Gannon Brenda, Aung Phyo Myat, Dhingra Aarushi, Zhou Yaying
School of Economics, The University of Queensland, Brisbane, Australia.
Department of Economics, University of Bologna, Bologna, Italy.
Int J Equity Health. 2025 Mar 17;24(1):76. doi: 10.1186/s12939-025-02432-3.
This study investigates whether healthcare utilisation among older Australians is equitable, particularly focusing on people with cognitive decline from age 50. It investigates the economic concept of horizontal inequity in various types of healthcare use among older Australians and compares inequity among three groups: a representative sample of all individuals aged 50 and above, those with cognitive impairment, and individuals with a disability. Additionally, we examine changes in these patterns over time.
This study utilizes cross-sectional data for 2013 and 2017 from the Household, Income and Labour Dynamics in Australia (HILDA) survey to investigate four types of healthcare utilisation-general practitioner (GP), specialist, dental, and hospital admissions. We calculate the concentration index to measure the inequality and inequity in use. To quantify inequity, we correct for differences in needs and health status, following the indirect standardisation approach.
Our findings suggest that among the three samples, the inequity faced by older Australians with cognitive impairment is the most pronounced. Individuals with higher socioeconomic status used dental care more, while GP visits were concentrated among the lower socioeconomic groups in 2013. By 2017, all types of healthcare except GP visits favour the better-off people (pro-rich). Among those with disabilities, we find a pro-rich distribution of dental care in both 2013 and 2017, and pro-rich inequity in the usage of specialist visits, even after adjusting for needs.
Pronounced disparities are observed among older people with cognitive impairment. Further targeting of policies to improve access to healthcare for older vulnerable Australians is recommended, to help achieve equitable and universal coverage in Australia.
本研究调查澳大利亚老年人的医疗保健利用情况是否公平，尤其关注50岁及以上认知能力下降的人群。研究探讨了澳大利亚老年人在各类医疗保健使用中横向不平等的经济概念，并比较了三组人群之间的不平等情况：50岁及以上所有个体的代表性样本、认知障碍者以及残疾人士。此外，我们还研究了这些模式随时间的变化。
本研究利用澳大利亚家庭、收入与劳动力动态调查（HILDA）2013年和2017年的横断面数据，调查四种医疗保健利用类型——全科医生（GP）诊疗、专科诊疗、牙科诊疗和住院治疗。我们计算集中指数以衡量使用中的不平等和不公平情况。为了量化不公平，我们遵循间接标准化方法，对需求和健康状况的差异进行校正。
我们的研究结果表明，在这三个样本中，认知障碍的澳大利亚老年人面临的不公平最为明显。社会经济地位较高的个体更多地使用牙科护理，而2013年全科医生诊疗集中在社会经济地位较低的群体中。到2017年，除全科医生诊疗外，所有类型的医疗保健都有利于富裕人群（有利于富人）。在残疾人群体中，我们发现在2013年和2017年牙科护理都存在有利于富人的分布情况，并且即使在调整需求后，专科诊疗的使用也存在有利于富人的不公平情况。
在认知障碍的老年人中观察到明显的差异。建议进一步针对性地制定政策，以改善澳大利亚弱势老年人群获得医疗保健的机会，帮助实现澳大利亚公平和全民覆盖。
