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Health Expenditure, Income and Health Status Among Indigenous and Other Australians

Health Expenditure, Income and Health Status Among Indigenous and Other Australians

M.C. Gray
B.H. Hunter
J. Taylor
Volume: CAEPR Monograph No. 21
Copyright Date: 2004
Published by: ANU Press
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  • Book Info
    Health Expenditure, Income and Health Status Among Indigenous and Other Australians
    Book Description:

    Using data from the 1995 National Health Survey (NHS) this study asks the question—what is the relationship between income, health expenditure and health status for the Indigenous and non-Indigenous populations in Australia? Income is generally seen as an indicator of ability to address the need for health expenditure, and as a factor in influencing health status. The expectation, therefore, is that income and health status are positively related. The analysis measures differences in health expenditure and reported health status between the Indigenous and non-Indigenous populations, holding income level constant. No association is found between income and Indigenous health status. A number of explanations are canvassed. The finding may simply reflect poor data quality, both in terms of income and self-assessed health status. An alternative hypothesis, with long-term implications, is that adult mortality reflects foetal and childhood health, regardless of current income status.  

    eISBN: 978-1-920942-14-4
    Subjects: Sociology

Table of Contents

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  1. Front Matter
    (pp. i-ii)
  2. Foreword
    (pp. iii-iv)
    Jon Altman

    This monograph has its genesis in an approach made to the Centre for Aboriginal Economic Policy Research (CAEPR) by the Australian Institute of Health and Welfare (AIHW). CAEPR was asked to undertake an analysis of 1995 National Health Survey data as input to the AIHWʹs second report on expenditures on health services for Aboriginal and Torres Strait Islander people. This approach was made late in 1999, and agreement to undertake the work was completed early in 2000. The AIHWʹs report Expenditures on Health Services for Aboriginal and Torres Strait Islander People, 1998–99 (AIHW cat. no. IHW 7) was published...

  3. Acknowledgments
    (pp. v-vi)
  4. Table of Contents
    (pp. vii-viii)
  5. List of figures and tables
    (pp. ix-x)
  6. Abbreviations and acronyms
    (pp. xi-xii)
  7. Executive summary
    (pp. xiii-xviii)
  8. 1. Background issues
    (pp. 1-6)

    While the broad profile of ill health and excess mortality among Indigenous Australians is well documented, research on determinants remains relatively undeveloped. Nonetheless, sufficient insight exists to place an emphasis in explanation on the compound effects of overall low socio-economic status, including low income. This is in line with theoretical trends generally in social epidemiology in which biological pathways between psychosocial stress and ill health are seen as explanatory (Berkman & Kawachi 2000; Kawachi, Kennedy & Wilkinson 1999; Marmot & Wilkinson 1999). Within this paradigm, persistently low levels of life expectancy among Indigenous Australians would be viewed as a product of their entrenched...

  9. 2. Indigenous health status in perspective
    (pp. 7-14)

    The infant mortality rate is used internationally as one of the key indicators of community health. It is defined as the number of infant deaths (deaths of children less than one year of age) for every 1000 live births. Among Indigenous Australians there was an exceedingly high rate of infant mortality of around 100 infant deaths per 1000 live births—recorded as recently as the mid-1960s. In subsequent years, there was a steady and precipitous decline to around 26 per 1000 by 1981, with much of this due to improvements in post-neonatal mortality. While further improvement in infant survival also...

  10. 3. Comparing like with like: analysis by income
    (pp. 15-22)

    An essential step in comparing like with like is to adjust family income for family size and composition in order to take into account differences in the costs of living. This is particularly important when comparing the per capita health expenditure of Indigenous and non-Indigenous Australians by income level due to substantial differences in the size and structure of households between the Indigenous and non-Indigenous populations.

    There is an ongoing and unresolved debate regarding appropriate equivalence scales for use in Australia (Saunders 1994). In the present analysis, the major challenge is to ensure that the distinctive circumstances of Indigenous people...

  11. 4. Per capita health expenditure by income and Indigenous origin
    (pp. 23-28)

    Our estimate of per capita health expenditure for Indigenous people living in non-sparsely settled areas is $2734, which is around $500 higher than the estimate of $2277 for non-Indigenous people. However, the estimates of per capita health expenditure are quite variable, particularly for the Indigenous population, for whom the standard error on the estimate of per capita expenditure is $334. While the estimates for the non-Indigenous population are also variable, the standard errors are smaller ($50). This means that the estimate of per capita health expenditure on Indigenous people is not statistically different from the estimate for the non-Indigenous population...

  12. 5. Further information on the usage of health services by equivalent income
    (pp. 29-30)

    As discussed above, the estimates of per capita health expenditure by income group have a great deal of sampling variability and therefore high standard errors. We are therefore very constrained in our ability to determine whether there are genuine differences in health expenditure by income and whether there are differences between the Indigenous and non-Indigenous populations.

    In an attempt to overcome this uncertainty, further analysis of usage of health services by equivalent income groups was conducted by focusing on those who reported no usage in the two weeks prior to interview. This is motivated in part by the fact that...

  13. 6. Health status by equivalent income
    (pp. 31-36)

    The analysis above suggests that for the non-Indigenous population a negative relationship exists between per capita health expenditure and equivalent income. In contrast, for the Indigenous population there is no evidence of a significant relationship between per capita health expenditure and equivalent income. Why should there be a difference in this relationship between the Indigenous and non-Indigenous populations? As far as per capita health expenditure is concerned, there are several factors that may be relevant. These can be separated into:

    differences in the met need for health and medical services (determined by both the number of medical conditions and the...

  14. 7. Conclusion
    (pp. 37-40)

    As the information base for profiling Indigenous health outcomes and proximate causes is progressively expanded, the indications of high absolute and relative morbidity and mortality remain unchanged, as do reported levels of exposure to risk factors that are strongly associated with a variety of chronic, preventable and non-communicable diseases. From a policy perspective, one element of the health complex that lends itself most directly to intervention is the level of expenditure (both public and private) on health and medical services. Previous analysis of the distribution of such expenditure noted that total health spending per capita was higher for Indigenous Australians...

  15. Appendix A. Construction of utilisation rates using the 1995 National Health Survey
    (pp. 41-42)
  16. Appendix B. Distribution of health expenditure by equivalent income
    (pp. 43-46)
  17. Appendix C. Estimates of cost per medical service
    (pp. 47-50)
  18. Appendix D. Method for estimation of standard errors and confidence intervals
    (pp. 51-52)
  19. Notes
    (pp. 53-56)
  20. References
    (pp. 57-62)
  21. Back Matter
    (pp. 63-64)