Private Health Insurance Status Research Articles

Distribution of health literacy strengths and weaknesses across socio-demographic groups: a cross-sectional survey using the Health Literacy Questionnaire (HLQ).

BackgroundRecent advances in the measurement of health literacy allow description of a broad range of personal and social dimensions of the concept. Identifying differences in patterns of health literacy between population sub-groups will increase understanding of how health literacy contributes to health inequities and inform intervention development. The aim of this study was to use a multi-dimensional measurement tool to describe the health literacy of adults in urban and rural Victoria, Australia.MethodsData were collected from clients (n = 813) of 8 health and community care organisations, using the Health Literacy Questionnaire (HLQ). Demographic and health service data were also collected. Data were analysed using descriptive statistics. Effect sizes (ES) for standardised differences in means were used to describe the magnitude of difference between demographic sub-groups.ResultsMean age of respondents was 72.1 (range 19–99) years. Females comprised 63 % of the sample, 48 % had not completed secondary education, and 96 % reported at least one existing health condition. Small to large ES were seen for mean differences in HLQ scales between most demographic groups. Compared with participants who spoke English at home, those not speaking English at home had much lower scores for most HLQ scales including the scales ‘Understanding health information well enough to know what to do’ (ES −1.09 [95 % confidence interval (CI) -1.33 to −0.84]), ‘Ability to actively engage with healthcare providers’ (ES −1.00 [95 % CI −1.24, −0.75]), and ‘Navigating the healthcare system’ (ES −0.72 [95 % CI −0.97, −0.48]). Similar patterns and ES were seen for participants born overseas compared with those born in Australia. Smaller ES were seen for sex, age group, private health insurance status, number of chronic conditions, and living alone.ConclusionsThis study has revealed some large health literacy differences across nine domains of health literacy in adults using health services in Victoria. These findings provide insights into the relationship between health literacy and socioeconomic position in vulnerable groups and, given the focus of the HLQ, provide guidance for the development of equitable interventions.

The relationship between body mass index and hospitalisation rates, days in hospital and costs: findings from a large prospective linked data study.

BackgroundInternationally there is limited empirical evidence on the impact of overweight and obesity on health service use and costs. We estimate the burden of hospitalisation—admissions, days and costs—associated with above-normal BMI.MethodsPopulation-based prospective cohort study involving 224,254 adults aged ≥45y in Australia (45 and Up Study). Baseline questionnaire data (2006-2009) were linked to hospitalisation and death records (median follow-up 3.42y) and hospital cost data. The relationships between BMI and hospital admissions and days were modelled using zero-inflated negative binomial regression; generalised gamma models were used to model costs. Analyses were stratified by sex and age (45-64, 65-79, ≥80y), and adjusted for age, area of residence, education, income, smoking, alcohol-intake and private health insurance status. Population attributable fractions were also calculated.ResultsThere were 459,346 admissions (0.55/person-year) and 1,483,523 hospital days (1.76/person-year) during follow-up. For ages 45-64y and 65-79y, rates of admissions, days and costs increased progressively with increments of above-normal BMI. Compared to BMI 22.5-<25kg/m2, rates of admissions and days were 1.64-2.54 times higher for BMI 40-50kg/m2; costs were 1.14-1.24 times higher for BMI 27.5-<30kg/m2, rising to 1.77-2.15 times for BMI 40-50kg/m2. The BMI-hospitalisation relationship was less clear for ≥80y. We estimated that among Australians 45-79y, around 1 in every 8 admissions are attributable to overweight and obesity (2% to overweight, 11% to obesity), as are 1 in every 6 days in hospital (2%, 16%) and 1 in every 6 dollars spent on hospitalisation (3%, 14%).ConclusionsThe dose-response relationship between BMI and hospital use and costs in mid-age and older Australians in the above-normal BMI range suggests even small downward shifts in BMI among these people could result in considerable reductions in their annual health care costs; whether this would result in long-term savings to the health care system is not known from this study.

The effect of economic factors on private health insurance enrollment and dental care utilization

Objectives: The study aimed to examine and derive policy implications from the contribution of private health insurance towards the effectiveness and equity of dental care utilization. Methods: The study used 2010-2011 Korea Health Panel data. We applied a two-stage probit least square (2SPLS) analysis method to 10,577 people who were aged 20 years and over and had out- patient health care utilization. Under the assumption that high demanders for dental outpatient health services try to subscribe and hold private health insurance, the study focuses on the changes in income and private health insurance status. Results: The results of the descriptive statistics indicated that the number of employed enrolled in pri- vate health insurance increased as age decreased and income increased. Two-year consecutive non- enrollment of private health insurance was highest in the groups aged 65 years or above, those that had completed primary school or below, and those that belonged to the top income bracket. The highest rates of continued enrollment in private health insurance were observed in the top fifth income group (highest quintile) and those with a college degree. Income was observed to have an effect on private health insurance enrollment status and the frequency of dental care services used. The results of the analysis indicated that changes in private health insurance status did not affect the frequency of dental care services used, but the frequency of dental care services used had a significantly positive effect on continued enrollment in private health insurance. Conclusions: To secure the right of health for citizens, it is necessary to establish measures that em- phasize equity and strengthen benefit coverage of health insurance. Moreover, regulatory policies that support the low-income population are required.

Private Health Insurance Status and Utilisation of Dental Services in Australia*

This article focuses on the relationship between private insurance status and dental service utilisation in Australia using data between 1995 and 2001. This article employs joint maximum likelihood to estimate models of time since last dental visit treating private ancillary health insurance (PAHI) as endogenous. The sensitivity of results to the choice between two different but related types of instrumental variables is examined. We find robust evidence in both 1995 and 2001 that individuals with a PAHI policy make significantly more frequent dental consultations relative to those without such coverage. A comparison of the 1995 and 2001 results, however, suggests that there has been an increasing role of PAHI in terms of the frequency of dental consultations over time. This seems intuitive given the trends in the price of unsubsidised private dental consultations. In terms of policy, our results suggest that while government measures to increase private health insurance coverage in Australia have been successful to a significant degree, that success may have come at some cost in terms of socio‐economic inequality as the privately insured are provided much better access to care and financial protection.

Prevalência de diagnóstico médico auto-relatado de miomas uterinos em população brasileira: Padrões demográficos e socioeconômicos no Estudo Pró-Saúde *

Uterine leiomyomas (UL) are considered the most common tumors of the female reproductive system. However, there are few epidemiological studies about this condition in Brazil. To estimate the prevalence of self-reported history of UL according to demographic and socioeconomic characteristics, and to markers of access to health care. We analyzed data from 1,733 university employees who participated at the baseline waves of the Pro-Saude Study (1999-2001), in relation to three outcomes: (1) self-reported medical diagnosis of UL, (2) UL with symptoms prior to diagnosis, and (3) cases with hysterectomy due to UL. Prevalence and 95% confidence intervals (95% CI) were estimated in relation to strata of variables related to demographic (age, color/race) and socioeconomic characteristics (education, income) and of markers of access to health care (Pap smear, breast clinical exam and private health insurance status). The prevalence of medically-diagnosed UL was 23.3% (95% CI - 21.3, 25.2), the UL with symptoms prior to diagnosis of 13.3% (95% CI - 11.7, 15.0) and hysterectomy due to UL, 8.4% (95% CI - 7.5, 10.3). Among participants younger than 45 years old, higher prevalence was observed among women with worse socioeconomic conditions and of black color/race. Among those with 45 years or more, there was higher prevalence among women with better access to health care. In this study population of Brazilian women, UL is a relevant health problem, and its prevalence and associated socio-demographic gradients are similar to those observed in other countries.

475 Does private health insurance status affect the pathological outcomes in patients undergoing radical prostatectomy in the United Kingdom?

475 Does private health insurance status affect the pathological outcomes in patients undergoing radical prostatectomy in the United Kingdom?

Regardless of where they give birth, women living in non-metropolitan areas are less likely to have an epidural than their metropolitan counterparts

Can differences in Australian birth intervention rates be explained by women's residence at the time of childbearing?. Data were collected prospectively via surveys in 1996, 2000, 2003, 2006 and 2009 from women, born between 1973 and 1978, of the Australian Longitudinal Study on Women's Health. Analysis included data from 5886 women who had given birth to their first child between 1994 and 2009. Outcome measures were self-report of birth interventions: pharmacological pain relief (epidural and spinal block analgesia, inhalational analgesia and intramuscular injections), surgical births (an elective or emergency caesarean section) and instrumental births (forceps and ventouse). Primiparous women residing in non-metropolitan areas of Australia experienced fewer birth interventions than women residing in metropolitan areas: 43% versus 56% received epidural analgesia; 8% versus 11% had elective caesarean sections; and 16% versus 18% had emergency caesarean sections. Differences in maternal age and private health insurance status at first birth accounted for differences in surgical birth rates but did not fully explain differences in epidural analgesia. Non-metropolitan women had fewer birth interventions, particularly epidural analgesia, than metropolitan women. Differences in maternal age and private health insurance do not fully explain the differences in epidural analgesia rates, suggesting care provided to labouring women may differ by area of residence. The difference in epidural analgesia rates may be due to lack of choice in maternity services, however it could also be due to differing expectations leading to differences in birth interventions for primiparous women living in metropolitan and non-metropolitan areas.

Policy Implications of Complementary and Alternative Medicine Use in Australia: Data from the National Health Survey

The objective of this study was to investigate the drivers of complementary and alternative medicine (CAM) use in the general population in Australia and to identify key policy implications. The National Health Survey 2007/2008, a representative survey of the Australian population, provides information on CAM use (practitioners and products) in the last 12 months. All adult respondents (N=15,779) aged 18 years or older are included in this study. Logistic regression is employed to determine the effect of socio-economic, condition-specific, health behavior variables, and private health insurance status on CAM use. In addition to socio-economic variables known to affect CAM use, individuals who have a chronic condition, particularly a mental health condition, are more likely to use CAM. There does not appear to be a correlation between CAM use and more frequent General Practitioner use; however, ancillary private health insurance is correlated with a greater likelihood of CAM use, as expected. The Australian government does not currently intervene in the CAM market in a systematic way. CAM is clearly considered to be a legitimate and important component of health care for many Australians, despite the limited availability of clinical evidence for its efficacy and safety. Policy interventions may include the regulation of CAM products, practitioners, and information as well as providing subsidies for cost-effective modalities.

Outcomes of singleton births after blastocyst versus nonblastocyst transfer in assisted reproductive technology

To compare obstetric and perinatal outcomes of singleton births after assisted reproductive technology (ART) with blastocyst transfer (days 5 to 6) versus nonblastocyst transfer (days 2 to 4). Retrospective cohort study. Monash IVF. 4,202 women who conceived using in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) between 2004 and 2009. Records analysis of fresh and frozen-thawed embryo transfers resulting in singleton births of at least 20 weeks' gestation. Perinatal outcomes: preterm birth, low birthweight, very low birthweight, small for gestational age, large for gestational age, preeclampsia, antepartum hemorrhage, placental abruption, placenta previa, and postpartum hemorrhage; and covariates: maternal age, year of birth of the baby, private health insurance status, maternal body mass index, smoking status, parity, gender of baby, and variations in treatment procedures. Multivariate analysis found no statistically significant difference between transfers on days 5 and 6 and days 2 and 4 for all maternal and perinatal outcomes. There were modest increases in the adjusted odds ratios for preeclampsia (adjusted odds ratio 1.72, 99% confidence interval 0.93-3.20) and placenta previa (1.65, 0.92-2.98). Obstetric and perinatal outcomes after blastocyst transfer on days 5 to 6 are similar when compared with embryo cleavage-stage transfers on days 2 to 4.

Private health insurance, mental health and service use in Australia

To report on the private health insurance (PHI) status of individuals with and without a mental health problem, and examine whether PHI status is associated with access to psychological services. This is a descriptive study of nationally representative population-based data collected in 2009 (HILDA) with participants aged 15-93 (n = 13,301). Key measures included: PHI status (categorised as 'hospital cover only', 'extras cover only', or 'both hospital and extras cover'); mental health status (categorised as 'have a mental health problem' or 'do not have a mental health problem' using the mental health index (MHI) of the medical outcomes study short form); mental health service use (access to a mental health professional (psychologist/psychiatrist) in the past 12 months categorised as 'yes' or 'no'). Individuals with a mental health problem were less likely to have PHI than those without a mental health problem. However, PHI was not associated with access to a mental health professional in the past 12 months. The findings suggest that while the discrepancy in PHI status is a marker of inequity between those with and without a mental health problem, it is not a key factor in facilitating access to mental health services.

Survival from breast cancer: an analysis of Australian data by surgeon case load, treatment centre location, and health insurance status

Early invasive breast cancer data from the Australian National Breast Cancer Audit were used to compare case fatality by surgeon case load, treatment centre location and health insurance status. Deaths were traced to 31 December 2007, for cancers diagnosed in 1998-2005. Risk of breast cancer death was compared using Cox proportional hazards regression. When adjustment was made for age and clinical risk factors: (i) the relative risk of breast cancer death (95% confidence limit) was lower when surgeons' annual case loads exceeded 20 cases, at 0.87 (0.76, 0.995) for 21-100 cases and 0.83 (0.72, 0.97) for higher case loads. These relative risks were not statistically significant when also adjusting for treatment centre location (P ≥ 0.15); and (ii) compared with major city centres, inner regional centres had a relative risk of 1.32 (1.18, 1.48), but the risk was not elevated for more remote sites at 0.95 (0.74, 1.22). Risk of death was not related to private insurance status. Higher breast cancer mortality in patients treated in inner regional than major city centres and in those treated by surgeons with lower case loads requires further study.

Is the self‐reported private health insurance status in the National Health Survey representative of private health insurance coverage in Australia?

This study determines whether the distribution of self-reported private health insurance (PHI) status in the 2004/05 National Health Survey (NHS) is representative of PHI coverage in Australia. Weighted estimates from the NHS 2004/05 are compared with PHI status reported for 2004/05 by the Private Health Insurance Administration Council (PHIAC, the independent regulator of the private health insurance industry). PHI status was imputed to children in the NHS based on PHI status of the adult in the household. The two data sources were deemed to be different if the PHIAC results were not within the 95% CI range for the NHS estimate. PHI status reported in the NHS and PHIAC are generally comparable except for some categories such as hospital cover of males aged 5-9 years and females aged 85 years and older where the NHS estimates are below PHIAC numbers; and males aged 25-29, 35-39, and 50-54 years where the NHS estimates are higher. The findings suggest that while the NHS 2004/05 estimates may accurately represent coverage in Australia particularly when examined at an aggregated level, there is some variation in the NHS estimates when examined by sex and age group. Researchers need to be aware of the potential for sampling and reporting bias to contribute to some misrepresentation of PHI status when using the NHS to generalise to the Australian population. Exploring corrective measures will ensure that the NHS continues to be a valuable data resource for health researchers in Australia.

Socio‐demographic correlates of screening intention for colorectal cancer

ObjectiveTo assess the relationship between socio‐demographic factors and screening intention for colorectal cancer (CRC). MethodsA cross‐sectional survey of a random sample of 884 Queenslanders aged 40–80 years was conducted using a computer‐assisted telephone interviewing system. The factors measured included socio‐demographic characteristics, personal history of CRC, knowledge of others with CRC and perceived symptom status. Chi‐squared and Monte Carlo estimates of Fisher Exact Tests were performed to determine the associations between socio‐demographic factors and screening intention. In multivariate analyses, multinomial logistic regression (MNLR) was utilised to examine potential determinants of screening intention. Results77.5% (95% Cl 74.0%‐80.7%) of the respondents indicated their intention to participate in CRC screening if it were recommended by their doctor or health authorities. The likelihood ratio chi‐squared tests in the MNLR analyses show that age (χ(df=6)2= 15.0 P=0.02) education (χ(df=8)2=19.4; p=0.01), perceived symptom status (χ(df=4)2= 22.9; p=0.00) sec (χ(df=2)2= 4.5; p=0.11), income (χ(df=14)2= 19.6; p=0.14) and personal history of CRC (χ(df=2)2= 4.3; p=0.12) were potential determinants of screening intention. Other socio‐demographic factors, including country of birth, private health insurance status, Socio‐economic Index for Areas, and Rural and Remote Areas Classification codes, were not associated with screening intention. Conclusions and implicationsThe results indicate that a variety of socio‐demographic factors are associated with screening intention and need to be considered in the future development of a population‐based sceening program for CRC.

Profile of maternal smokers and their pregnancy outcomes in south western Sydney.

The prevalence of maternal smoking remains high in New South Wales. In order to better understand the profile of maternal smokers, a study has been conducted to examine the social and demographic characteristics and pregnancy outcomes of women who smoked during their pregnancy in south western Sydney. Women and babies of a retrospective cohort of 7,191 singleton births between March 1996 and December 1998, at Liverpool Hospital were analyzed. The prevalence of maternal smoking for the study population was 18.8%. The study found that the sociodemographic factors, such as marital status, ethnic origin, English speaking background, working status during pregnancy, and private health insurance status were independent risk factors for maternal smoking, but maternal age was not. Women who smoked during their pregnancy had higher rates of abruptio placenta, threatened premature labour, and premature labour. The adverse neonatal outcomes due to maternal smoking were low birth weight and increased neonatal morbidity. Smoking appears to have a protective effect on pregnancy induced hypertension. The findings of this study suggests that future smoking cessation programs should pay more attention to addressing sociodemographic and cultural factors that influence the behaviour of maternal smokers.

Features of infant exposure to tobacco smoke in a cohort study in Tasmania.

To document changes in smoking style around infants over time and to identify factors associated with the smoking hygiene of mothers and others. A population based cohort study. Population based, involving 22% of live births in Tasmania, Australia. From 1 May 1988 to 30 April, 1993, 6109 infants and their mothers (89% of eligible infants) participated in the hospital and home interview of the cohort study. Infants eligible for cohort entry were those assessed at birth to be at a higher risk of SIDS. The overall proportion of mothers who smoked during pregnancy and postnatally did not decline. Increasing trends were found for mothers and others not smoking in the same room as baby or while holding or feeding the baby, significant over the five year period. Good smoking hygiene (mother not smoking in the same room as baby) was positively associated with--first birth (OR = 1.74 (1.30, 2.33)), low birth weight (1.69 (1.27, 2.23)), being born after 1 May 1991 (1.67 (1.33, 2.11)), and private health insurance status (1.39 (1.02, 1.90)). Good smoking hygiene was negatively associated with maternal smoking during pregnancy (0.50 (0.31, 0.80)), intention to bottle feed (0.62 (0.49, 0.78)), the level of maternal postnatal smoking, increasing numbers of smokers in the household, and parents cohabiting but unmarried. A similar analysis was conducted for other household residents who smoked. Changes in maternal smoking prevalence have been small. The exposure of infants to tobacco smoke postnatally has decreased significantly, although a large proportion of infants are still exposed to tobacco smoke. The identification of the above parental and infant factors associated with good smoking hygiene should be useful for health education planning.