Academic journal article Australian Journal of Social Issues

Ancillary and Specialist Health Services: The Relationship between Income, User Rates and Equity of Access

Academic journal article Australian Journal of Social Issues

Ancillary and Specialist Health Services: The Relationship between Income, User Rates and Equity of Access

Article excerpt

Australia's public health system currently provides substantial funding to, amongst its other objectives, ensure access to hospital, medical and pharmaceutical services by all families irrespective of income (McClelland, 1991, p. 6).

However most ancillary, services are not similarly subsidised and there is some evidence that income presents a barrier to the use of these services. There is also evidence that low income might also reduce access to specialist medical practitioner services which, while funded through Medicare, are less likely to be bulk billed than general practitioner services, and which therefore attract higher out-of pocket costs.

In this study, the 1989-90 National Health Survey is used to examine whether there are indicators that low income reduces access to a range of ancillary services such as physiotherapy, optician services, chiropractic and dental services and to specialist medical practitioner services.


In Australia, while there is debate about the appropriate mix between public and private delivery of health services, it is nonetheless widely accepted that one of the government's key responsibilities is to ensure the integrity and efficiency of the health system and that services are both widely available and affordable. To this end, tax-payer funded public medical insurance is provided through Medicare and the Pharmaceutical Benefits Scheme. These programs heavily subsidise the cost of `basic' health items, that is, medical practitioner services, hospital services and pharmaceuticals.

Available evidence suggests that services included in these subsidy arrangements are indeed accessible to people from all income groups. For example, a study for the National Health Strategy (1992a, p. 105), reported that `universal coverage has been instrumental in removing barriers to access of health services' and that `access to basic health care services provided under Medicare is equitable'. Scott (1996) found that doctor and hospital services remain equitably distributed by income even after accounting for need.

However, while access to `basic' health services may bc generally equitable, there are indicators that access to other health services might not be so equitably distributed and in particular, that where there are few available public services, low income may present a barrier to their use. These `non-basic' health services include ancillary services (such as dental and physiotherapy services) and specialist medical practitioner services. If access were much less equitable, then it would indicate that Australia's health system is, in effect, two tiered. The first tier would include the heavily subsidised health services which are accessible to the rich and poor alike, and the second, the unsubsidised or less heavily subsidised services which are consequently less likely to be accessible to the poor.

In this context it is significant to note that people on lower incomes have been identified as having poorer health than those on higher incomes (see, for example, National Health Strategy, 1992a, p. 105). If income does function as a barrier to the use of some health services it is therefore likely that this will aggravate some of the existing disadvantages of low income groups.

To determine whether there are indicators that Australia's health services are two tiered, this study examines the distribution of a range of ancillary services and specialist medical practitioner services by people in different income groups. Also examined is the impact of the provision of public services to equity of access.

Income inequality in access to ancillary and specialist health services

There is a small but growing body of evidence which suggests that although programs such as Medicare address potential inequality of access to `basic' health services, there is still serious inequality in terms of access to some health services. …

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