Academic journal article Australian Health Review

Did General Practice Health Assessments of Older Australians Improve Equity?

Academic journal article Australian Health Review

Did General Practice Health Assessments of Older Australians Improve Equity?

Article excerpt

Abstract

Objective: To examine if claims for general practice health assessments of older persons in Australia over the period 1 November 1999 to 30 September 2002 were equitably distributed.

Design: Closed cohort study with data analysis using logistic regression.

Setting: Private general practice in Australia.

Participants: All Australians aged 75 or more years at 1 October 1999, who were eligible to claim for a health assessment.

Measures studied: Medicare and Department of Veterans' Affairs (DVA) medical claims data, and personal characteristics of claimants: age, sex, DVA beneficiary status, rurality and socio-economic status of postcode of residence. Rurality was classified by the Rural Remote and Metropolitan Area Classification (RRMA) and socio-economic status by the Index of Relative Socio-economic Deprivation (IRSD) for the postcode.

Results: The cohort initially contained 886 185 subjects. Over the 35 months, 271 939 individuals (31%) claimed at least one health assessment. Those most likely to have claimed for a health assessment were aged 80 to 84 years, female, entitled to treatment under DVA arrangements, lived in postcodes classified as RRMA 1-4 and classified as the most disadvantaged IRSD quartile.

Conclusion: Over this period, general practice health assessments appear to have been equitably distributed except for those living in post-codes classified as RRMA 5-7.

Aust Health Rev 2008: 32(3): 488-493

What is known about the topic?

Three previous studies that looked at equity of general practice health assessments of older persons in Australia using Health Insurance Commission claim data suggested that the distribution was equitable. These studies utilised unrepresentative samples and two were of short duration.

What does this paper add?

This study examines the uptakes for the whole Australian population over the first 35 months following the universal funding of health assessments

What are the implications for practitioners?

General practice appears to have targeted health assessments to those older persons at highest risk of adverse health outcomes.

A COMMITMENT TO removing inequity in health care outcomes underpins the policies that determine Commonwealth financing of health care in Australia.1 In spite of this policy commitment, there is evidence that inequity in access to health interventions is not exceptional in Australia. It has been shown that longer general practice consultations (which are believed to be more effective at improving health status2) and community dispensing of the statin class of drugs (a proven intervention to prevent or treat cardiovascular disease3) are more likely to be accessed by those residing in more advantaged localities despite them being at lower risk of adverse health outcomes.

On the 1 November 1999, all Australians aged 75 or more years, who were not residents of a residential aged care facility (RACF) became eligible to access reimbursement towards the cost of having a comprehensive health assessment performed by their general practitioner. Three metaanalyses of randomised controlled trials4"6 suggest that health assessments conducted in the patient's home lower mortality, lessen the risk of nursing home admission, and slow the rate of functional decline.

The International Society of Equity in Health has defined equity as:

the absence of systematic and potentially remediable differences in one or more aspects of health across populations or population groups defined socially, economically, demographically or geographically. Considerations of equity require not only attention to manifestations of ill health but also to risks of ill health as well as the potential for improved health.7

Among older Australians, health status is worse with increasing age,8 among those treated under Department of Veterans' Affairs (DVA) arrangements,9 those living in rural locations,10 and in disadvantaged postcodes as indicated by the Index of Relative Socio-economic Deprivation (IRSD) of the Australian Bureau of Statistics (ABS). …

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