Glover John, Tennant Sarah, Duckett Stephen
Public Health Information Development Unit, University of Adelaide, South Australia, 5005, Australia.
Aust New Zealand Health Policy. 2009 Aug 17;6:19. doi: 10.1186/1743-8462-6-19.
Private health insurance has been a major focus of Commonwealth Government health policy for the last decade. Over this period, the Howard government introduced a number of policy changes which impacted on the take up of private health insurance. The most expensive of these was the introduction of the private health insurance rebate in 1997, which had an estimated cost of $3 billion per annum.
This article uses information on the geographic distribution of the population with private health insurance cover to identify associations between rates of private health insurance cover and socioeconomic status. The geographic analysis is repeated with survey data on expenditure on private health insurance, to provide an estimate of the rebate flowing to different socioeconomic groups.
The analysis highlights the strong association between high rates of private health insurance cover and high socioeconomic status and shows the substantial transfer of funds, under the private health insurance rebate, to those living in areas of highest socioeconomic status, compared with those in areas of lower socioeconomic status, and in particular those in the most disadvantaged areas. The article also provides estimates of private health insurance cover by federal electorate, emphasising the substantial gaps in cover between Liberal Party and Australian Labor Party seats.
The article concludes by discussing implications of the uneven distribution of private health insurance cover across Australia for policy formation. In particular, the study shows that the prevalence of private health insurance is unevenly distributed across Australia, with marked differences in prevalence in rural and urban areas, and substantial differences by socioeconomic status. Policy formation needs to take this into account. Evaluating the potential impact of changes in private health insurance requires more nuanced consideration than has been implied in the rhetoric about private health insurance over the last decade.
在过去十年中，私人医疗保险一直是联邦政府卫生政策的主要关注点。在此期间，霍华德政府实施了多项政策变革，这些变革对私人医疗保险的参保情况产生了影响。其中最昂贵的举措是1997年引入私人医疗保险回扣，估计每年成本为30亿澳元。
本文利用拥有私人医疗保险覆盖人群的地理分布信息，来确定私人医疗保险覆盖率与社会经济地位之间的关联。利用关于私人医疗保险支出的调查数据重复进行地理分析，以估计流向不同社会经济群体的回扣情况。
分析突出了私人医疗保险高覆盖率与高社会经济地位之间的紧密关联，并表明在私人医疗保险回扣政策下，与社会经济地位较低地区的人群，特别是最弱势地区的人群相比，大量资金流向了社会经济地位最高地区的人群。本文还提供了按联邦选区划分的私人医疗保险覆盖率估计数据，强调了自由党和澳大利亚工党选区在覆盖率上的巨大差距。
本文通过讨论澳大利亚私人医疗保险覆盖分布不均对政策形成的影响来得出结论。特别是，该研究表明私人医疗保险的普及率在澳大利亚分布不均，城乡地区的普及率存在显著差异，且因社会经济地位不同而有很大差异。政策制定需要考虑到这一点。评估私人医疗保险变化的潜在影响需要比过去十年关于私人医疗保险的言辞中所暗示的更为细致入微的考量。
