CSIRO Publishing blank image blank image blank image blank imageBooksblank image blank image blank image blank imageJournalsblank image blank image blank image blank imageAbout Usblank image blank image blank image blank imageShopping Cartblank image blank image blank image You are here: Journals > Australian Journal of Primary Health   
Australian Journal of Primary Health
http://www.latrobe.edu.au/aipca/
  The issues influencing community health services and primary health care
 
blank image Search
 
blank image blank image
blank image
 
  Advanced Search
   

Journal Home
About the Journal
Editorial Board
Contacts
Content
Online Early
Current Issue
Just Accepted
All Issues
Special Issues
Sample Issue
For Authors
General Information
Instructions to Authors
Submit Article
Open Access
For Referees
Referee Guidelines
Review an Article
Annual Referee Index
For Subscribers
Subscription Prices
Customer Service
Print Publication Dates

blue arrow e-Alerts
blank image
Subscribe to our email Early Alert or RSS feeds for the latest journal papers.

red arrow Connect with CP
blank image
facebook twitter youtube

 

Article << Previous     |     Next >>   Contents Vol 19(2)

Multimorbidity is associated with higher out-of-pocket spending: a study of older Australians with multiple chronic conditions

Ian McRae A E , Laurann Yen B , Yun-Hee Jeon C , Pushpani M. Herath A and Beverley Essue D

A Australian Primary Health Care Research Institute, Ian Potter House, Corner Marcus Clarke and Gordon Streets, The Australian National University, Acton, Canberra, ACT 0200, Australia.
B Menzies Centre for Health Policy, Ian Potter House, Corner Marcus Clarke and Gordon Streets, The Australian National University, Acton, Canberra, ACT 0200, Australia.
C Faculty of Nursing and Midwifery, The University of Sydney, 88 Mallett Street, Camperdown, NSW 2006, Australia.
D The George Institute for Global Health, Level 10, King George V Building, Missenden Road, Camperdown, NSW 2050, Australia.
E Corresponding author. Email: ian.s.mcrae@anu.edu.au

Australian Journal of Primary Health 19(2) 144-149 http://dx.doi.org/10.1071/PY12035
Submitted: 27 March 2012  Accepted: 24 April 2012   Published: 24 May 2012


 
PDF (176 KB) $25
 Export Citation
 Print
  
Abstract

Most older Australians have at least one chronic health condition. The management of chronic disease is associated with potentially severe economic consequences for patients and their households, partially due to the financial burden associated with out-of-pocket costs for medical and health-related care. A questionnaire was mailed to a cross-sectional sample of older Australians in mid-2009, with 4574 responding. Multivariate logistic regression models were developed to investigate the relationships between multimorbidity and out-of-pocket spending on medical and health-related expenses, including the factors associated with severe financial stress among older Australians. We found a positive relationship between number of chronic conditions and out-of-pocket spending on health and that people with multiple chronic conditions tend to be on lower incomes. People with five or more chronic conditions spent on average five times as much on their health as those with no diagnosed chronic conditions and each additional chronic disease added 46% to the likelihood of a person facing a severe financial burden due to health costs.

While health policy may minimise out-of-pocket spending for individual conditions, costs compound rapidly for patients with multiple conditions and this burden falls most heavily on those with the lowest incomes.



References

45 and Up Study Collaborators (2008) Cohort profile: the 45 and Up Study. International Journal of Epidemiology 37, 941–947.

Ataguba JE (2011) Reassessing catastrophic health-care payments with a Nigerian case study. Health Economics, Policy and Law 1–18.
CrossRef |

Australian Bureau of Statistics (2006) ‘National health survey, 2004–05.’ Cat. no. 4364.0. (Australian Bureau of Statistics: Canberra)

Australian Bureau of Statistics (2007a) ‘Household income and income distribution, Australia, 2005–06.’ Cat. no. 6523.0. (Australian Bureau of Statistics: Canberra)

Australian Bureau of Statistics (2007b) ‘Census of population and housing, non-school qualification, level of education by age and sex.’ Cat. no. 2068.0. (Australian Bureau of Statistics: Canberra)

Australian Bureau of Statistics (2007c) ‘Census of population and housing, CDATA 2006.’ (Australian Bureau of Statistics: Canberra.)

Australian Bureau of Statistics (2008) ‘Census of population and housing: socio-economic indexes for areas (SEIFA), Australia - data only - 2033.0.55.001.’ (Australian Bureau of Statistics: Canberra)

Australian Bureau of Statistics (2009a) ‘National health survey: summary of results, 2007–2008 (reissue).’ Cat. no. 4364.0. (Australian Bureau of Statistics: Canberra)

Australian Bureau of Statistics (2009b) ‘Australian labour market statistics, July 2009.’ Cat. no. 6105.0. (Australian Bureau of Statistics: Canberra)

Australian Bureau of Statistics (2009c) ‘Australian social trends 2009.’ Cat. no. 4102.0. (Australian Bureau of Statistics: Canberra)

Australian Institute of Health and Welfare (2006) ‘Chronic disease and associated risk factors in Australia 2006.’ Cat. no. PHE 81. (Australian Institute of Health and Welfare: Canberra)

Australian Institute of Health and Welfare (2010) ‘Australia’s health 2010.’ (Australian Institute of Health and Welfare: Canberra)

Dewey HM, Thrift AG, Mihalopoulos C, Carter R, Macdonell RA, McNeil JJ, Donnan GA (2004) ‘Out of pocket’ costs to stroke patients during the first year after stroke - results from the North East Melbourne Stroke Incidence Study. Journal of Clinical Neuroscience 11, 134–137.
CrossRef |

Doggett J (2009) ‘Out of pocket: thinking health copayments.’ (Center for Policy Development: Canberra)

Doran E, Robertson J, Henry D (2005) Moral hazard and prescription medicine use in Australia - the patient perspective. Social Science & Medicine 60, 1437–1443.
CrossRef |

Essue B, Kelly P, Roberts M, Leeder S, Jan S (2011) We can’t afford my chronic illness! The out-of-pocket burden associated with managing chronic obstructive pulmonary disease in Western Sydney, Australia. Journal of Health Services Research & Policy 16, 226–231.
CrossRef |

Gordon LG, Ferguson M, Chambers SK, Dunn J (2009) Fuel, beds, meals and meds: out-of-pocket expenses for patients with cancer in rural Queensland. The Cancer Forum 33, 206–212.

Goss J (2008) ‘Projection of Australian health care expenditure by disease, 2003 to 2033.’ Cat. no. HWE 43. (AIHW: Canberra)

Hwang W, Weller W, Ireys H, Anderson G (2001) Out-of-pocket medical spending for care of chronic conditions. Health Affairs 20, 267–278.
CrossRef | CAS |

Jones G, Savage E, Van Gool K (2008) The distribution of household health expenditures in Australia. The Economic Record 84, S99–S114.
CrossRef |

Kemp A, Roughead E, Preen D, Glover J, Semmens J (2010) Determinants of self-reported medicine underuse due to cost: a comparison of seven countries. Journal of Health Services Research & Policy 15, 106–114.
CrossRef |

Lapsley H, March LM, Tribe K, Cross M, Courtenay B, Brooks P (2002) Living with rheumatoid arthritis: expenditures, health status, and social impact on patients. Annals of the Rheumatic Diseases 61, 818–821.
CrossRef | CAS |

Lehnert T, Heider D, Leicht H, Heinrich S (2011) Health care utilization and costs of elderly persons with multiple chronic conditions. Medical Care Research and Review 68, 387–420.
CrossRef |

Menzies Centre for Health Policy and Nous Group (2009) 2008 report 2: financial stress and health. Sydney. Available at http://www.menzieshealthpolicy.edu.au/mn_survey/index.htm [Verified 10 May 2012]

NATSEM (2008) ‘Distribution of expenditure on health goods and services by Australian households.’ (National Centre for Social and Economic Modelling: Canberra)

Paez KA, Zhao L, Hwang W (2009) Rising out-of-pocket spending for chronic conditions: a ten year trend. Health Affairs 28, 15–25.
CrossRef |

Private Health Insurance Administration Council (2009) ‘Quarterly statistics, September 2009.’ (Private Health Insurance Administration Council: Canberra)

Piette JD, Heisler MH, Wagner TH (2004) Cost related medication underuse among chronically ill adults: the treatments people forgo, how often and who is at risk. American Journal of Public Health 94, 1782–1787.
CrossRef |

Schoen C, Osborn R, Squires D, Doty MM, Peirson R, Appelbaum S (2010) How health insurance design affects access to care and costs, by income, in eleven countries. Health Affairs 29, 2323–2334.
CrossRef |

Wagstaff A, van Doorslear E (2003) Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993-1998. Health Economics 12, 921–934.
CrossRef |

Ware J, Kosinski M, Keller S (1996) A 12-Item short-form health survey: construction of scales and preliminary tests of reliability and validity. Medical Care 34, 220–233.
CrossRef |

Wooden M, Freiden S, Watson N (2002) The Household Income and Labour Dynamics in Australia (HILDA) survey: wave 1. Australian Economic Review 35, 339–348.

Xu K, Evans D, Kawabata K, Zeramdini R, Klavus J, Murray C (2003) Household catastrophic health expenditure: a multicountry analysis. The Lancet 362, 111–117.


   
Subscriber Login
Username:
Password:  

 
    
Legal & Privacy | Contact Us | Help

CSIRO

© CSIRO 1996-2014