Healthcare expenditure on Indigenous and non-Indigenous Australians at high risk of cardiovascular disease

Blake Angell,Laurent Billot,Tom Lung,David Peiris,Natasha Rafter,Barbara Molanus,Andrew Tonkin,Alan Cass,Tracey-Lea Laba,Alex Brown,Graham Hillis,Christopher Reid,Anushka Patel,Ruth Webster,Stephen Jan,Sandra Eades,Tim Usherwood

doi:10.1186/s12939-017-0610-2

Abstract

BackgroundIn spite of bearing a heavier burden of death, disease and disability, there is mixed evidence as to whether Indigenous Australians utilise more or less healthcare services than other Australians given their elevated risk level. This study analyses the Medicare expenditure and its predictors in a cohort of Indigenous and non-Indigenous Australians at high risk of cardiovascular disease.MethodsThe healthcare expenditure of participants of the Kanyini Guidelines Adherence with the Polypill (GAP) pragmatic randomised controlled trial was modelled using linear regression methods. 535 adult (48% Indigenous) participants at high risk of cardiovascular disease (CVD) were recruited through 33 primary healthcare services (including 12 Aboriginal Medical Services) across Australia.ResultsThere was no significant difference in the expenditure of Indigenous and non-Indigenous participants in non-remote areas following adjustment for individual characteristics. Indigenous individuals living in remote areas had lower MBS expenditure ($932 per year P < 0.001) than other individuals. MBS expenditure was found to increase with being aged over 65 years ($128, p = 0.013), being female ($472, p = 0.003), lower baseline reported quality of life ($102 per 0.1 decrement of utility p = 0.004) and a history of diabetes ($324, p = 0.001), gout ($631, p = 0.022), chronic obstructive pulmonary disease ($469, p = 0.019) and established CVD whether receiving guideline-recommended treatment prior to the trial ($452, p = 0.005) or not ($483, p = 0.04). When controlling for all other characteristics, morbidly obese patients had lower MBS expenditure than other individuals (−$887, p = 0.002).ConclusionThe findings suggest that for the majority of participants, once individuals are engaged with a primary care provider, factors other than whether they are Indigenous determine the level of Medicare expenditure for each person.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN 126080005833347.

Highlights

In spite of bearing a heavier burden of death, disease and disability, there is mixed evidence as to whether Indigenous Australians utilise more or less healthcare services than other Australians given their elevated risk level
Understanding the healthcare utilisation patterns of these populations is important to ensure that the health system is providing the level of care required to close the gap in health outcomes between Indigenous and non-Indigenous Australians and appropriate levels of care to those living with chronic diseases
Participants Data were collected during the Kanyini Guidelines Adherence with the Polypill (GAP) randomised controlled trial testing the effectiveness of a cardiovascular combination polypill in Indigenous and non-Indigenous adults over 18 years at high-risk of cardiovascular diseases (CVD)

Summary

Introduction

In spite of bearing a heavier burden of death, disease and disability, there is mixed evidence as to whether Indigenous Australians utilise more or less healthcare services than other Australians given their elevated risk level. This study analyses the Medicare expenditure and its predictors in a cohort of Indigenous and non-Indigenous Australians at high risk of cardiovascular disease. Healthcare service use of indigenous Australians Without controlling for the relative need of the two groups, the average public spend on healthcare for an Indigenous Australian is estimated at $1.47 for every $1 spent for the care of a non-Indigenous Australian [8] The distribution of this spend differs markedly between the two groups, with Indigenous Australians utilising significantly less Medicare Benefit Schedule (MBS) and medication expenditure (at a rate of 0.63 and 0.44 respectively) than other Australians but having much higher average hospital expenditure (1.76 times higher than non-Indigenous Australians). One study that was able to do so (through controlling for self-reported indicators of ill health) found that Indigenous Australians used more healthcare services than other Australians [10]

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