Out-of-pocket healthcare expenditure and chronic disease – do Australians forgo care because of the cost?Emily J. Callander A D , Lisa Corscadden B and Jean-Frederic Levesque B C
A Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Qld 4811, Australia.
B Bureau of Health Information, Level 11, 67 Albert Avenue, Chatswood, NSW 2057, Australia.
C Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia.
D Corresponding author. Email: firstname.lastname@example.org
Australian Journal of Primary Health 23(1) 15-22 https://doi.org/10.1071/PY16005
Submitted: 21 January 2016 Accepted: 23 April 2016 Published: 25 July 2016
Although we do know that out-of-pocket healthcare expenditure is relatively high in Australia, little is known about what health conditions are associated with the highest out-of-pocket expenditure, and whether the cost of healthcare acts as a barrier to care for people with different chronic conditions. Cross-sectional analysis using linear and logistic regression models applied to the Commonwealth Fund international health policy survey of adults aged 18 years and over was conducted in 2013. Adults with asthma, emphysema and chronic obstructive pulmonary disease (COPD) had 109% higher household out-of-pocket healthcare expenditure than did those with no health condition (95% CI: 50–193%); and adults with depression, anxiety and other mental health conditions had 95% higher household out-of-pocket expenditure (95% CI: 33–187%). People with a chronic condition were also more likely to forego care because of cost. People with depression, anxiety and other mental health conditions had 7.65 times higher odds of skipping healthcare (95% CI: 4.13–14.20), and people with asthma, emphysema and chronic obstructive pulmonary disease had 6.16 times higher odds of skipping healthcare (95% CI: 3.30–11.50) than did people with no health condition. People with chronic health conditions in Canada, the United Kingdom, Germany, France, Norway, Sweden and Switzerland were all significantly less likely to skip healthcare because of cost than were people with a condition in Australia. The out-of-pocket cost of healthcare in Australia acts as a barrier to accessing treatment for people with chronic health conditions, with people with mental health conditions being likely to skip care. Attention should be given to the accessibility and affordability of mental health services in Australia.
Additional keywords: chronic health conditions, patient contributions.
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