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Do marginal changes in PHI membership accurately predict marginal changes in PHI use in Western Australia?
Rachael Elizabeth Moorin1, Cashel D'Arcy James Holman
1Australian Centre for Economic Research on Health (ACERH), School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia. rachmoor@sph.uwa.edu.au
Health Policy (Amsterdam, Netherlands)
|August 2, 2005
Summary
Private health insurance (PHI) membership trends aligned with PHI use from 1981-1991. However, post-1992, only surgical trends remained congruent, suggesting membership changes alone incompletely predict PHI use.
Area of Science:
- Health Services Research
- Health Economics
- Public Health Policy
Background:
- Private health insurance (PHI) plays a significant role in healthcare utilisation.
- Understanding the relationship between PHI membership and its actual use is crucial for health policy evaluation.
- Previous studies have not fully explored the temporal congruence between PHI membership and utilisation across different clinical categories.
Purpose of the Study:
- To compare annual trends in private health insurance utilisation with PHI membership data in Western Australia.
- To assess the predictive power of PHI membership for PHI use across medical, surgical, and obstetric clinical categories.
- To evaluate the effectiveness of policies aimed at shifting patients to the private system.
Main Methods:
- Utilised the WA Data Linkage System for hospital morbidity records (1981-2001).
- Estimated annual incidence rate ratios of private vs. public (Medicare) hospitalisation using Poisson regression.
- Compared rate ratio trends with published PHI membership trends across clinical and age groups.
Main Results:
- Significant shifts in PHI use occurred between 1981-1984, mirroring PHI membership trends.
- From 1992, surgical category trends diverged from PHI membership, unlike medical and obstetric categories.
- By 2000-2001, only surgical PHI use trends remained consistent with membership trends.
Conclusions:
- PHI membership and utilisation were congruent across all categories from 1981-1991.
- Post-1992, congruence diminished, with only the surgical category maintaining alignment by 2000-2001.
- Monitoring PHI membership changes alone is insufficient for evaluating policies targeting public healthcare system pressure.