One quarter of chronically ill Australians are skipping healthcare because of prohibitive medical costs, with those suffering from mental health conditions such as depression and anxiety most likely to forfeit care.
The finding comes from research led by James Cook University in Queensland that examined the chronic health conditions associated with the highest out-of-pocket costs and whether those costs prevented people from accessing treatment.
Researchers analysed the data from 1,988 Australian respondents to the Commonwealth Fund international health survey conducted in 2013 and compared those to responses from 10 other countries, including Canada, Switzerland, Germany and the US.
They found the US was the only country out of those studied where more people with chronic conditions skipped medical care because of the cost than Australians.
Of the 226 Australian respondents with depression, anxiety and other mental health conditions, 44% skipped healthcare treatment, while 32% of the 227 people with asthma, emphysema and chronic obstructive pulmonary disease could not afford the treatments they needed.
The average out-of-pocket household healthcare costs spent by Australians was $986. But those with arthritis reported out-of-pocket costs of $1,220 per year, people with depression $1,350 per year and those with asthma, emphysema and chronic obstructive pulmonary disease $1,640 per year.
One quarter of the respondents reported no out-of-pocket healthcare expenditure, while 14% reported an expenditure of more than $2,000 each year.
“Those with mental health conditions were shown to have particularly large out-of-pocket expenditure and be restively more likely to forgo care, which indicates that the cost of mental health services may be prohibitively high,” the authors wrote in the Australian Journal of Primary Health.
“Other studies have noted that the Medicare rebates for mental health are particularly low relative to the fees charged by mental health practitioners.”
Psychiatrist and national mental health commissioner Prof Ian Hickie described access to mental health care as “one of the great inequities of the Australian healthcare system”.
Because of the onset of many mental illnesses in youth, those patients experienced a lower rate of participation in the workforce, lower lifetime wealth and a longer period of time throughout their lifetime having to pay for treatments, he said.
“Their capacity to purchase care is decreased,” he said. “People are making active decisions every day not to pursue care because of the cost of the system, which remains largely blind to this disparity for mental health patients.”
Government funding was mostly directed to those mental health patients who ended up in hospital and therefore, more severe disease, he said. More of that funding should be directed toward community-based mental health services and the pharmaceutical benefits scheme, he said, to prevent people’s illnesses from becoming so severe that they required hospitalisation.
The lead author of the study, Dr Emily Callander, said there were clear implications from the findings for government policy.
“For most healthy, working Australians I think we have a terrific healthcare system,” she said. “For those people, healthcare is largely accessible. But for those people with chronic conditions, which are increasingly common in Australia, they are often dealing with the double disadvantage of poor health and poor income.
“Successive federal governments have talked about increasing out-of-pocket costs, whether directly through increases in the Medicare co-payment or indirectly through things like rebate freezes or changing the Medicare safety net threshold. It shows the importance of these discussions and that in the back of our mind, we should always consider the implications for access.”
A professor of health economics at the University of Melbourne’s Centre for Health Policy, Philip Clarke, said the paper raised important issues. But he said the government needed to be more forthcoming in providing access to the data it held to allow more comprehensive analysis of those bearing the brunt of healthcare costs.
“The government has the data to do this in areas like Medicare statistics where it collects all out-of-pocket expenses related to Medicare treatments but only limited amounts of this information is released,” he said.
“We should try to systematically use the data we have got, particularly where we can link data sets to, for example, data about those with chronic diseases. There’s no reason why researchers shouldn’t be allowed to analyse this information systematically.”
