Private Health Insurance Status Research Articles

Racial disparities in treatments and mortality among a large population-based cohort of older men and women with colorectal cancer

BackgroundThere were racial disparities in treatment and mortality among patients with colorectal cancer, but few studies incorporated information on hypertension and diabetes and their treatment status. Patients and methodsThe study identified 101,250 patients from Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database in the United States who were diagnosed with colorectal cancer at age ≥65 years between 2007 and 2015 with follow-up to December 2016. ResultsThere were substantial racial and ethnic disparities in the prevalence of hypertension and diabetes in patients with colorectal cancer, in receiving chemotherapy and radiation therapy, and in receiving antihypertensive and antidiabetic treatment. Racial disparities in receiving these therapies remained significant in this large cohort of Medicare beneficiaries after stratifications by private health insurance status at the time of cancer diagnosis and by tumor stage. Non-Hispanic black patients had a significantly higher risk of all-cause mortality (hazard ratio: 1.07, 95% CI: 1.04–1.10), which remained significantly higher (1.05, 1.02–1.08) after adjusting for patient sociodemographics, tumor factors, comorbidity and treatments as compared to non-Hispanic white patients. The adjusted risk of colorectal cancer-specific mortality was also significantly higher (1.08, 1.04–1.12) between black and white patients. ConclusionsThere were substantial racial disparities in prevalence of hypertension and diabetes in men and women diagnosed with colorectal cancer and in receipt of chemotherapy, radiation therapy, antihypertensive and antidiabetic treatment. Black patients with colorectal cancer had a significantly higher risk of all-cause mortality and colorectal cancer-specific mortality than whites, even after adjusting for sociodemographic characteristics, tumor factors, comorbidity scores, and treatments.

Use of pharmacy services in community-dwelling middle-aged and older adults in Ireland

Abstract Introduction Pharmacy has a potentially significant role in meeting the escalating need for healthcare, particularly with population ageing and shifts to more community-based care under Ireland’s health reform policies. The role of community pharmacists has evolved in recent years with expansion in pharmacy services offered. This study aims to assess pharmacy services use among adults aged ≥50 years in Ireland, and determine the demographic and clinical factors associated with pharmacy services use. Methods This cross-sectional study included community-dwelling participants in wave 4 of The Irish Longitudinal Study on Ageing (TILDA), aged ≥50 years who were self-respondents (i.e. proxy respondents were omitted). TILDA is a nationally representative cohort study, and wave 4 data was collected during 2016. TILDA participants were asked if they availed of several named services when visiting the pharmacy in the last 12 months. These included: requesting advice about medication; vaccination; blood pressure (BP) or cholesterol checks; advice on smoking cessation or weight management; and diabetes, asthma, or allergy tests. We considered age, sex, educational attainment, GP utilization, medical card and private health insurance status, loneliness, polypharmacy, use of high risk medications (anticoagulants, NSAIDs, opioids, diuretics, antiplatelets, antimicrobials, insulin and hypoglycaemics) and comorbidities. Multivariate logistic regression was used to examine the association of these with reporting (i) any pharmacy service use and (ii) requesting medicines advice. Results This study included 5,782 participants, 55.5% were female with a mean age of 68 years. 96.6% of participants (5,587) reporting visiting a pharmacy in the previous 12 months, and almost one quarter of these (1,323) availed of at least one specified pharmacy service. The most common services reported were requesting advice about medications (786, 13.6%), blood pressure monitoring (184, 3.2%), and vaccination (166, 2.9%). Compared to those not using any services, service users were a similar age (mean 68 years), but were taking more medications (mean 3.6 versus 2.8), were more often female (64.1% versus 54.2%), had higher educational attainment, and had higher GP visit rates. Controlling for other factors, the following were associated with a high likelihood of availing of pharmacy services: female gender (odds ratio (OR) 1.32, 95%CI 1.14–1.52), third level education (OR 1.85, 95%CI 1.51–2.27), higher rates of GP visits, private health insurance (OR 1.29, 95%CI 1.07–1.56), higher number of medications, loneliness, and a diagnosed respiratory condition (OR 1.42, 95% CI 1.14–1.74). The relationship between these factors and requesting medicines advice were similar. Conclusion A high proportion of middle-aged and older adults visit community pharmacy and a quarter avail of specified pharmacy services. Despite advances in the services offered in pharmacies, medicines advice remains at the core of pharmacists’ practice. Those on multiple medications, who may derive greater benefit from such services, are more likely to avail of them. Number of GP visits was also associated with service use, suggesting patients may avail of pharmacy services as a complement, rather than a substitute, to visiting their GP. Services were more often used by people who are lonely, and pharmacists should consider interventions to support these people.

Lower Vegetable Variety and Worsening Diet Quality Over Time Are Associated With Higher 15-Year Health Care Claims and Costs Among Australian Women

BackgroundThe relationship between diet quality and health care costs is unclear. ObjectiveThe aim of this study was to investigate the relationship between baseline diet quality and change in diet quality over time, with 15-year cumulative health care claims/costs. DesignData from a longitudinal cohort study were analyzed. Participants/settingData for survey 3 (2001) (n = 7,868) and survey 7 (2013) (n = 6,349 both time points) from the 1946-1951 cohort of the Australian Longitudinal Study on Women’s Health were analyzed. Main outcome measuresDiet quality was assessed using the Australian Recommended Food Score (ARFS). Fifteen-year cumulative Medicare Benefits Schedule (Australia’s universal health care coverage) data were reported by baseline ARFS quintile and category of diet quality change (“diet quality worsened” [ARFS change ≤ –4 points], “remained stable” [–3 ≤ change in ARFS ≤3 points], or “improved” [ARFS change ≥4 points]). Statistical analysesLinear regression analyses were conducted adjusting for area of residence, socioeconomic status, lifestyle factors, and private health insurance status. ResultsConsuming a greater variety of vegetables at baseline but fewer fruit and dairy products was associated with lower health care costs. For every 1-point increment in the ARFS vegetable subscale, women made 3.3 (95% CI, 1.6-5.0) fewer claims and incurred AU$227 (95% CI, AU$104-350 [US$158; 95% CI, US$72-243]) less in costs. Women whose diet quality worsened over time made more claims (median, 251 claims; quintile 1, quintile 3 [Q1; Q3], 168; 368 claims) and incurred higher costs (AU$15,519; Q1; Q3, AU$9,226; AU$24,847 [US$10,793; Q1; Q3, US$6,417; US$17,281]) compared with those whose diet quality remained stable (median, 236 claims [Q1; Q3, 158; 346 claims], AU$14,515; Q1; Q3, AU$8,539; AU$23,378 [US$10,095; Q1; Q3, US$5,939; US$16,259]). ConclusionsGreater vegetable variety was associated with fewer health care claims and costs; however, this trend was not consistent across other subscales. Worsening diet quality over 12 years was linked with higher health care claims and costs.

Birthing in regional Australia: women's decision making surrounding birthplace.

Objective Although there is some research on women's choice of birthplace, most of this research has been conducted overseas. This study explored factors influencing the decision to use public or private maternity services within regional Australia. Methods This cross-sectional study consisted of a community-based, anonymous, online questionnaire focused on factors influencing a woman's choice of birth location and included adult females who had given birth in the past 2 years within two regional areas. Descriptive statistics were used to analyse demographic characteristics and factors influencing decisions regarding birthplace. Pearson's Chi-squared test was used to compare public and private births for multiple variables. Binary logistic regression was used to determine the odds ratio for each potential factor based on whether participants with private health insurance (PHI) elected to birth in the public or private regional hospitals. Open coding was used to group responses to open ended questions into themes. Results Data from 510 questionnaires were analysed. The three most frequently reported factors influencing a woman's decision about birthplace were financial reasons, the ability to choose their doctor and not having PHI. Women with PHI who opted for birth in the public system were almost four-fold more likely to select access to intensive care services and 2.6-fold more likely to select a preference for a low-intervention birth as one of their top five most influential factors. The results highlight that women want access to midwifery continuity of care. Conclusion This study provides insights into the factors influencing a woman's complex decision about where and with whom to birth and how health insurance affects that decision, an area where there is a paucity of peer-reviewed literature. This research highlights the importance of being able to choose one's doctor and the desire for access to midwife-led models of care, and provides evidence to advocate for improved access to additional models of care in the private sector. What is already known? The viability of regional private maternity hospitals is in question because, once the birth rate goes below a certain threshold, providing private obstetric service becomes unviable. Closure of regional private hospitals means less choice in regional areas. Minimal information is available about the factors influencing a woman with PHI to give birth in the public system, and much of the evidence is anecdotal. What does this paper add? This study provides insight into how PHI status and other factors influence a woman's decision to birth in the public versus private sector, an area where there is a paucity of peer-reviewed literature. It also highlights a desire from women for access to midwifery continuity of care in the private system. What are the implications for practitioners? This research provides evidence to advocate for improved access to additional models of care, especially for midwifery-led care in the private sector.

The Longitudinal Impact of Private Health Insurance on the Usage of Outpatient Services Among Aging Koreans

South Korea has a universal national health insurance system; however, its coverage is only about 65%. Consequently, many Koreans have supplemental private health insurance. This study aims to examine 1) how utilization of health care services and out-of-pocket expenditure of outpatient services varies by private health insurance status and 2) whether this relationship changes for these individuals over time. We analyze six waves of the Korean Longitudinal Study of Aging (KLoSA) from 2006 to 2016. Our primary outcomes of interest are the total number of outpatient visits and total out-of-pocket spending on outpatient services per year. Our independent variable of interest is private health insurance holding status. We use simple OLS regressions for each year to test if differences exist and change over time, controlling for age, sex, education, income, and various indicators of health conditions. The difference between those who never had private health insurance and those who always or sometimes had private health insurance becomes larger over time. When comparing total out-of-pocket expenditure, those who always had private health insurance have the lowest spending at the beginning of the study period (2006); however, their spending increases sharply by 2010 and remains higher than the other groups for the rest of the study period. Findings suggest that those who always had supplemental insurance use outpatient services more frequently and spend more out-of-pocket for services as a result. In addition, discrepancies become larger over time. As private health insurance holders age, the risk of higher utilization of outpatient services grows.

The Study on Determinants of Intention of Taking Herbal Medicine: Using the Usage and Consumption of Korean Medicine Report in 2017

본 연구는 첩약(한약) 건강보험 시범사업에 앞서 한약 복용 의향에 미치는 영향요인을 규명하여, 향후 첩약(한약) 건강보험 시범사업 및 본사업 적용 시 기초자료를 제공하고자 진행되었다. 자료는 2017 한방의료이용 및 한약소비실태조사를 이용하였고, 한약 복용 의향의 영향요인을 파악하기 위하여 한방의료 이용자 2,535명을 대상으로 빈도분석, 카이제곱 검정, 로지스틱 회귀분석을 실시하였다. 로지스틱 회귀분석 결과, 교육수준과 민간의료보험 가입 여부가 한약 복용 의향에 유의한 영향요인으로 나타났다. 교육수준이 높을수록 한약 안전성에 대한 우려가 높은 것과, 민간의료보험 미가입자의 경제적 부담이 향후 한약 복용 의향에 영향을 미친 것으로 유추할 수 있다. 따라서 한약 복용 의향을 증대시키기 위해 한약 안전성과 질 관리 방안 등의 정책적 노력이 필요하며, 경제적 부담 완화를 위해 본인부담금 지원 확대 정책을 고려해야 할 것이다.The purpose of this study is to identify the factors affecting intention of taking herbal medicine before implementation of Pilot Project on Introducing Herbal Medicine for the National Health Insurance and to provide basic data for the pilot project and main project. This study used data from Usage and Consumption of Korean Medicine Report in 2017. To identify the factors affecting intention of taking herbal medicine, this study conducted frequency analysis, chi-square test, and logistic regression analysis on 2,535 subjects using herbal medical service. The result of logistic regression analysis showed that education level and private health insurance status had a significant influence on intention of taking herbal medicine. We infer that subjects with higher education level showed higher concerns over safety of herbal medicine and subjects who were not privately insured showed lower intention of taking herbal medicine due to financial burden. To increase the intention of taking herbal medicine, it is necessary to arrange policies for safety and quality of herbal medicine. In addition, policies for expanding support on herbal medicine charges should be considered to relieve the financial burden.

Factors Related to Oral Healthcare Service Utilization among Korean Adults Aged 25–79 Years

The factors related to oral healthcare service utilization (OHSU) among Korean adults aged 25–79 years were assessed using the Andersen model with the sixth Korean National Health and Nutrition Examination Survey data. The study included 12,937 participants aged 25–79 years who answered questions on the predisposing, enabling, and need factors related to OHSU at dental clinics within the past 1 year. Age, sex, and education level were selected as predisposing factors; household income, residence region, and national and private health insurance status as enabling factors; and self-perceived oral health, dental pain, chewing status, and discomfort while speaking as need factors. These factors were assessed using multivariable complex logistic regression models. OHSU at dental clinics within the past 1 year was lower among less-educated participants, those with low, middle–low, and middle–high household income levels, rural participants, those benefiting from the Medicaid system, and non-insured participants. OHSU was higher among older participants, those who rated their self-perceived oral health status as bad, those with experience of dental pain, and those who experienced discomfort while chewing and speaking. The need factors were the most influential. Thus, interventions to reduce inequalities in OHSU are required to promote oral health for all.

Education-related variation in coronary procedure rates and the contribution of private health care in Australia: a prospective cohort study

BackgroundContemporary Australian evidence on socioeconomic variation in secondary cardiovascular disease (CVD) care, a possible contributor to inequalities in cardiovascular disease outcomes, is lacking. This study examined the relationship between education, an individual-level indicator of socioeconomic position, and receipt of angiography and revascularisation procedures following incident hospitalisation for acute myocardial infarction (AMI) or angina, and the role of private care in this relationship.MethodsParticipants aged ≥45 from the New South Wales population-based 45 and Up Study with no history of prior ischaemic heart disease hospitalised for AMI or angina were followed for receipt of angiography or revascularisation within 30 days of hospital admission, ascertained through linked hospital records. Education attainment, measured on baseline survey, was categorised as low (no school certificate/qualifications), intermediate (school certificate/trade/apprenticeship/diploma) and high (university degree). Cox regression estimated the association (hazard ratios [HRs]) between education and coronary procedure receipt, adjusting for demographic and health-related factors, and testing for linear trend. Private health insurance was investigated as a mediating variable.ResultsAmong 4454 patients with AMI, 68.3% received angiography within 30 days of admission (crude rate: 25.8/person-year) and 48.8% received revascularisation (rate: 11.7/person-year); corresponding figures among 4348 angina patients were 59.7% (rate: 17.4/person-year) and 30.8% (rate: 5.3/person-year). Procedure rates decreased with decreasing levels of education. Comparing low to high education, angiography rates were 29% lower among AMI patients (adjusted HR = 0.71, 95% CI: 0.56–0.90) and 40% lower among angina patients (0.60, 0.47–0.76). Patterns were similar for revascularisation among those with angina (0.78, 0.61–0.99) but not AMI (0.93, 0.69–1.25). After adjustment for private health insurance status, the HRs were attenuated and there was little evidence of an association between education and angiography among those admitted for AMI.ConclusionsThere is a socioeconomic gradient in coronary procedures with the most disadvantaged patients being less likely to receive angiography following hospital admission for AMI or angina, and revascularisation procedures for angina. Unequal access to private health care contributes to these differences. The extent to which the remaining variation is clinically appropriate, or whether angiography is being underused among people with low socioeconomic position or overused among those with higher socioeconomic position, is unclear.

Selection bias and moral hazard in the Australian private health insurance market: Evidence from the Queensland skin cancer database

This study estimates the effects of moral hazard and selection bias in private insurance by exploiting the unique characteristics of private health insurance in Australia using a longitudinal data of about 37,000 individuals. We estimate determinants of private health insurance status and health service consumption together as a system to control for individual unobserved effects. We also take into account the evolution of the health production process by controlling for the lagged dependent variables. We found that risk-averse individuals were more likely to purchase private health insurance, suggesting an advantageous selection. There is also evidence of ex-post moral hazard as privately insured individuals consumed more health services. Controlling for the lagged health service consumption reduces the magnitude of moral hazard considerably. The presence of advantageous selection and moral hazard in private health insurance indicates that the Australian healthcare system can be more efficient by increasing coverage and monitoring consumption.

Uptake of cancer screening services among middle and older ages in Ireland: the role of healthcare eligibility

ObjectivesThe aim of this analysis was to examine the association between public healthcare eligibility combined with private health insurance (PHI) status and the uptake of breast and prostate cancer screening services among middle and older age groups in Ireland. Study designThis is a cross-sectional analysis using The Irish Longitudinal Study on Ageing (TILDA). MethodsThe analysis included 6902 people aged 50 years and older who completed an in-house interview as part of TILDA. The interview collects information on a range of demographic, socio-economic, health and health service usage variables including the uptake of cancer screening services. An eligibility variable was created using information on public healthcare entitlement and PHI status. The association between eligibility and the uptake of two cancer screening services—mammogram and prostate-specific antigen (PSA) test—was examined using weighted multivariate logistic regression analysis. ResultsThe uptake of a mammogram and PSA testing was significantly higher in those with PHI. This relationship held after controlling for a range of confounders including health and socio-economic status. ConclusionsMore research is required to identify the reasons for the higher uptake of cancer screening services among those with PHI, given that insurance does not confer any advantages in accessing these services. It is possible that the higher uptake is explained by differential access to secondary care services between those with and without PHI. Consideration of the integrated nature of healthcare systems is essential when seeking to maximise the uptake of services (such as cancer screening) that potentially involve multiple parts of the healthcare system.

Utilization of complementary and alternative medicine and conventional medicine for headache or migraine during pregnancy: A cross-sectional survey of 1,835 pregnant women

ObjectivesLittle is known about women’s use of health services affected by headache or migraine during pregnancy. This paper directly addresses the research gap reporting on the healthcare utilization among Australian pregnant women experiencing headache or migraine. Design and settingIn this retrospective observational study, data on 1,835 Australian pregnant women were obtained from the nationally-representative Australian Longitudinal Study on Women’s Health. Information on quality of life and health seeking behaviors regarding conventional medicine and complementary and alternative medicine providers was identified among these participants. Factors associated with healthcare use were analyzed using regression analyses. ResultsA total of 16% of the pregnant women surveyed experienced headache or migraine, and over 20% sought help from more than two types of healthcare practitioners for their headache or migraine. General practitioners (37.8%) were the most commonly consulted providers of pregnant women for their headache or migraine. Women with headache or migraine during pregnancy had worse health-related quality of life than those without. Education level and private health insurance status of pregnant women are the predictors of the use of healthcare practitioners for their management of headache or migraine (both p < 0.05). ConclusionsHeadache or migraine during pregnancy significantly impacts upon pregnant women’s quality of life. The use of multiple healthcare practitioners, including conventional medicine and complementary and alternative medicine practitioners, highlights the need for further research investigating health services utilization of pregnant women with headache or migraine in different severity and frequency to help inform effective and safe treatment.

The impact of a history of poor mental health on health care costs in the perinatal period.

The perinatal period is a critical time for mental health and is also associated with high health care expenditure. Our previous work has identified a history of poor mental health as the strongest predictor of poor perinatal mental health. This study aims to examine the impact of a history of poor mental health on health care costs during the perinatal period. Data from the 1973-1978 cohort of the Australian Longitudinal Study on Women's Health (ALSWH) were linked with a number of administrative datasets including the NSW Admitted Patient Data Collection and Perinatal Data Collection, the Medicare Benefits Scheme and the Pharmaceuticals Benefits Scheme between 2002 and 2011. Even when taking birth type and private health insurance status into account, a history of poor mental health resulted in an average increase of over 11% per birth across the perinatal period. These findings indicate that an investment in prevention and early treatment of poor mental health prior to child bearing may result in a cost saving in the perinatal period and a reduction of the incidence of women experiencing poor perinatal mental health.

Cost Analysis of Initial Treatment With Endovascular Revascularization, Open Surgery, or Primary Major Amputation in Patients With Peripheral Artery Disease

Purpose: To compare the total initial treatment costs for open surgery, endovascular revascularization, and primary major amputation within a single-payer healthcare system. Methods: A multicenter, retrospective analysis was undertaken to evaluate 1138 patients with symptomatic peripheral artery disease (PAD) who underwent 1017 endovascular procedures, 86 open surgeries, and 35 major amputations between 2013 and 2016. A cost-mix analysis was performed on individual patient data generated for selected diagnosis-related groups. Mean costs are presented with the 95% confidence interval (CI). Results: There was no intergroup difference in demographics or private health insurance status. However, the amputation group had a higher proportion of emergency procedures (68.6% vs 13.3% vs 27.9%, p<0.001) and critical limb ischemia (88.6% vs 35.9% vs 37.2%, p<0.001) compared with the endovascular therapy and open surgery groups, respectively. The endovascular revascularization group spent less time in hospital and used fewer intensive care unit (ICU) resources compared with the open surgery and major amputation groups (hospital length of stay: 3.4 vs 10.0 vs 20.2 days, p<0.01; ICU: 2.4 vs 22.6 vs 54.6 hours, p<0.01), respectively. While mean prosthetic and device costs were higher in the endovascular group [AUD$2770 vs AUD$1658 (open) and AUD$1219 (amputation), p<0.01], substantial disparities were observed in costs associated with longer operating theater times, length of stay, and ICU utilization, which resulted in significantly higher costs in the open and amputation groups. After adjusting for confounders, the AUD$18,396 (95% CI AUD$16,436 to AUD$20,356) mean cost per admission for the endovascular revascularization group was significantly less (p<0.001) than the open surgery (AUD$31,908, 95% CI AUD$28,285 to AUD$35,530) and major amputation groups (AUD$43,033, 95% CI AUD$37,706 to AUD$48,361). Conclusion: Endovascular revascularization procedures for PAD cost the health payer less compared with open surgery and primary amputation. While devices used to deliver contemporary endovascular therapy are more expensive, the reduction in bed days, ICU utilization, and related hospital resources results in a significantly lower mean total cost per admission for the initial treatment.

Influence of social characteristics on the duration of treatment, severity of the disease and social support of patients in a surgical intensive care unit

In critical illnesses low socioeconomic status (SES) is associated with higher morbidity and mortality. In addition to the SES, further factors at an individual level (e.g., sex, health insurance status and place of residence) may influence the severity of illness and medical treatment. We investigated these additional parameters in asecondary analysis of the ECSSTASI data. Within the framework of the ECSSTASI study, 996patients were recruited from asurgical intensive care unit. We examined the influence of sex, insurance status and place of residence on health-related behavior, disease severity, duration of intensive care and ventilation (28ventilator-free days score, 28-VFDS) and social support by the next of kin. Multivariate-adjusted logistic regression analyses were carried out and odds ratios (OR) are presented with corresponding 95% confidence intervals. Among patients admitted to the intensive care unit, the disease severity (SOFA score >5) was significantly lower in women than in men (OR 0.62 [0.45-0.87]). Increasing size of the patient's town of residence was associated with asignificantly shorter duration of treatment on the intensive care unit (OR 0.54 [0.32-0.91]). An increasing number of persons in the household was associated with asignificantly increased risk of being ventilated longer compared to 1‑person households (p = 0.028). Patients with private insurance (OR1.87 [1.28-2.70]), patients from households with ≥4 persons (OR1.92 [1.1-3.33]) and patients without German citizenship (OR2.56 [1.39-4.55]) were visited significantly more often by next of kin. In addition to the SES, sociodemographic characteristics of the individual patient are associated with the course of treatment in intensive care medicine. The extent of social support by the next of kin depends on intercultural and individual patient characteristics. An increasing size of the town of residence and private health insurance status positively influence intensive care outcomes. In order to evaluate these data, further epidemiological studies in intensive care medicine are necessary.

An actuarial investigation into maternal out-of-hospital cost risk factors

AbstractThis paper adopts an actuarial approach to identify the risk factors of government-funded maternal out-of-hospital costs in Australia, with a focus on women who experience adverse birth outcomes. We use a two-phase modelling methodology incorporating both classification and regression trees and generalised linear models on a data set that links administrative and longitudinal survey data from a large sample of women, to address maternal out-of-hospital costs. We find that adverse births are a statistically significant risk factor of out-of-hospital costs in both the delivery and postnatal periods. Furthermore, other significant cost risk factors are in-vitro fertilisation, specialist use, general practitioner use, area of residence and mental health factors (including anxiety, intense anxiety, postnatal depression and stress about own health) and the results vary by perinatal sub-period and the patient’s private health insurance status. We highlight these differences and use the results as an evidence base to inform public policy. Mental health policy is identified as a priority area for further investigation due to the dominance of these factors in many of the fitted models.

An actuarial investigation into maternal hospital cost risk factors for public patients

AbstractWe investigate an actuarial approach to identifying the factors impacting government-funded maternal hospital costs in Australia, with a focus on women who experience adverse birth outcomes. We propose a two-phase modelling methodology that adopts actuarial methods from typical insurance claim cost modelling and extends to other statistical techniques to account for the large volume of covariates available for modelling. Specifically, Classification and Regression Trees and generalised linear mixed models are employed to analyse a data set that links longitudinal survey and administrative data from a large sample of women. The results show that adverse births are a statistically significant risk factor affecting maternal hospital costs in the antenatal and delivery periods. Other significant cost risk factors in the delivery period include mode of delivery, private health insurance status, diabetes, smoking status, area of residence and onset of labour. We demonstrate the efficacy of using actuarial techniques in non-traditional areas and highlight how the results can be used to inform public policy.

Age Differences in Health Literacy: Do Younger Korean Adults Have a Higher Level of Health Literacy than Older Korean Adults?

The purpose of this study was to investigate the level of health literacy of adults living in South Korea and identify factors associated with health literacy in different age groups. Using a quota sampling method, authors recruited 1,000 Korean adults age 20 years and older. Health literacy was measured by using three items selected from a 16-question self-report health literacy measure. In accordance with Andersen's behavioral model, predisposing, enabling, and need factors were included in the multiple regression model. Age differences were found in health literacy levels; specifically, lower health literacy was associated with older age. For the 20 through 44-year age group, health literacy was positively associated with having private health insurance and higher self-rated health status. For the 45 through 64 and the 65 and over age groups, education was positively associated with health literacy. For the oldest age group, gender also had a positive association with health literacy. Lower levels of depression were significantly linked to a higher level of health literacy across all ages. This study illustrates ways to increase health literacy among different age groups and prioritizes target intervention groups in an effort to reduce health disparities.

Bleeding Hearts, Profiteers, or Both: Specialist Physician Fees in an Unregulated Market.

This study shows that, in an unregulated fee-setting environment, specialist physicians practise price discrimination on the basis of their patients' income status. Our results are consistent with profit maximisation behaviour by specialists. These findings are based on a large population survey that is linked to administrative medical claims records. We find that, for an initial consultation, specialist physicians charge their high-income patients AU$26 more than their low-income patients. While this gap equates to a 19% lower fees for the poorest patients (bottom 25% of the household income distribution), it is unlikely to remove the substantial financial barriers they face in accessing specialist care. There are large variations across specialties, with neurologists exhibiting the largest fee gap between the high-income and low-income patients. Several possible channels for deducing the patient's income are examined. We find that patient characteristics such as age, health concession card status and private health insurance status are all used by specialists as proxies for income status. These characteristics are particularly important to further practise price discrimination among the low-income patients but are less relevant for the high-income patients. Copyright © 2016 John Wiley & Sons, Ltd.

Factors Determining Children's Private Health Insurance Enrolment and Healthcare Utilization Patterns: Evidence From the 2008 to 2011 Health Panel Data.

Objectives:Parental socioeconomic status (SES) exerts a substantial influence on children’s health. The purpose of this study was to examine factors determining children’s private health insurance (PHI) enrolment and children’s healthcare utilization according to PHI coverage.Methods:Korea Health Panel data from 2011 (n=3085) was used to explore the factors determining PHI enrolment in children younger than 15 years of age. A logit model contained health status and SES variables for both children and parents. A fixed effects model identified factors influencing healthcare utilization in children aged 10 years or younger, using 2008 to 2011 panel data (n=9084).Results:The factors determining children’s PHI enrolment included children’s age and sex and parents’ educational status, employment status, and household income quintile. PHI exerted a significant effect on outpatient cost, inpatient cost, and number of admissions. Number of outpatient visits and total length of stay were not affected by PHI status. The interaction between PHI and age group increased outpatient cost significantly.Conclusions:Children’s PHI enrolment was influenced by parents’ SES, while healthcare utilization was affected by health and disability status. Therefore, the results of this study suggest disparities in healthcare utilization according to PHI enrollment.

The equity of admissions to the University Hospital of Brasilia.

Brazil has a highly stratified population with large socioeconomic disparities, as evidenced by marked differentiation in health status and access to health services by the population. In addition, the fact that the universal national healthcare system and a liberalised private care model exist side by side leads to increasingly inequitable health outcomes. This study aims to appraise the equity of access to the University Hospital in Brasilia, Brazil, in 2013. This study was a quantitative analysis of hospital admissions data. The sample included all patients admitted over a six-month period in 2013. Patient data was crossed with socioeconomic data (income and private health insurance status). Frequency tabulations and chi-square calculations were used to describe the patient mix, observe trends and appraise equity of admissions. Analysis of the data showed that the number of patients from each neighbourhood relative to the neighbourhood population was equitable. However, when assessed on the basis of insurance status (i.e., deducting the population covered by private health insurance), a high level of inequity was detected (chi-square 71.828, df 3, p<0,0001) whereby patients from wealthier neighbourhoods were overrepresented compared to those from poorer neighbourhoods. This study has shown that access to the University Hospital in Brasilia is not equitable when individual access to private healthcare is accounted for. The results show that dual access to both public and private healthcare is likely to be common, increasing some of the population's access to healthcare while decreasing access for others, and therefore contributing to inequity of access to healthcare services.