Inequity in physician visits: the case of the unregulated fee market in Australia

Pulok, M; Van Gool, K; Hall, J

Inequity in physician visits: the case of the unregulated fee market in Australia

Pulok, M

Van Gool, K

Hall, J

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Publisher:: Elsevier
Publication Type:: Journal Article
Citation:: Social Science and Medicine, 2020, 255, pp. 113004
Issue Date:: 2020

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Field	Value	Language
dc.contributor.author	Pulok, M https://orcid.org/0000-0002-9168-5732
dc.contributor.author	Van Gool, K https://orcid.org/0000-0002-1424-9304
dc.contributor.author	Hall, J https://orcid.org/0000-0002-2191-0543
dc.date.accessioned	2020-09-22T07:26:32Z
dc.date.available	2020-04-18
dc.date.available	2020-09-22T07:26:32Z
dc.date.issued	2020
dc.identifier.citation	Social Science and Medicine, 2020, 255, pp. 113004
dc.identifier.issn	0277-9536
dc.identifier.issn	1873-5347
dc.identifier.uri	http://hdl.handle.net/10453/142807
dc.description.abstract	Equity is one of the key goals of universal healthcare coverage (UHC). Achieving this goal does not just depend on the presence of UHC, but also on its design and organisation. In Australia, out-of-hospital medical services are provided by private physicians in a market where fees are unregulated. This makes an interesting case to study equity. Using data from the Australian National Health Survey of 2014–15, we distinguish between the probability of any visit and the number of visits conditional on having any visit to analyse income-related inequity in general practitioner (GP) and specialist visits. We apply the horizontal inequity approach to measure the extent of inequity, and the decomposition method to explain the factors accounting for inequity. Our results show a small pro-rich inequity in the probability of any GP visit, but the distribution of conditional GP visits was concentrated among the poor. Inequity in the probability of any specialist visit was pro-rich. However, there was almost no inequity in conditional specialist visits. We find holding a concession card explained pro-poor inequity while income, education, and private health insurance contributed to pro-rich inequity in specialist visits. Although Australia has a universal health insurance system, there is unequal use (adjusted for health need) of physician services by socioeconomic status. This has implications for insurance design in other countries.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Elsevier
dc.relation	Capital Markets Cooperative Research Centre - Capital Markets CRC
dc.relation.ispartof	Social Science and Medicine
dc.relation.isbasedon	10.1016/j.socscimed.2020.113004
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	11 Medical and Health Sciences, 14 Economics, 16 Studies in Human Society
dc.subject.classification	Public Health
dc.title	Inequity in physician visits: the case of the unregulated fee market in Australia
dc.type	Journal Article
utslib.citation.volume	255
utslib.location.activity	England
utslib.for	11 Medical and Health Sciences
utslib.for	14 Economics
utslib.for	16 Studies in Human Society
pubs.organisational-group	/University of Technology Sydney/Faculty of Business
pubs.organisational-group	/University of Technology Sydney/Strength - CHERE - Centre for Health Economics Research and Evaluation
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/DVC (International)
utslib.copyright.status	closed_access	*
pubs.consider-herdc	false
dc.date.updated	2020-09-22T07:26:27Z
pubs.publication-status	Published
pubs.volume	255

Abstract:

Equity is one of the key goals of universal healthcare coverage (UHC). Achieving this goal does not just depend on the presence of UHC, but also on its design and organisation. In Australia, out-of-hospital medical services are provided by private physicians in a market where fees are unregulated. This makes an interesting case to study equity. Using data from the Australian National Health Survey of 2014–15, we distinguish between the probability of any visit and the number of visits conditional on having any visit to analyse income-related inequity in general practitioner (GP) and specialist visits. We apply the horizontal inequity approach to measure the extent of inequity, and the decomposition method to explain the factors accounting for inequity. Our results show a small pro-rich inequity in the probability of any GP visit, but the distribution of conditional GP visits was concentrated among the poor. Inequity in the probability of any specialist visit was pro-rich. However, there was almost no inequity in conditional specialist visits. We find holding a concession card explained pro-poor inequity while income, education, and private health insurance contributed to pro-rich inequity in specialist visits. Although Australia has a universal health insurance system, there is unequal use (adjusted for health need) of physician services by socioeconomic status. This has implications for insurance design in other countries.

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http://hdl.handle.net/10453/142807