Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Victoria.
Cancer Epidemiology and Population Health Research Group, Allied Health and Human Performance Academic Unit, University of South Australia, Adelaide, South Australia.
Aust N Z J Public Health. 2022 Apr;46(2):237-242. doi: 10.1111/1753-6405.13197. Epub 2022 Feb 17.
OBJECTIVE: This study investigated variations in healthcare expenditure for colorectal cancer (CRC) patients in South Australia by socioeconomic position (SEP) and remoteness area. METHODS: Benefits incidence analysis (BIA) was used to examine healthcare expenditure and utilisation in relation to CRC patients by SEP and remoteness areas. Utilisation data was obtained for patients diagnosed with CRC in 2003-2013 from a dataset linked to a population-based cancer registry, Medicare Benefits Scheme (MBS), Pharmaceutical Benefits Scheme (PBS), hospital and death data. Concentration indices estimated the distribution of health expenditure on MBS, MBS palliative care, PBS and general practitioners. Costs of claims data and length of stay in hospital were used as indicators of healthcare utilisation. RESULTS: The results indicated that MBS palliative healthcare services utilisation favoured the more advantaged groups for both SEP and remoteness area (Concentration index (CI)= 0.1681, t-value=54.42 (SEP) and CI=0.1546, t-value=41.64). MBS expenditure was also favourable to the more advantaged groups (CI: 0.0785 and 0.0493).PBS and MBS general practitioner expenditure were equal (-0.0093 to 0.0250). CONCLUSION: Overall MBS and PBS healthcare expenditure for CRC patients was close to equality, however utilisation of MBS-funded palliative healthcare services was less concentrated in low SEP and more remote areas. IMPLICATIONS FOR PUBLIC HEALTH: Whether the differences in palliative healthcare utilisation supplied by private providers are offset by other services requires investigation to determine if there is a need for initiatives to improve equality and give greater support to those who choose to die at home.
目的:本研究通过社会经济地位(SEP)和偏远地区调查南澳大利亚结肠癌(CRC)患者的医疗支出差异。
方法:利用福利发生率分析(BIA),根据 SEP 和偏远地区,考察 CRC 患者的医疗支出和利用情况。利用 2003 年至 2013 年间从一个与人群癌症登记处、医疗保险福利计划(MBS)、药品福利计划(PBS)、医院和死亡数据相链接的数据集获得的 CRC 患者的利用数据。集中指数估计了 MBS、MBS 姑息治疗、PBS 和全科医生的健康支出分布。索赔数据的费用和住院时间长短被用作医疗利用的指标。
结果:结果表明,对于 SEP 和偏远地区的所有优势群体,MBS 姑息治疗服务的利用都有利于更有利的群体(SEP 的集中指数(CI)=0.1681,t 值=54.42;CI=0.1546,t 值=41.64)。MBS 支出也有利于优势群体(CI:0.0785 和 0.0493)。PBS 和 MBS 全科医生支出相等(-0.0093 至 0.0250)。
结论:总体而言,CRC 患者的 MBS 和 PBS 医疗支出接近平等,但 MBS 资助的姑息治疗服务的利用在低 SEP 和更偏远地区的集中程度较低。
公共卫生意义:私营机构提供的姑息治疗服务的利用差异是否被其他服务所抵消,需要进行调查,以确定是否需要采取主动行动,以提高平等性,并为那些选择在家中死亡的人提供更大的支持。
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