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1.
Rural Remote Health ; 24(2): 8572, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38632695

RESUMO

INTRODUCTION: Aboriginal and Torres Strait Islander Peoples (First Nations Australians) living in remote communities are hospitalised with skin and soft tissue infections (SSTIs) at three times the rate of non-First Nations Australians. The Torres Strait in tropical northern Australia has a highly dispersed population mainly comprising First Nations Australians. This study aimed to define the health service utilisation and health system costs associated with SSTIs in the Torres Strait and to improve the quality of regional healthcare delivery. METHODS: The research team conducted a retrospective, de-identified audit of health records for a 2-year period, 2018-2019. The aim was to define health service utilisation, episodes of outpatient care, emergency department care, inpatient care and aeromedical retrieval services for SSTIs. RESULTS: Across 2018 - 2019, there were 3509 outpatient episodes of care for SSTIs as well as 507 emergency department visits and 100 hospitalisations. For individuals with an SSTI, the mean outpatient clinic episode cost $240; the mean emergency department episode cost $400.85, the mean inpatient episode cost $8403.05 while an aeromedical retrieval service cost $18,670. The total costs to the health system for all services accessed for SSTI management was $6,169,881 per year, 3% of the total annual health service budget. CONCLUSION: Healthcare costs associated with SSTIs in the Torres Strait are substantial. The implementation of effective preventative and primary care interventions may enable resources to be reallocated to address other health priorities in the Torres Strait.


Assuntos
Serviços de Saúde do Indígena , Aceitação pelo Paciente de Cuidados de Saúde , Dermatopatias Infecciosas , Infecções dos Tecidos Moles , Humanos , Austrália/epidemiologia , Povos Aborígenes Australianos e Ilhéus do Estreito de Torres , Atenção à Saúde , Estudos Retrospectivos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos
2.
Birth ; 49(2): 194-201, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-34617314

RESUMO

OBJECTIVES: The purpose of this study was to identify differences in health service expenditure on Indigenous and non-Indigenous women who experience a stillbirth, women's out-of-pocket costs, and health service use. METHODS: The project used a whole-of-population linked data set called "Maternity1000," which includes all women who gave birth in Queensland, Australia, between July 1, 2012, and June 30, 2018 (n = 396 158). Multivariable analysis was undertaken to assess differences in mean health service expenditure; and number of health care services accessed between Indigenous and non-Indigenous women who had a stillbirth from birth to twelve months postpartum. Costs are presented in 2019/20 Australian dollars. RESULTS: There was a total of 1864 babies stillborn to women in Queensland between July 1, 2012, and June 30, 2018, with 135 being born to Indigenous women and 1729 born to non-Indigenous women. There was significantly lower total expenditure per woman for Indigenous women compared with non-Indigenous women ($16 083 and $18 811, respectively). This was consistent across public hospital inpatient ($12 564 compared with $14 075), outpatient ($1127 compared with $1470), community-based services ($198 compared with $313), pharmaceuticals ($8 compared with $22), private hospital ($434 compared with $1265), and for individual out-of-pocket fees ($21 compared with $86). Mean expenditure on emergency department services per woman was higher for Indigenous women compared with non-Indigenous women ($947 compared with $643). Indigenous women who experienced a stillbirth accessed fewer general practitioners, allied health, specialist, obstetrics, and outpatient services, and fewer pathology and diagnostic test than their non-Indigenous counterparts. CONCLUSIONS: Inequities in access to health services exist between Indigenous and non-Indigenous women who experience a stillbirth.


Assuntos
Serviços de Saúde do Indígena , Natimorto , Austrália , Feminino , Gastos em Saúde , Serviços de Saúde , Humanos , Mães , Gravidez
3.
Int J Health Plann Manage ; 36(6): 2182-2198, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34270134

RESUMO

BACKGROUND: Disparities in health service use exist in many sectors of Australia's health system, particularly affecting the most vulnerable people in the population, who are typically those with the greatest healthcare needs. Understanding patterns of health service coverage is critical for acknowledging the underlying, systemic drivers including racialised practices that inhibit the uptake of health services for certain population groups. This study aims to determine whether there are disparities in health service utilisation between socioeconomic, geographic and ethnic groups of mothers who experience hypertension, diabetes and mental health conditions. METHODS: This study utilised a linked administrative healthcare dataset containing data of all mothers who gave birth in Queensland, Australia, between 2012 and 2015 (n = 186,789), plus their resultant babies (n = 189,909). The study compared health service utilisation for mothers with maternal health conditions between population groups. RESULTS: The results of this study showed a broad trend of inequitable health service utilisation, with mothers who experienced the greatest healthcare needs-First Nations, rural and remote and socio-economically disadvantaged mothers-being less likely to access health services and in some cases when care was accessed, fewer services being utilised during the perinatal period. CONCLUSION: Access to health care during the perinatal period is a reflection of Australia's general health system strengths and weaknesses, in particular a failure of the government to translate national and state policy intent into acceptable and accessible care in rural and remote areas, for First Nations women and for mothers experiencing socio-economic disadvantage.


Assuntos
Serviços de Saúde Materna , Austrália , Atenção à Saúde , Etnicidade , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Gravidez , Fatores Socioeconômicos
4.
Nutr Metab Cardiovasc Dis ; 31(5): 1427-1433, 2021 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-33846005

RESUMO

BACKGROUND AND AIMS: In the context of the rising rate of diabetes in pregnancy in Australia, this study aims to examine the health service and resource use associated with diabetes during pregnancy. METHODS AND RESULTS: This project utilised a linked administrative dataset containing health and cost data for all mothers who gave birth in Queensland, Australia between 2012 and 2015 (n = 186,789, plus their babies, n = 189,909). The association between maternal characteristics and diabetes status were compared with chi-square analyses. Multiple logistic regression produced the odds ratio of having different outcomes for women who had diabetes compared to women who did not. A two-sample t-test compared the mean number of health services accessed. Generalised linear regression produced the mean costs associated with health service use. Mothers who had diabetes during pregnancy were more likely to have their labour induced at <38 weeks gestation (OR:1.39, 95% CI:1.29-1.50); have a cesarean section (OR: 1.26, 95% CI:1.22-1.31); have a preterm birth (OR:1.24, 95%: 1.18-1.32); have their baby admitted to a Special Care Nursery (OR: 2.34, 95% CI:2.26-2.43) and a Neonatal Intensive Care Unit (OR:1.25, 95%CI: 1.14-1.37). On average, mothers with diabetes access health services on more occasions during pregnancy (54.4) compared to mothers without (50.5). Total government expenditure on mothers with diabetes over the first 1000 days of the perinatal journey was significantly higher than in mothers without diabetes ($12,757 and $11,332). CONCLUSION: Overall, mothers that have diabetes in pregnancy require greater health care and resource use than mothers without diabetes in pregnancy.


Assuntos
Cesárea/economia , Diabetes Gestacional/economia , Diabetes Gestacional/terapia , Custos de Cuidados de Saúde , Recursos em Saúde/economia , Serviços de Saúde Materna/economia , Gravidez em Diabéticas/economia , Gravidez em Diabéticas/terapia , Adulto , Bases de Dados Factuais , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Unidades de Terapia Intensiva Neonatal/economia , Terapia Intensiva Neonatal/economia , Trabalho de Parto Induzido/economia , Admissão do Paciente/economia , Gravidez , Gravidez em Diabéticas/epidemiologia , Queensland , Medição de Risco , Fatores de Risco , Fatores de Tempo , Adulto Jovem
5.
J Paediatr Child Health ; 57(5): 618-625, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33426720

RESUMO

AIM: To examine the differences in return to work time after childbirth; the differences in income; and the differences in out of pocket health-care costs between mothers who had a preterm birth and mothers who delivered a full term baby in Australia. METHODS: Using administrative data, the length of time and 'risk' of returning to employment for mothers whose child was born premature relative to those whose child was born full term was reported. Multivariate linear regression models were constructed to assess the difference in maternal income and the differences in mean out-of-pocket costs between mothers who had a preterm birth and mothers who had a full term birth. RESULTS: The mean length of time for mothers of babies born full term to return to work was 1.9 years and for mothers of preterm babies it was 2.8 years. Mothers of preterm babies had a significantly lower median income ah at 0-1, 2-3 and 4-5 years postpartum compared to mothers of full term babies. The adjusted mean out of pocket costs for health care paid by mothers who had a preterm birth was $1298 for those whose child was aged 32-36 weeks; and $2491 for those whose child was aged <32 weeks. This is in comparison to mothers of children born 37 weeks and over, whose mean out of pocket costs were $1059. CONCLUSION: Mothers who have a preterm birth have longer return to work time, a lower weekly income and also have higher out of pocket costs compared with mothers who have a full term birth.


Assuntos
Nascimento Prematuro , Austrália/epidemiologia , Criança , Feminino , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Mães , Gravidez , Nascimento Prematuro/epidemiologia , Prevalência
6.
Int J Health Policy Manag ; 10(9): 554-563, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32610760

RESUMO

BACKGROUND: Maternity care is a significant contributor to overall healthcare expenditure, and private care is seen as a mechanism to reduce the cost to public funders. However, public funders may still contribute to part of the cost of private care. The paper aims to quantify (1) the cost to different funders of maternal and early childhood healthcare over the first 1000 days for both women giving birth in private and public hospitals; (2) any variation in cost to different funders by birth type; and (3) the cost of excess caesarean sections in public and private hospitals in Australia. METHODS: This study utilised a whole of population linked administrative dataset, and classified costs by the funding source. The mean cost to different funders for private hospital births, and public hospital births in the Australian state, Queensland are presented by time period and by birth type. The World Health Organization's (WHO's) C-model was used to identify the optimal caesarean section rate based upon demographic and clinical factors, and counterfactual analysis was utilised to identify the cost to different funders if caesarean section had been utilised at this rate across Australia. RESULTS: We found that for women who gave birth in a public hospital as a public patient, the mean cost was $22 474. For women who gave birth in a private hospital the mean cost was $24 731, and the largest contributor was private health insurers ($11 550), followed by Medicare ($7261) and individuals ($3312). Private hospital births cost government funders $10 050 on average; whereas public hospital public patient births cost government funders $21 723 on average and public hospital private patient births cost government funders $20 899 on average. If caesarean section deliveries were reduced, public hospital funders could save $974 million and private health insurers could save $216 million. CONCLUSION: Private hospital births cost government funders less than public hospital births, but government funders still pay for around 40% of the cost of private hospital births. Caesarean sections, which are more frequently performed in private hospitals, are costly to all funders and reducing them could impart significant cost savings to all funders.


Assuntos
Cesárea , Serviços de Saúde Materna , Idoso , Austrália , Pré-Escolar , Atenção à Saúde , Feminino , Hospitais Privados , Hospitais Públicos , Humanos , Programas Nacionais de Saúde , Gravidez
7.
Pregnancy Hypertens ; 21: 197-199, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32634609

RESUMO

In Australia, Hypertensive Disorders of Pregnancy are one of the leading causes of maternal death. Additionally, mothers and babies can experience significant morbidity associated with Hypertensive Disorders of Pregnancy. Currently, there is little understanding about the resources spent on this pregnancy complication in Australia. Therefore, using a linked administrative dataset from the Queensland population in Australia, this study aims to determine the difference in government expenditure between mothers that have Hypertensive Disorders of Pregnancy and mothers who do not. The total government expenditure on mothers that had HDP was significantly higher than in mothers who did not have HDP ($14,388 and $11,395 respectively). Most notably, the greatest difference in costs were experienced during the time of birth ($8696 and $6509).


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Hipertensão Induzida pela Gravidez/economia , Adulto , Austrália , Estudos de Casos e Controles , Custos e Análise de Custo , Feminino , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Terapia Intensiva Neonatal/economia , Gravidez , Sistema de Registros
8.
Birth ; 47(1): 49-56, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31612550

RESUMO

BACKGROUND: Designing effective universal health care systems has challenges, including the use of patient co-payments and the role of the public and private systems. This study sought to quantify the total amount of out-of-pocket fees incurred by women who gave birth in private and public hospitals within Australia-a country with universal health coverage-and assess the impact that variation in birth type has on out-of-pocket fees. METHODS: Data came from a linked administrative data set of all women who gave birth in the Australian state Queensland between July 1, 2012, and June 30, 2015, plus their resultant children. Propensity score matching was used to create two similar cohorts of women who gave birth in private and public hospitals. RESULTS: The mean total out-of-pocket fees for care from conception to the child's first birthday was $2813 (±2683 standard deviation) and $623 (±1202) for women who gave birth in private and public hospitals, respectively. Total fees were higher in both public and private hospitals for women who had a cesarean birth ($716 [±1419] and $3010 [±2988]) than for women who had a vaginal birth without instruments ($556 [±1044] and $2560 [±2284]). DISCUSSION: Australia's strong policy incentives for women to take out private health insurance are leaving women with large out-of-pocket costs. This should hold important lessons for other countries implementing a universal health care system, to ensure that using a combination of public and private practitioners does not undermine the intention of universal care.


Assuntos
Cesárea/economia , Gastos em Saúde/estatística & dados numéricos , Hospitais Privados , Hospitais Públicos , Cobertura Universal do Seguro de Saúde , Adulto , Feminino , Humanos , Modelos Logísticos , Serviços de Saúde Materna/economia , Gravidez , Pontuação de Propensão , Queensland , Fatores Socioeconômicos , Adulto Jovem
9.
Birth ; 47(2): 183-190, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31737924

RESUMO

BACKGROUND: Reducing stillbirth rates is an international priority; however, little is known about the cost of stillbirth. This analysis sought to quantify the costs of stillbirth in Australia. METHODS: Mothers and costs were identified by linking a state-based registry of all births between 2012 and 2015 to other administrative data sets. Costs from time of birth to 2 years postbirth were included. Propensity score matching was used to account for differences between women who had a stillbirth and those that did not. Macroeconomic costs were estimated using value of lost output analysis and value of lost welfare analysis. RESULTS: Cost to government was on average $3774 more per mother who had a stillbirth compared with mothers who had a live birth. After accounting for gestation at birth, the cost of a stillbirth was 42% more than a live birth (P < .001). Costs for inpatient services, emergency department services, services covered under Medicare (such as primary and specialist care, diagnostic tests and imaging), and prescription pharmaceuticals were all significantly higher for mothers who had a stillbirth. Mothers who had a stillbirth paid on average $1479 out of pocket, which was 52% more than mothers who had a live birth after accounting for gestation at birth (P < .001). The value of lost output was estimated to be $73.8 million (95% CI: 44.0 million-103.9 million). The estimated value of lost social welfare was estimated to be $18 billion. DISCUSSION: Stillbirth has a sustained economic impact on society and families, which demonstrates the potential resource savings that could be generated from stillbirth prevention.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Serviços de Saúde Materna/economia , Natimorto/economia , Austrália , Custos e Análise de Custo , Feminino , Humanos , Recém-Nascido , Modelos Lineares , Nascido Vivo/economia , Programas Nacionais de Saúde , Gravidez , Pontuação de Propensão
10.
Paediatr Perinat Epidemiol ; 34(1): 3-11, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31885099

RESUMO

BACKGROUND: Clinical interventions known to reduce the risk of caesarean delivery include routine induction of labour at 39 weeks, caseload midwifery and chart audit, but they have not been compared for cost-effectiveness. OBJECTIVE: To assesses the cost-effectiveness of three different interventions known to reduce caesarean delivery rates compared to standard care; and conduct a budget impact analysis. METHODS: A Markov microsimulation model was constructed to compare the costs and outcomes produced by the different interventions. Costs included all costs to the health system, and outcomes were quality-adjusted life years (QALY) gained. A budget impact analysis was undertaken using this model to quantify the costs (in Australian dollars) over three years for government health system funders. RESULTS: All interventions, plus standard care, produced similar health outcomes (mean of 1.84 QALYs gained over 105 weeks). Caseload midwifery was the lowest cost option at $15 587 (95% confidence interval [CI] 15 269, 15 905), followed by routine induction of labour ($16 257, 95% CI 15 989, 16 536), and chart audit ($16 325, 95% CI 15 979, 16 671). All produced lower costs on average than standard care ($16 905, 95% CI 16 551, 17 259). Caseload midwifery would produce the greatest savings of $172.6 million over three years if implemented for all low-risk nulliparous women in Australia. CONCLUSIONS: Caseload midwifery presents the best value for reducing caesarean delivery rates of the options considered. Routine induction of labour at 39 weeks and chart audit would also reduce costs compared to standard care.


Assuntos
Cesárea/economia , Auditoria Clínica/economia , Continuidade da Assistência ao Paciente , Custos de Cuidados de Saúde , Trabalho de Parto Induzido/economia , Tocologia/economia , Austrália , Auditoria Clínica/métodos , Simulação por Computador , Redução de Custos , Análise Custo-Benefício , Feminino , Financiamento Governamental , Humanos , Trabalho de Parto Induzido/métodos , Cadeias de Markov , Tocologia/métodos , Paridade , Gravidez , Anos de Vida Ajustados por Qualidade de Vida
11.
BMC Public Health ; 19(1): 1540, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752792

RESUMO

BACKGROUND: The World Health Organization states there are three interrelated domains that are fundamental to achieving and maintaining universal access to care - raising sufficient funds for health care, reducing financial barriers to access by pooling funds in a way that prevents out-of-pocket costs, and allocating funds in a way that promotes quality, efficiency and equity. In Australia, a comprehensive account of the mechanisms for financing the health system have not been synthesised elsewhere. Therefore, to understand how the maternal health system is financed, this review aims to examine the mechanisms for funding, pooling and purchasing maternal health care and the influence these financing mechanisms have on the delivery of maternal health services in Australia. METHODS: We conducted a scoping review and interpretative synthesis of the financing mechanisms and their impact on Australia's maternal health system. Due to the nature of the study question, the review had a major focus on grey literature. The search was undertaken in three stages including; searching (1) Google search engine (2) targeted websites and (3) academic databases. Executive summaries and table of contents were screened for grey literature documents and Titles and Abstracts were screened for journal articles. Screening of publications' full-text followed. Data relating to either funding, pooling, or purchasing of maternal health care were extracted for synthesis. RESULTS: A total of 69 manuscripts were included in the synthesis, with 52 of those from the Google search engine and targeted website (grey literature) search. A total of 17 articles we included in the synthesis from the database search. CONCLUSION: Our study provides a critical review of the mechanisms by which revenues are raised, funds are pooled and their impact on the way health care services are purchased for mothers and babies in Australia. Australia's maternal health system is financed via both public and private sources, which consequentially creates a two-tiered system. Mothers who can afford private health insurance - typically wealthier, urban and non-First Nations women - therefore receive additional benefits of private care, which further exacerbates inequity between these groups of mothers and babies. The increasing out of pocket costs associated with obstetric care may create a financial burden for women to access necessary care or it may cause them to skip care altogether if the costs are too great.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Financiamento da Assistência à Saúde , Serviços de Saúde Materna/economia , Austrália , Feminino , Humanos , Gravidez
12.
Aust Health Rev ; 43(5): 556-564, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31303194

RESUMO

Objective This study sought to compare costs for women giving birth in different public hospital services across Queensland and their babies. Methods A whole-of-population linked administrative dataset was used containing all health service use in a public hospital in Queensland for women who gave birth between 1 July 2012 and 30 June 2015 and their babies. Generalised linear models were used to compare costs over the first 1000 days between hospital and health services. Results The mean unadjusted cost for each woman and her baby (n = 134910) was A$17406 in the first 1000 days. After adjusting for clinical and demographic factors and birth type, women and their babies who birthed in the Cairns Hospital and Health Service (HHS) had costs 19% lower than those who birthed in Gold Coast HHS (95% confidence interval (CI) -32%, -4%); women and their babies who birthed at the Mater public hospitals had costs 28% higher than those who birthed at Gold Coast HHS (95% CI 8, 51). Conclusions There was considerable variation in costs between hospital and health services in Queensland for the costs of delivering maternity care. Cost needs to be considered as an important additional element of monitoring programs. What is known about the topic? The Australian maternal care system delivers high-quality, safe care to Australian mothers. However, this comes at a considerable financial cost to the Australian public health system. It is known that there are variations in the cost of care depending upon the model of care a woman receives, and the type of delivery she has, with higher-cost treatment not necessarily being safer or producing better outcomes. What does this paper add? This paper compares the cost of delivering a full cycle of maternity care to a woman at different HHSs across Queensland. It demonstrates that there is considerable variation in cost across HHSs, even after adjusting for clinical and demographic factors. What are the implications for practitioners? Reporting of cost should be an ongoing part of performance monitoring in public hospital maternity care alongside clinical outcomes to ensure the sustainability of the high-quality maternal health care Australian public hospitals deliver.


Assuntos
Custos de Cuidados de Saúde , Hospitais Públicos/economia , Serviços de Saúde Materna/economia , Adulto , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Gravidez , Queensland
13.
BMC Pregnancy Childbirth ; 19(1): 226, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272397

RESUMO

BACKGROUND: There is global concern for the overuse of obstetric interventions during labour and birth. Of particular concern is the increasing amount of mothers and babies experiencing morbidity and mortality associated with caesarean section compared to vaginal birth. In high-income settings, emerging evidence suggests that overuse of obstetric intervention is more prevalent among wealthier mothers with no medical need of it. In Australia, the rates of caesarean section and other obstetric interventions are rising. These rising rates of intervention have been mirrored by a decreasing rate of unassisted non-instrumental vaginal deliveries. In the context of rising global concern about rising caesarean section rates and the known health effects of caesarean section on mothers and children, we aim to better characterise the use of obstetric intervention in the state of Queensland, Australia by examining the characteristics of mothers receiving obstetric intervention. Identifying whether there is overuse of obstetric interventions within a population is critical to improving the quality, value and appropriateness of maternity care. METHODS: The association between demographic characteristics (at birth) and birth delivery type were compared with chi-square. The percentage of mothers based on their socioeconomic characteristics were reported and differences in percentages of obstetric interventions were compared. Multivariate analysis was undertaken using multiple logistic regression to assess the likelihood of receiving obstetric intervention and having a vaginal (non-instrumental) delivery after accounting for key clinical characteristics. RESULTS: Indigenous mothers, mothers in major cities and mothers in the wealthiest quintile all had higher percentages of all obstetric interventions and had the lowest percentages of unassisted (non-instrumental) vaginal births. These differences remained even after adjusting for other key sociodemographic and clinical characteristics. CONCLUSIONS: Differences in obstetric practice exist between economic, ethnic and geographical groups of mothers that are not attributable to medical or lifestyle risk factors. These differences may reflect health system, organisational and structural conditions and therefore, a better understanding of the non-clinical factors that influence the supply and demand of obstetric interventions is required.


Assuntos
Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Uso Excessivo dos Serviços de Saúde/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Parto Obstétrico/economia , Feminino , Disparidades em Assistência à Saúde/economia , Disparidades em Assistência à Saúde/etnologia , Humanos , Modelos Logísticos , Uso Excessivo dos Serviços de Saúde/economia , Padrões de Prática Médica/economia , Gravidez , Queensland , Saúde da População Rural/economia , Saúde da População Rural/etnologia , Saúde da População Rural/estatística & dados numéricos , Fatores Socioeconômicos , Saúde da População Urbana/economia , Saúde da População Urbana/etnologia , Saúde da População Urbana/estatística & dados numéricos
14.
Health Econ Rev ; 9(1): 10, 2019 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-30859357

RESUMO

BACKGROUND: Poor health increases the likelihood of experiencing poverty by reducing a person's ability to work and imparting costs associated with receiving medical treatment. Universal health care is a means of protecting against the impoverishing impact of high healthcare costs. This study aims to document the recent trends in the amount paid by Australian households out-of-pocket for healthcare, identify any inequalities in the distribution of this expenditure, and to describe the impact that healthcare costs have on household living standards in a high-income country with a long established universal health care system. We undertook this analysis using a longitudinal, nationally representative dataset - the Household Income and Labour Dynamics in Australia Survey, using data collected annually from 2006 to 2014. Out of pocket payments covered those paid to health practitioners, for medication and in private health insurance premiums; catastrophic expenditure was defined as spending 10% or more of household income on healthcare. RESULTS: Average total household expenditure on healthcare items remained relatively stable between 2006 and 2014 after adjusting for inflation, changing from $3133 to $3199. However, after adjusting for age, self-reported health status, and year, those in the lowest income group (decile one) had 15 times the odds (95% CI, 11.7-20.8) of having catastrophic health expenditure compared to those in the highest income group (decile ten). The percentage of people in income decile 2 and 3 who had catastrophic health expenditure also increased from 13% to 19% and 7% to 13% respectively. CONCLUSIONS: Ongoing monitoring of out of pocket healthcare expenditure is an essential part of assessing health system performance, even in countries with universal health care.

15.
Aust Health Rev ; 43(6): 639-643, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30248280

RESUMO

Objective Fear of childbirth is known to increase a woman's likelihood of having a Caesarean section. Continuity of midwifery care is known to reduce this risk, but less than 8% of women have access to this relationship-based, primary care model. The aims of this study were to determine whether healthcare use and access to continuity models are equal across different indicators of socioeconomic status for women who are fearful of birth. Methods A secondary analysis was conducted of data obtained during a randomised controlled trial of a psychoeducation intervention by trained midwives to minimise childbirth fear (the Birth Emotions and Looking to Improve Expectant Fear (BELIEF) study). In all, 1410 women were screened, with 339 women reporting high levels of fear (Wijma-Delivery Expectancy/Experience Questionnaire ≥66). Demographic, obstetric information, birth preference and psychosocial measures were collected at recruitment and at 36 weeks gestation for the 339 fearful women, with the birth method and health service use returned by 183 women at 6 weeks after the birth. Results Univariate analysis revealed no significant difference in the number of general practitioner and midwife visits between women of high and low income and high and low education. However, women with higher levels of education had 2.51-fold greater odds of seeing the same midwife throughout their pregnancy than women with lower education (95% confidence interval 1.25-5.04), after adjusting for age, parity and hospital site. Conclusions Given the known positive outcomes of continuity of midwifery care for women fearful of birth, health policy makers need to provide equity in access to evidence-based models of midwifery care. What is known about this topic? Caseload midwifery care is considered the gold standard care due to the known positive outcomes it has for the mother and baby during the perinatal period. Pregnant women who receive caseload midwifery care are more likely to experience a normal vaginal birth. What does this paper add? There is unequal access to midwifery caseload care for women fearful of birth across socioeconomic boundaries. Midwifery caseload care is not used for all fearful mothers during the perinatal period. What are the implications for practitioners? Health policy makers seeking to provide equity in access to maternity care should be aware of these inequalities in use to target delivery of care at this specific cohort of mothers.


Assuntos
Medo/psicologia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Parto/psicologia , Gestantes/psicologia , Adulto , Feminino , Clínicos Gerais/estatística & dados numéricos , Humanos , Tocologia/estatística & dados numéricos , Gravidez , Fatores Socioeconômicos , Adulto Jovem
17.
BMJ Open ; 8(2): e017816, 2018 02 06.
Artigo em Inglês | MEDLINE | ID: mdl-29437751

RESUMO

INTRODUCTION: The current literature in Australia demonstrates that there are variations in access and outcomes in perinatal care based on socioeconomic factors. However, little has been done looking at the level of out-of-pocket healthcare costs associated with perinatal care. The primary aim of this project will be to quantify health service use and out-of-pocket healthcare expenditure associated with childbearing and early childhood in Queensland, Australia. METHODS AND ANALYSIS: This project will build Australia's first model (called Maternal & Child Cost MOD) of out-of-pocket healthcare expenditure by using administrative data from the Queensland Perinatal Data Collection, of all childbearing women and their resultant children, who gave birth in Queensland between 1 July 2012 and 30 June 2016.The current costs to the health system and out-of-pocket health care expenditure of patients associated with maternity and early childhood health care will be identified. The differences in costs based on indigenous identification, socioeconomic status and geographic location will be assessed using linear regression modelling and counterfactual modelling techniques. ETHICS AND DISSEMINATION: Human Research Ethics approval has been obtained from Townsville Hospital and Health Service Human Research Ethics Committee (HREC) (HREC Reference number: HREC/16/QTHS/223). Consent will not be sought from participants whose de-identified data will be used in this study. Permission to waive consent has been gained from Queensland Health under the Public Health Act 2005.The results of this study will be disseminated through publications in peer-reviewed journals and through presentations at conferences, regionally and nationally. Our target audience is clinicians, health professionals and health policy-makers.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/economia , Armazenamento e Recuperação da Informação/métodos , Serviços de Saúde Materno-Infantil/economia , Assistência Perinatal/economia , Adulto , Criança , Pré-Escolar , Coleta de Dados/métodos , Feminino , Programas Governamentais , Disparidades em Assistência à Saúde , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Serviços de Saúde Materno-Infantil/estatística & dados numéricos , Mães/estatística & dados numéricos , Havaiano Nativo ou Outro Ilhéu do Pacífico , Assistência Perinatal/estatística & dados numéricos , Gravidez , Queensland , Fatores Socioeconômicos
18.
Aust N Z J Obstet Gynaecol ; 58(3): 362-365, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29327343

RESUMO

Recent health reforms alongside unregulated provider fees have led to increased attention being given to out-of-pocket healthcare costs. This study utilised annual statistics published by the Department of Health for services provided under the Medicare Benefits Schedule (MBS) from 1992/3 to 2016/17 to identify changes in out-of-pocket charges for obstetric items over time, and estimate the change in demand for obstetric items in response to price increases. Since 1992/3 out-of-pocket charges increased by 1035% for out-of-hospital items and 77% for in-hospital items. Demand for obstetric items has reduced with increasing charges.


Assuntos
Gastos em Saúde , Programas Nacionais de Saúde , Cuidado Pré-Natal/economia , Austrália , Feminino , Humanos , Gravidez , Estados Unidos
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