Equity and the distribution of health care in Australia

Scott, Mari-Ann (1996) Equity and the distribution of health care in Australia. Masters by Research thesis, Murdoch University.

Abstract

The aim of this study was to examine equity in the distribution of health care services in Australia, where equity is defined as equal utilisation for equal need. The research was based on the analysis of the 1989/90 Australian National Health Survey unit record file, from which morbidity variables were used to derive need groups, and equivalent income was used to measure socio-economic status. The method was based on the 'Intergroup Comparison Approach', where age and sex standardised rates of health care service use are compared across income quintiles. Equity can be said to be achieved when the distribution of health care services is equal across socio-economic groups.

Measures of utilisation used included the average number of doctor consultations, casualty/outpatient attendances and hospital inpatient stays. Previous studies in this area have mainly restricted their analysis of equity in the distribution of health care to comparisons of the volume of health care services used across socio-economic groups. The economic and social factors influencing the number of services used by an individual are not identical to the factors influencing whether or not an individual makes contact with a health care service in the first place.

This thesis extends the analysis of equity in the distribution of health care to examine the volume of services used and the probability of use for each type of health care service across income quintiles. Consequently, the extent to which the distribution in average number of services used is the result of whether or not each socio-economic group utilised health care services in the first place as distinct from the number of repeat services used is revealed.

In addition to allowing an examination of equity with respect to the number of services used, the Australian National Health Survey includes information which can provide valuable insights into equity between income groups in the quality of services used. With regard to doctor consultations the unit record file contains information about the type of medical practitioner consulted. If the assumption is made that a specialist medical consultation is of superior quality to a general practitioner consultation, then equity with respect to the quality of health care services used is revealed. To this end, for each need group, the probability of a specialist medical practitioner consultation for persons that had at least one doctor consultation by income quintile was calculated.

The results showed that for three out of the four health/need groups, there is no evidence of inequality favouring either higher income groups or lower income groups in the use of doctor services. The fourth group did suggest a socio-economic gradient favouring the lower income quintiles (albeit a small one). Thus, with regard to the volume of doctor consultations it appears that the distribution of health care services is equitable. With regard to the quality of services however there was a positive strong socio-economic gradient in the use of specialist medical services. Within all four need groups the distribution of the average number of casualty/outpatient attendances and hospital inpatient stays shows an inverse gradient with respect to income. This inverse socio-economic gradient in the use of casualty/outpatient services and hospital inpatient stays, however, is unlikely to reflect inequity in the distribution of health care.

Item Type:	Thesis (Masters by Research)
Murdoch Affiliation(s):	School of Business
Notes:	Note to the author: If you would like to make your thesis openly available on Murdoch University Library's Research Repository, please contact: repository@murdoch.edu.au. Thank you.
Supervisor(s):	Norris, Keith
URI:	http://researchrepository.murdoch.edu.au/id/eprint/51276

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