Callander Emily J, Corscadden Lisa, Levesque Jean-Frederic
Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Qld 4811, Australia.
Bureau of Health Information, Level 11, 67 Albert Avenue, Chatswood, NSW 2057, Australia.
Aust J Prim Health. 2017 Apr;23(1):15-22. doi: 10.1071/PY16005.
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.
尽管我们知道澳大利亚的自付医疗费用相对较高，但对于哪些健康状况与最高的自付费用相关，以及医疗费用是否成为不同慢性病患者获得医疗服务的障碍，我们却知之甚少。2013年，我们对英联邦基金针对18岁及以上成年人的国际卫生政策调查数据进行了横断面分析，运用线性和逻辑回归模型。患有哮喘、肺气肿和慢性阻塞性肺疾病（COPD）的成年人家庭自付医疗费用比没有健康问题的成年人高出109%（95%置信区间：50 - 193%）；患有抑郁症、焦虑症和其他心理健康问题的成年人家庭自付费用高出95%（95%置信区间：33 - 187%）。慢性病患者也更有可能因费用问题而放弃治疗。患有抑郁症、焦虑症和其他心理健康问题的人跳过医疗服务的几率比没有健康问题的人高出7.65倍（95%置信区间：4.13 - 14.20），患有哮喘、肺气肿和慢性阻塞性肺疾病的人跳过医疗服务的几率比没有健康问题的人高出6.16倍（95%置信区间：3.30 - 11.50）。在加拿大、英国、德国、法国、挪威、瑞典和瑞士，患有慢性健康问题的人因费用问题而跳过医疗服务的可能性明显低于澳大利亚患有同样疾病的人。澳大利亚的自付医疗费用成为了慢性病患者获得治疗的障碍，心理健康问题患者很可能会跳过治疗。澳大利亚应关注心理健康服务的可及性和可负担性。
