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How fair is Medicare? The income-related distribution of Medicare benefits with special focus on chronic care items.

Knott, Rachel J., Cass, Alan, Heeley, Emma L., Chalmers, John P., Peiris, David P. and Clarke, Philip M. (2012). How fair is Medicare? The income-related distribution of Medicare benefits with special focus on chronic care items.. Medical Journal of Australia,197(11):1-6.

Document type: Journal Article

IRMA ID 84473293xPUB55
Title How fair is Medicare? The income-related distribution of Medicare benefits with special focus on chronic care items.
Author Knott, Rachel J.
Cass, Alan
Heeley, Emma L.
Chalmers, John P.
Peiris, David P.
Clarke, Philip M.
Journal Name Medical Journal of Australia
Publication Date 2012
Volume Number 197
Issue Number 11
ISSN 0025-729X   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-84874407266
Start Page 1
End Page 6
Total Pages 5
Publisher Australasian Medical Publishing Company
HERDC Category C1 - Journal Article (DIISR)
Abstract Objective: To use patient-level data, clinical information and linked Medicare records to assess the distribution of benefits (rebates) across income groups, including benefits relating to chronic conditions such as the Chronic Disease Dental Scheme (CDDS).

Design, setting and participants:
Nationally representative, cluster-stratified survey (the Australian Hypertension and Absolute Risk Study) involving 322 general practitioners who each collected clinical data on 15–20 patients aged ≥ 55 years who presented between 1 April 2008 and 30 June 2008 and who consented to have their information linked with Medicare administrative records over 12 months.

Main outcome measures: Distribution of total out-of-hospital Medicare expenditure quantified using concentration indices and determinants of use calculated by odds ratios.

Results: There were 2862 patients in the study. After controlling for need, the concentration index for overall funding was slightly progressive (pro-poor) at − 0.008 (95% CI, − 0.009 to − 0.008). Medicare expenditure on chronic care-related services consistently contributed to progressivity of the overall scheme, particularly services under the CDDS with a need-adjusted concentration index of − 0.205 (95% CI, − 0.208 to − 0.201). Uptake of chronic care items varied by locality and comorbid conditions (there was greater uptake by patients with one or more comorbid conditions).

Conclusions: Chronic care items, particularly dental items, have primarily been used by individuals from lower income households. Uptake of chronic care items contributes to the overall progressivity of Medicare.
DOI http://dx.doi.org/10.5694/mja12.10514   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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Created: Tue, 24 Feb 2015, 12:43:43 CST