the Australian healthcare system in delivering healthcare services during the period of encouraging greater private healthcare financing. This thesis first measures the degree of horizontal inequity (unequal care for equal need) in eight indicators of healthcare use between 2011-12 and 2014-15. Secondly, it examines inequity in GP and specialist visit by making a distinction between the probability of visit and the conditional visit. Thirdly, this thesis investigates how co-payment is related to area-level socioeconomic inequality in Medicare-funded specialist care by using national administrative data. Finally, it measures and explains inequity in use of healthcare services within the non-remote Indigenous Australians. The overall finding is that there was pro-rich inequity in use of out-of-hospital services while the utilisation of hospital-related services was almost equitable. There was a small degree of pro-rich inequity in the probability of GP visits, but significant pro-poor inequity in conditional visits to GP. On the contrary, there was considerable inequity in the probability of visiting a specialist favouring richer people. The distribution of conditional visits for this care was almost equitable, but it appears to be pro-rich when higher users were excluded from the analysis. Income, private health insurance, and education significantly accounted for pro-rich inequity while the contribution of concession card to inequity was pro-poor. The analysis of Medicare Benefit Schedule (MBS) data shows that inequality in specialist services was favourable to the individuals living in socioeconomically advantaged areas. Most importantly, this inequality was higher for visits with co-payment while there was almost no inequality in visits without co-payment. Finally, there was no evidence of inequity in the utilisation of GP services and inpatient admission within the Indigenous Australians. However, wealthier Indigenous Australians were higher users of specialist services than their poorer counterparts despite having similar levels of need. Pro-rich inequity in specialist services suggests the need for policy discussions to reform Medicare safety net arrangements so that poorer people have a chance to access larger benefits. Policy reforms should ensure that Medicare serves financially vulnerable and sicker people equitably.
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