Abstract
BackgroundThe Australian federal government introduced private health insurance incentive policy reforms in 2000 that increased the uptake of private health insurance in Australia. There is currently a lack of evidence on the effect of the policy reforms on access to cardiovascular interventions in public and private hospitals in Australia. The aim was to investigate whether the increased private health insurance uptake influenced trends in emergency and elective coronary artery revascularisation procedures (CARPs) for private and public patients.MethodsWe included 34,423 incident CARPs from Western Australia during 1995-2008 in this study. Rates of emergency and elective CARPs were stratified for publicly and privately funded patients. The average annual percent change (AAPC) in trend was calculated before and after 2000 using joinpoint regression.ResultsThe rate of emergency CARPs, which were predominantly percutaneous coronary interventions (PCIs) with stenting, increased throughout the study period for both public and private patients (AAPC=12.9%, 95% CI=5.0,22.0 and 14.1%, 95% CI=9.8,18.6, respectively) with no significant difference in trends before and after policy implementation. The rate of elective PCIs with stenting from 2000 onwards remained relatively stable for public patients (AAPC=−6.0, 95% C= −16.9,6.4), but increased by 4.1% on average annually (95% CI=1.8,6.3) for private patients (pdifference=0.04 between groups). This rate increase for private patients was only seen in people aged over 65 years and people residing in high socioeconomic areas.ConclusionsThe private health insurance incentive policy reforms are a likely contributing factor in the shift in 2000 from public to privately-funded elective PCIs with stenting. These reforms as well as the increasing number of private hospitals may have been successful in increasing the availability of publicly-funded beds since 2000.
Highlights
The Australian federal government introduced private health insurance incentive policy reforms in 2000 that increased the uptake of private health insurance in Australia
From the index Coronary artery revascularisation procedure (CARP) cases, 57.4% were publicly funded patients and 42.6% were privately funded, with 94% of the public patients treated in public hospitals and 72% of the private patients treated in private hospitals
This trend was evident for patients undergoing elective CARPs as the proportion of public patients treated in public hospitals declined from 51.1% in the period prior to year 2000 to 39.4% after year 2000 with the proportion of private patients treated in public hospitals showing a similar pattern in terms of absolute percent decrease (15.1% to 5.7%)
Summary
The Australian federal government introduced private health insurance incentive policy reforms in 2000 that increased the uptake of private health insurance in Australia. There is currently a lack of empirical evidence on the effect of the policy reforms on cardiovascular interventions and whether the reforms were successful in relieving pressure on access to coronary interventions in public hospitals Such information is important as cardiovascular diseases are the most expensive group of diseases in Australia [9]. Coronary heart disease (CHD) alone accounted for 31% of the total cardiovascular disease cost in 2004–5 or $1.8 billion [9], with almost threequarters of the cost due to CHD spent on hospitaladmitted patients [9] This high cost of cardiovascular interventions in hospitals can mainly be attributed to coronary artery revascularisation procedures (CARPs) as they are the primary procedural intervention for stable and unstable CHD in Australia. These procedures include coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), with or without stenting [10]
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