Horizontal inequities in Australia's mixed public/private health care system
Horizontal inequities in Australia's mixed public/private health care system
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DOI：
10.1016/j.healthpol.2007.09.018
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发表时间：
2008-04-01
期刊：
影响因子：
3.3
通讯作者：
Hall, Jane
中科院分区：
文献类型：
--
作者：
Van Doorslaer, Eddy;Clarke, Philip;Hall, Jane
经合组织国家最近的比较证据表明，澳大利亚公私混合的卫生系统在确保较高和相当平等地获得医生、医院和牙科保健服务方面做得很好。本文对2001年澳大利亚全国健康调查的相同数据进行了进一步分析，以检查当数据的全部潜力得到实现时，横向公平的一般结果是否仍然存在。我们扩展了共同核心跨国比较分析，扩展了医疗保健需求差异标准化过程中使用的指标集，为全科医生和专科医生的使用提供了单独的分析，并区分了公立和私立医院的入院患者。总体而言，我们的分析证实，在2001年，联邦医疗保险制度似乎在很大程度上实现了医疗服务的公平分配：需要医疗服务的澳大利亚人确实能去看医生并住院。然而，他们看同一位医生和躺在同一张病床上的可能性并不相同。与其他经合组织国家一样，在其他条件相同的情况下，收入较高的澳大利亚人更有可能咨询专家，而收入较低的患者更有可能咨询全科医生。私人健康保险覆盖年龄按收入的不平等分配造成了富裕者和不太富裕者没有得到同样的服务。与其他一些经合组织国家一样，私营部门今后在二级保健服务方面的扩展有可能进一步损害平等需要平等获得服务的原则。在某种程度上，这种使用上的不平等可能转化为健康结果上的不平等，这可能是令人关切的。(C)2007爱思唯尔爱尔兰有限公司保留所有权利。
Recent comparative evidence from OECD countries suggests that Australia's mixed public-private health system does a good job in ensuring high and fairly equal access to doctor, hospital and dental care services. This paper provides some further Analysis of the same data from the Australian National Health Survey for 2001 to examine whether the general finding of horizontal equity remains when the full potential of the data is realized. We extend the common core cross-country comparative analysis by expanding the set of indicators used in the procedure of standardizing for health care need differences, by providing a separate analysis for the use for general practitioner and specialist care and by differentiating between admissions as public and private patients.Overall, our analysis confirms that in 2001 Medicare largely did seem to be attaining an equitable distribution of health care access: Australians in need of care did get to see a doctor and to be admitted to a hospital. However, they were not equally likely to see the same doctor and to end up in the same hospital bed. As in other OECD countries, higher income Australians are more likely to consult a specialist, all else equal, while lower income patients are more likely to consult a general practitioner. The unequal distribution of private health insurance covet-age by income contributes to the phenomenon that the better-off and the less well-off do not receive the same mix of services. There is a risk that - as in some other OECD countries - the principle of equal access for equal need may be further compromised by the future expansion of the private sector in secondary care services. To the extent that such inequalities in use may translate in inequalities in health outcomes, there may be some reason for concern. (C) 2007 Elsevier Ireland Ltd. All rights reserved.