Moorin Rachael, Brameld Kate J, Holman C D'Arcy J
School of Population Health, University of Western Australia, 35 Stirling Highway Crawley, Perth, WA 6009, Australia.
Aust Health Rev. 2006 Feb;30(1):73-82.
The aim was to identify and explain trends and cut points in payment classification (privately insured or otherwise) for episodes of hospitalisation in Western Australia.
Hospital morbidity data from 1980 to 2001 were used to produce trend lines of the proportion of hospital separations in each payment category in each year in age and clinical subgroups.
The most significant changes in payment classification over time were found in all groups between 1980 and 1984, corresponding to a period when free public hospital care in Australia was abolished (Sep 1981 to Feb 1984). The trend associated with this policy change rebounded significantly just before the introduction of Medicare in 1984. These observations were consistent over all age groups except in the oldest group (70+ years). This trend was more pronounced for the surgical subgroup compared with other broad clinical categories. More recently, a trend towards increasing public episodes was reversed from 2000 following introduction of incentives for private health cover and sanctions against deferred uptake in younger people.
The public appeared to adopt a short-term crisis reaction to major policy change but then reversed towards past patterns of behaviour. The implications for policy makers include the need to understand the underlying culture of the population; to realise that attitudes become fixed as people age; and to recognise the difference in the effectiveness of incentive- and deterrent-based policies.
旨在识别并解释西澳大利亚州住院病例支付分类（私人保险或其他方式）的趋势及分界点。
利用1980年至2001年的医院发病数据，得出各年龄和临床亚组中每年各支付类别出院比例的趋势线。
1980年至1984年间，所有组别的支付分类变化最为显著，这一时期澳大利亚免费公立医院护理被取消（1981年9月至1984年2月）。与这一政策变化相关的趋势在1984年医疗保险引入前显著反弹。除最年长组（70岁以上）外，所有年龄组的这些观察结果均一致。与其他广泛的临床类别相比，手术亚组的这一趋势更为明显。最近，自2000年以来，随着对私人医疗保险的激励措施以及对年轻人延迟参保的制裁措施的出台，公共病例增加的趋势发生了逆转。
公众似乎对重大政策变化采取了短期危机反应，但随后又转向过去的行为模式。对政策制定者的启示包括需要了解民众的潜在文化；意识到随着年龄增长态度会变得固定；以及认识到基于激励和威慑的政策在有效性方面的差异。
