The Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW, Australia.
The George Institute for Global Health, UNSW Sydney, Level 10 King George V Building, 83-117 Missenden Road, Camperdown, 2050, NSW, Australia.
Int J Equity Health. 2017 Jun 23;16(1):108. doi: 10.1186/s12939-017-0610-2.
In spite of bearing a heavier burden of death, disease and disability, there is mixed evidence as to whether Indigenous Australians utilise more or less healthcare services than other Australians given their elevated risk level. This study analyses the Medicare expenditure and its predictors in a cohort of Indigenous and non-Indigenous Australians at high risk of cardiovascular disease.
The healthcare expenditure of participants of the Kanyini Guidelines Adherence with the Polypill (GAP) pragmatic randomised controlled trial was modelled using linear regression methods. 535 adult (48% Indigenous) participants at high risk of cardiovascular disease (CVD) were recruited through 33 primary healthcare services (including 12 Aboriginal Medical Services) across Australia.
There was no significant difference in the expenditure of Indigenous and non-Indigenous participants in non-remote areas following adjustment for individual characteristics. Indigenous individuals living in remote areas had lower MBS expenditure ($932 per year P < 0.001) than other individuals. MBS expenditure was found to increase with being aged over 65 years ($128, p = 0.013), being female ($472, p = 0.003), lower baseline reported quality of life ($102 per 0.1 decrement of utility p = 0.004) and a history of diabetes ($324, p = 0.001), gout ($631, p = 0.022), chronic obstructive pulmonary disease ($469, p = 0.019) and established CVD whether receiving guideline-recommended treatment prior to the trial ($452, p = 0.005) or not ($483, p = 0.04). When controlling for all other characteristics, morbidly obese patients had lower MBS expenditure than other individuals (-$887, p = 0.002).
The findings suggest that for the majority of participants, once individuals are engaged with a primary care provider, factors other than whether they are Indigenous determine the level of Medicare expenditure for each person.
Australian New Zealand Clinical Trials Registry ACTRN 126080005833347.
尽管承受着更高的死亡、疾病和残疾负担，但由于土著澳大利亚人面临更高的风险水平，他们是否比其他澳大利亚人使用更多或更少的医疗保健服务，证据不一。本研究分析了心血管疾病高危人群中土著和非土著澳大利亚人医疗保险支出及其预测因素。
采用线性回归方法对 Kanyini 指南依从性与多药治疗（GAP）实用随机对照试验的参与者的医疗保健支出进行建模。通过澳大利亚 33 个初级保健服务机构（包括 12 个原住民医疗服务机构）招募了 535 名患有心血管疾病（CVD）高危的成年（48%为土著人）参与者。
在调整个人特征后，非偏远地区的土著和非土著参与者的支出没有显著差异。居住在偏远地区的土著人 MBS 支出较低（每年 932 美元，P<0.001）。研究发现，MBS 支出随年龄增长而增加（65 岁以上每年增加 128 美元，P=0.013）、女性（472 美元，P=0.003）、基线报告的生活质量较低（每 0.1 分下降 102 美元，P=0.004）、糖尿病史（324 美元，P=0.001）、痛风（631 美元，P=0.022）、慢性阻塞性肺疾病（469 美元，P=0.019）和已确诊的心血管疾病（无论在试验前是否接受指南推荐的治疗，452 美元，P=0.005；或未接受治疗，483 美元，P=0.04）。在控制所有其他特征后，病态肥胖患者的 MBS 支出低于其他患者（-887 美元，P=0.002）。
研究结果表明，对于大多数参与者而言，一旦与初级保健提供者建立联系，决定每个人医疗保险支出水平的因素不是他们是否为土著人，而是其他因素。
澳大利亚新西兰临床试验注册中心 ACTRN 126080005833347。
