Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney (UTS), NSW, Australia; Nova Scotia Health Authority, Halifax, NS, Canada.
Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney (UTS), NSW, Australia.
Public Health. 2020 Sep;186:35-43. doi: 10.1016/j.puhe.2020.06.051. Epub 2020 Aug 5.
Although several studies have examined the gap in healthcare use between indigenous and non-indigenous people, empirical evidence on inequity in healthcare use within indigenous populations is limited. This study aims to fill this gap in the literature by investigating income-related inequity (unequal use for equal need) in healthcare use among indigenous Australians living in non-remote areas.
This is a cross-sectional study.
This study used data from the Australian Aboriginal and Torres Strait Islander Health Survey, 2012-13. Logistic regression analysis was used to determine the association of income with the probability of a general practitioner (GP) visit, a specialist visit and inpatient admission. The horizontal inequity (HI) index and decomposition analysis were also used to quantify and explain inequity in healthcare use.
No consistent association was found between income and the probability of GP visit or inpatient admission after controlling for health need. However, the likelihood of visiting a specialist was about three times (odds ratio = 2.96, P = 0.028) higher for the richest compared with the poorest population subgroups. The inequity index was 0.016 (P < 0.001), indicating a pro-rich inequity for the probability of visiting a specialist. Income inequality, unequal distribution of private health insurance and inequality in education were the main factors explaining the pro-rich inequity in specialist utilisation.
Although there was no income-related inequity in GP visits or inpatient admissions, wealthier indigenous Australians had a higher probability of visiting a specialist than their poorer counterparts, after adjusting for need. Specific policies and initiatives are required to address the inequity faced by low-income indigenous people in Australia.
尽管已有多项研究调查了原住民和非原住民在医疗保健利用方面的差距，但关于原住民群体内部医疗保健利用不平等的实证证据有限。本研究旨在通过调查居住在非偏远地区的澳大利亚原住民中与收入相关的（医疗服务利用不平等，即需要相同但利用不平等）医疗保健利用不平等问题，填补这一文献空白。
这是一项横断面研究。
本研究使用了 2012-2013 年澳大利亚原住民和托雷斯海峡岛民健康调查的数据。采用逻辑回归分析确定收入与全科医生就诊、专科医生就诊和住院治疗概率之间的关系。还使用水平不公平（HI）指数和分解分析来量化和解释医疗保健利用方面的不公平现象。
在控制健康需求后，收入与全科医生就诊或住院治疗的概率之间没有一致的关联。然而，与最贫困的人群相比，最富裕的人群就诊专科医生的可能性大约高出三倍（优势比=2.96，P=0.028）。不公平指数为 0.016（P<0.001），表明就诊专科医生的概率存在有利于富人的不公平现象。收入不平等、私人医疗保险分布不均以及教育不平等是导致专科医生利用方面有利于富人的不公平现象的主要因素。
尽管在全科医生就诊或住院治疗方面没有与收入相关的不公平现象，但在调整需求因素后，较富裕的澳大利亚原住民就诊专科医生的可能性高于较贫困的原住民。需要制定具体的政策和举措来解决澳大利亚低收入原住民面临的不公平问题。
