Private health insurance and quality of life: perspectives of older Australians with multiple chronic conditionsYun-Hee Jeon A C , Annie Black A , Janelle Govett A , Laurann Yen B and Ian McRae B
A Sydney Nursing School, The University of Sydney, 88 Mallett Street, Camperdown, NSW 2050, Australia.
B Australian Primary Health Care Research Institute, Level 1, Ian Potter House, Corner of Gordon and Marcus Clarke Streets, The Australian National University, Acton, ACT 2601, Australia.
C Corresponding author. Email: email@example.com
Australian Journal of Primary Health 18(3) 212-219 https://doi.org/10.1071/PY11059
Submitted: 20 May 2011 Accepted: 18 August 2011 Published: 17 November 2011
A qualitative study was conducted to explore in-depth issues relating to the health costs of chronic illness as identified in a previous study. A key theme that emerged from interviews carried out was the benefits and challenges of private health insurance (PHI) membership, and choices older Australians with multimorbidity make in accessing health services, with and without PHI. This is the focus of this paper. Semistructured interviews were conducted with 40 older people with multiple chronic conditions. Data were analysed using content analysis. Key motivators for maintaining PHI included: fear of an inability to access timely health care; the opportunity to exercise choice in service provider; a belief of being ‘better off’ both medically and financially, which was often ill-founded; and the core values of self reliance and independence. Most described financial pressure caused by rising PHI premiums as well as other out-of-pocket health related expenses. Many older people who can ill afford PHI still struggle to maintain it, potentially at the cost of their quality of life, based on beliefs about costs of health care that they have never properly assessed. The findings highlight the degree to which people whose resources are constrained are prepared to go to maintain access to private hospital care. Attention should be given to assisting older people to make informed and valid choices of health insurance derived from the facts, rather than being based on fear and assumptions.
Additional keywords: chronic disease, health care costs, multimorbidity, older people.
ReferencesAbbott T (2005) Private health insurance rebate increases today for older Australians. Available at http://www.tonyabbott.com.au/LatestNews/InterviewTranscripts/tabid/85/articleType/ArticleView/articleId/3778/PRIVATE-HEALTH-INSURANCE-REBATE-INCREASES-TODAY-FOR-OLDER-AUSTRALIANS.aspx [Verified 3 May 2011]
Armstrong BK, Gillespie JA, Leeder SR, Rubin GL, Russell LM (2007) Challenges in health and health care for Australia. The Medical Journal of Australia 187, 485–489.
Australian Bureau of Statistics (2009) ‘National Health Survey: summary of results, 2007–2008.’ (Australian Bureau of Statistics: Canberra)
Australian Institute of Health and Welfare (2006) ‘Chronic diseases and associated risk factors in Australia.’ Cat. no. PHE 81. (Australian Institute of Health and Welfare: Canberra)
Beaton A, Usherwood T, Leeder SR, Russel L (2011) ‘Perceptions of economic hardship and implications for illness management: a survey of general practitioners in western Sydney.’ (Menzies Centre for Health Policy, and Sydney Medical School: Sydney) Available at http://www.menzieshealthpolicy.edu.au/pubs_reports2011.php [Verified 30 April 2011]
Ellis RP, Savage E (2008) Run for cover now or later? The impact of premiums, threats and deadlines on private health insurance in Australia. International Journal of Health Care Finance and Economics 8, 257–277.
| Run for cover now or later? The impact of premiums, threats and deadlines on private health insurance in Australia.CrossRef | 18568433PubMed |
Humpel N, O’Loughlin K, Wells Y, Kendig H (2010) The health of Australian baby boomers. Australasian Journal on Ageing 29, 8–13.
| The health of Australian baby boomers.CrossRef | 20398080PubMed |
Jeon YH, Essue B, Jan S, Wells R, Whitworth JA (2009) Economic hardship associated with managing chronic illness: a qualitative inquiry. BMC Health Services Research 9, 182
Jeon Y-H, Jowsey T, Yen L, Glasgow NJ, Essue B, Kljakovic M, Pearce-Brown C, Mirzaei M, Usherwood T, Jan S, Kraus SG, Aspin C (2010) Achieving a balanced life in the face of chronic illness. Australian Journal of Primary Health 16, 66–74.
| Achieving a balanced life in the face of chronic illness.CrossRef | 21133301PubMed |
Jowsey T, Jeon Y-H, Dugdale P, Glasgow NJ, Kljakovic M, Usherwood T (2009) Challenges for co-morbid chronic illness care and policy in Australia: a qualitative study. Australia and New Zealand Health Policy 6, 22
| Challenges for co-morbid chronic illness care and policy in Australia: a qualitative study.CrossRef | 19735576PubMed |
Kleinman A, Eisenberg L, Good B (1978) Culture, illness and care: clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine 88, 251–258.
Korda RJ, Banks E, Clements MS, Young AF (2009) Is inequity undermining Australia’s ‘universal’ health care system? Socio-economic inequalities in the use of specialist medical and non-medical ambulatory health care. Australian and New Zealand Journal of Public Health 33, 458–465.
| Is inequity undermining Australia’s ‘universal’ health care system? Socio-economic inequalities in the use of specialist medical and non-medical ambulatory health care.CrossRef | 19811484PubMed |
Lokuge B, Denniss R, Faunce TA (2005) Private health insurance and regional Australia. The Medical Journal of Australia 182, 290–293.
McRae I, Yen L, Jeon Y-H, Skladzien E, Herath M (2010) Costs faced by older Australians with chronic conditions. International Federation on Ageing 10th Global Conference on Ageing, 3–6 May 2010. Melbourne, Australia.
Moorin RE, Holman CDJ (2006) The effects of socioeconomic status, accessibility to services and patient type on hospital use in Western Australia: a retrospective cohort study of patients with homogenous health status. BMC Health Services Research 6, 74
Moorin RE, Holman CDJ (2007) Modelling changes in the determinants of PHI utilisation in Western Australia across five health care policy eras between 1981 and 2001. Health Policy 81, 183–194.
| Modelling changes in the determinants of PHI utilisation in Western Australia across five health care policy eras between 1981 and 2001.CrossRef | 16831484PubMed |
Moorin RE, D’Arcy J, Holman C (2006) Does federal health care policy influence switching between the public and private sectors in individuals? Health Policy 79, 284–295.
| Does federal health care policy influence switching between the public and private sectors in individuals?CrossRef | 16510206PubMed |
Morse J, Field P (1995) ‘Qualitative research methods for health professionals.’ 2nd edn. (Sage Publications: Thousand Oaks, CA)
Quine S, Bernard D, Kendig H (2006) Understanding baby boomers’ expectations and plans for their retirement: findings from a qualitative study. Australasian Journal on Ageing 25, 145–150.
| Understanding baby boomers’ expectations and plans for their retirement: findings from a qualitative study.CrossRef |
Schoen C, Davis K, DesRoches C, Donelan K, Blendon R (2000) Health insurance markets and income inequality: findings from an international health policy survey. Health Policy 51, 67–85.
| Health insurance markets and income inequality: findings from an international health policy survey.CrossRef | 1:STN:280:DC%2BD3M%2Fgs1agtA%3D%3D&md5=07616eff028dbd608f0af4a2fa4ccce3CAS | 10699676PubMed |
Schoenberg NE, Kim H, Edwards W, Fleming ST (2007) Burden of common multiple-morbidity constellations on out-of-pocket medical expenditures among older adults. The Gerontologist 47, 423–437.
| Burden of common multiple-morbidity constellations on out-of-pocket medical expenditures among older adults.CrossRef | 17766664PubMed |
SPSS Inc. (2007) ‘SPSS statistics 17.0 brief guide.’ (SPSS Inc.: USA)
State and Territory Health Ministers (2007) ‘Caring for our health? A report card on the Australian Government’s performance on health care.’ (Acorn Press: Brookvale, NSW)
Stoelwinder JU (2002) The price of choice: private health insurance in Australia. Australian Health Review 25, 42–48.
| The price of choice: private health insurance in Australia.CrossRef | 12536861PubMed |
Temple JB (2004) Will the government’s proposed insurance reform increase the health insurance coverage of older Australians? People and Place 12, 2–10.
Temple JB (2006) Health insurance reform and older Australians. Australasian Journal on Ageing 25, 63–68.
| Health insurance reform and older Australians.CrossRef |
The Senate Standing Committee on Community Affairs (2008) ‘A decent quality of life. Inquiry into the cost of living pressures on older Australians.’ (Commonwealth of Australia: Canberra)
Van Doorslaer E, Clarke P, Savage E, Hall J (2008) Horizontal inequities in Australia’s mixed public/private health care system. Health Policy 86, 97–108.
| Horizontal inequities in Australia’s mixed public/private health care system.CrossRef | 18006176PubMed |
Walker C (2007) Chronic illness and consumer inequality: the impact of health costs on people with chronic illnesses in rural and regional Australia. Australian Health Review 31, 203–210.
| Chronic illness and consumer inequality: the impact of health costs on people with chronic illnesses in rural and regional Australia.CrossRef | 17470040PubMed |
Ware J, Kosinski M, Keller SD (1996) A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Medical Care 34, 220–233.
Williams A, Botti M (2002) Issues concerning the on-going care of patients with comorbidities in acute care and post-discharge in Australia: a literature review. Journal of Advanced Nursing 40, 131–140.
| Issues concerning the on-going care of patients with comorbidities in acute care and post-discharge in Australia: a literature review.CrossRef | 12366642PubMed |
Yen L, McRae I, Jeon Y-H, Essue B, Herath M (2011) The impact of chronic illness on workforce participation and the need for assistance with household tasks and personal care by older Australians. Health & Social Care in the Community
| The impact of chronic illness on workforce participation and the need for assistance with household tasks and personal care by older Australians.CrossRef |