Trends in private medical insurance ownership: lessons for the public sector.

Data on ownership of private medical insurance were collected from a fully national sample of over 1000 adults. Findings were compared with those of a study undertaken in 1981. Private medical insurance was owned by 40% of the sample, an increase from the 35% ownership in the earlier study. The increase has been predominantly amongst nonMaori New Zealanders and women have increased ownership more than men. Insurance ownership was most common amongst the middle age group (36-50 years) but it has increased significantly amongst the older groups. Greatest areas of growth in ownership were in Auckland and Wellington where proportionate ownership was 52% and 50% respectively. Medical insurance was employer provided amongst 15% of those with insurance, the same proportion as found in the earlier study. Employer subsidy to insurance was evident also. Major reasons to take out insurance were for primary care purposes, so as to overcome the cost barrier to general practitioner services. Other reasons mentioned included avoidance of waiting for treatment and increase in choice of specialist or hospital. Reasons for giving up insurance were cost of premium, disillusionment with benefits and disqualification through age or illness.

Mammographic screening for breast cancer: prospects for New Zealand.

The Cancer Society and the Department of Health invited a working group to make recommendations on screening by mammography. Mammography offers the best opportunity for preventing deaths from breast cancer. Randomised trials suggest that mortality can be reduced by about 30% in women over 50; the value of routine mammography in younger women is still uncertain. Apart from financial costs, the main drawback of mammography is that many women receive unnecessary investigation because of false-positive results. Careful design and monitoring of programmes is essential to ensure that the benefits of screening outweigh the disadvantages. In New Zealand there is a shortage of radiologists, pathologists, and clinicians who are skilled in the specialised techniques required for the screening of asymptomatic women. Decisions about routine screening should be delayed until pilot programmes have been established, with assessment of their effectiveness, economic efficiency, and social acceptability. Recommendations for the design of such programmes are made.

Impact of private medical insurance on the demand for child consultations with general practitioners.

Data were collected on over 4000 consultations with general practitioners for childhood complaints. Almost half of these consultations (46%) were covered by private medical insurance. A larger proportion of consultations for respiratory conditions were covered by insurance (50%) compared to those for nonrespiratory conditions (42% insured). Amongst those with respiratory conditions larger proportions of consultations for upper respiratory tract infections were insured (50%) than was the case for the potentially more serious conditions of asthma or otitis media (46% insured). The delay in seeking consultation for respiratory conditions was examined. In consultations for followup or persisting problems there was less delay among the insured (8.7 days) than amongst the noninsured (11 days). Those consultations initiated by the patient (or parent) were more likely to be covered by insurance (50%) than those which had been initiated by the doctor or other agency (44%). The findings are discussed in terms of the implications for equity and efficiency in health care.

The cost of renal transplants.

Patient records were examined for the 12 months immediately following a renal transplantation in 29 patients admitted to the department of nephrology of the Christchurch Hospital. Data were collected on their use of health care facilities and resources during the period including details of inpatient stays, outpatient visits, dialysis, drugs and diagnostic procedures. From this information estimates were made of the average cost of the treatment and the total annual cost of renal transplantation in New Zealand. The average cost of treatment during the first year following renal transplantation was estimated to be +16,717. For the country as a whole it was estimated that the annual cost of first year renal transplant therapy was +1,270,492 in 1986 prices.

Some characteristics of women smokers.

Smokers were compared with non-smokers in a sample of 978 women aged 18 to 60 years. The smokers were more likely to come from blue collar occupational backgrounds, they were more likely to report family problems and depressive symptoms, and they were more likely to make excessive use of other dependency type substances. Smoking amongst mothers and partners of the women was found to be more prevalent amongst the smokers. The findings are discussed in terms of their implications for smoking prevention amongst women.

The economic costs to New Zealand of lost production due to alcohol abuse.

This paper estimates the economic cost of lost production in New Zealand due to the abuse of alcohol. Four categories of lost production are examined including excess unemployment amongst abusers, decreased efficiency of abusers in the workforce, temporary withdrawal from the work force due to alcohol induced illness or accident, and permanent withdrawal from the work force due to the premature death of abusers. Assuming full employment, a 4.3% prevalence rate of alcohol abuse, and a 3 : 1 ratio of male to female abusers, the study presents estimates of costs for a range of possible abuser employment levels. The findings indicate that the cost of lost production due to alcohol abuse was between $582 million and $770 million for the 1981/82 financial year. This was equivalent to between 2% and 2.3% of GNP for that year.

Private medical insurance in New Zealand: issues of membership and growth.

Questions concerning ownership of private medical insurance were included in a recent Department of Statistics' survey of a random sample of almost 7000 New Zealanders. The results indicated that 35% of those surveyed owned private medical insurance and such ownership was significantly related to various social, demographic and health related variables. The findings are discussed in terms of the possibilities for growth of private medical insurance and the implications of such growth for both the public and the private health care sectors.