The effects of socioeconomic status, accessibility to services and patient type on hospital use in Western Australia: a retrospective cohort study of patients with homogenous health status.

Full Abstract

BACKGROUND:
This study aimed to investigate groups of patients with a relatively homogenous health status to evaluate the degree to which use of the Australian hospital system is affected by socio-economic status, locational accessibility to services and patient payment classification.

METHOD:
Records of all deaths occurring in Western Australia from 1997 to 2000 inclusive were extracted from the WA mortality register and linked to records from the hospital morbidity data system (HMDS) via the WA Data Linkage System. Adjusted incidence rate ratios of hospitalisation in the last, second and third years prior to death were modelled separately for five underlying causes of death.

RESULTS:
The independent effects of socioeconomic status on hospital utilisation differed markedly across cause of death. Locational accessibility was generally not an independent predictor of utilisation except in those dying from ischaemic heart disease and lung cancer. Private patient status did not globally affect utilisation across all causes of death, but was associated with significantly decreased utilisation three years prior to death for those who died of colorectal, lung or breast cancer, and increased utilisation in the last year of life in those who died of colorectal cancer or cerebrovascular disease.

CONCLUSION:
It appears that the Australian hospital system may not be equitable since equal need did not equate to equal utilisation. Further it would appear that horizontal equity, as measured by equal utilisation for equal need, varies by disease. This implies that a 'one-size-fits-all' approach to further improvements in equity may be over simplistic. Thus initiatives beyond Medicare should be devised and evaluated in relation to specific areas of service provision.

Learn Faster Today Improve your study skills

Author information

Author/s: Moorin, Rachael E (RE); Holman, C D'Arcy J (CD);

Affiliation: Australian Centre for Economic Research on Health (ACERH), School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia. rachael.moorin(-atsign-)uwa.edu.au

Journal and publication information

Publication Type: Journal Article; Research Support, Non-U.S. Gov't

Journal: BMC health services research (BMC Health Serv Res), published in England. (Language: eng)

Reference: 2006-; vol 6 (issue ) : pp 74

Dates: Created 2006/08/28; Completed 2006/09/07; Revised 2008/11/20;

PMID: 16774689, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

External Links for this article (including full text providers, if available):

Click Electronic Full-text Provider Links to see options for finding the electronic full text links to this article. Note there may be a subscription or fee required for access to the full text. See our FAQ for information on finding FREE full text articles.

This article may also be located in paper journal collections available in many libraries. Use the Journal and Publication Information above to find the full article.

MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adolescent
Adult
Aged
Aged, 80 and over
Breast Neoplasms - mortality
Cerebrovascular Disorders - mortality
Child
Cohort Studies
Colorectal Neoplasms - mortality
Episode of Care
Female
Health Services Accessibility - economics; statistics & numerical data
Health Services Needs and Demand
Hospitals - utilization
Humans
Insurance Coverage - classification

These are the highest related articles currently in the database:

See 100+ related articles.