The influence of federal health care policy reforms on the use of private health insurance in disadvantaged groups

Abstract

Objective: To examine changes in the incidence rate ratio of private health insurance (PHI) and Medicare use for episodes of hospitalisation as a function of socio-economic status and accessibility to evaluate the impact of federal health policy reforms. Methods: The WA Data Linkage System was used to extract all hospital morbidity records in Western Australia from 1991, 1996 and 2001. Adjusted odds ratios of PHI use were estimated in each socio-economic and locational accessibility category in each year using logistic regression. The odds ratios were then converted to adjusted incidence rate ratios controlled for population size. Results: In all cases between 1991 and 1996 the adjusted incident rate ratios fell; this was followed by an increase in the adjusted rate ratio in 2001 to levels near those of 1991 in the most accessible? highest socio-economically advantaged group. However in all other groups the increase fell short of the 1991 levels. The magnitude of the shortfall was associated with worsening accessibility or socio-economic status. In addition, significant changes in the within-group differential incident rate ratios were also observed over time. Conclusion: Our study indicates that the recent federal government policies which were aimed at making PHI more affordable to, and therefore more widely used by, lower to middle income earners were successful, lending empirical support for price elasticity of demand for PHI. Our results also indicate that the magnitude of their success varied according to disadvantage, suggesting that this elasticity is variable across both the level and typology of disadvantage.