School of Medicine, Griffith University, Gold Coast, Australia.
Australian Institute of Tropical Health and Medicine (AITHM), James Cook University, Townsville, Australia.
Int J Equity Health. 2019 Feb 12;18(1):32. doi: 10.1186/s12939-019-0931-4.
BACKGROUND: Indigenous Australians diagnosed with cancer have poorer survival compared to non-Indigenous Australians. We aim to: 1) identify differences by Indigenous status in out-of-pocket expenditure for the first three-years post-diagnosis; 2) identify differences in the quantity and cost of healthcare services accessed; and 3) estimate the number of additional services required if access was equal between Indigenous and non-Indigenous people with cancer. METHODS: We used CancerCostMod, a model using linked administrative data. The base population was all persons diagnosed with cancer in Queensland, Australia (01JUL2011 to 30JUN2012) (n = 25,553). Each individual record was then linked to their Admitted Patient Data Collection, Emergency Data Information System, Medicare Benefits Schedule (MBS), and Pharmaceutical Benefits Scheme (PBS) records (01JUL2011 to 30JUN2015). We then weighted the population to be representative of the Australian population (approximately 123,900 Australians, 1.7% Indigenous Australians). The patient co-payment charged for each MBS service and PBS prescription was summed for each month from date of diagnosis to 36-months post-diagnosis. We then limited our model to MBS items to identify the quantity and type of healthcare services accessed during the first three-years. RESULTS: On average Indigenous people with cancer had less than half the out-of-pocket expenditure for each 12-month period (0-12 months: mean $401 Indigenous vs $1074 non-Indigenous; 13-24 months: mean $200 vs $484; and 25-36 months: mean $181 vs $441). A stepwise generalised linear model of out-of-pocket expenditure found that Indigenous status was a significant predictor of out of pocket expenditure. We found that Indigenous people with cancer on average accessed 236 services per person, however, this would increase to 309 services per person if Indigenous people had the same rate of service use as non-Indigenous people. CONCLUSIONS: Indigenous people with cancer had lower out-of-pocket expenditure, but also accessed fewer Medicare services compared to their non-Indigenous counterparts. Indigenous people with cancer were less likely to access specialist attendances, pathology tests, and diagnostic imaging through MBS, and more likely to access primary health care, such as services provided by general practitioners.
背景：与非原住民相比，澳大利亚原住民癌症患者的生存率较低。我们的目标是：1）确定诊断后前三年个人自费支出的差异；2）确定获得的医疗服务数量和成本的差异；3）如果原住民和非原住民癌症患者的服务获取机会均等，估计需要增加的服务数量。
方法：我们使用 CancerCostMod 进行分析，这是一个使用链接行政数据的模型。基础人群是所有在澳大利亚昆士兰州诊断出患有癌症的人（2011 年 7 月 1 日至 2012 年 6 月 30 日）（n=25553）。然后，将每个个体记录与他们的住院患者数据采集、紧急数据信息系统、医疗保险福利计划（MBS）和药品福利计划（PBS）记录相关联（2011 年 7 月 1 日至 2015 年 6 月 30 日）。然后，我们对人群进行加权，使其能够代表澳大利亚人口（约 123900 名澳大利亚人，其中 1.7%为原住民）。从诊断日期到诊断后 36 个月的每个月，将每个 MBS 服务和 PBS 处方的患者自付费用相加。然后，我们将模型仅限于 MBS 项目，以确定前三年内获得的医疗服务的数量和类型。
结果：平均而言，癌症原住民患者在每个 12 个月期间的自费支出不到一半（0-12 个月：平均 401 澳元原住民 vs 1074 澳元非原住民；13-24 个月：平均 200 澳元 vs 484 澳元；25-36 个月：平均 181 澳元 vs 441 澳元）。自付支出的逐步广义线性模型发现，原住民身份是自付支出的一个显著预测因素。我们发现，癌症原住民患者平均每人使用 236 项服务，但如果原住民与非原住民的服务使用率相同，服务使用量将增加到每人 309 项。
结论：与非原住民相比，癌症原住民患者的自费支出较低，但获得的医疗保险服务也较少。癌症原住民患者更有可能通过 MBS 获得初级保健服务，如全科医生提供的服务，而不太可能接受专科就诊、病理检查和诊断成像。
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