Medicare funds find their mark

PATIENTS from lower income households are the key beneficiaries of Medicare spending on chronic care items, according to research published today by the MJA. (1)

A national cluster-stratified survey of 2862 patients aged 55 years and older found that, after controlling for need, Medicare Benefits Schedule (MBS) expenditure was relatively evenly distributed across income groups, but spending on chronic care items favoured patients in the lower income bands.

Chronic care items include those under the Chronic Disease Management program, the Chronic Disease Dental Scheme (CDDS), and various allied health services.

“This study provides evidence that Medicare funding is progressive in that a greater proportion of government subsidies for out-of-hospital Medicare items flow to lower income groups”, the study authors wrote.

However, an accompanying editorial said that while Medicare had improved equity in some areas of health, challenges remained in ensuring equity of access to medical specialist, psychological and dental care. (2)

“The overall effect of Medicare has been to reduce differentials in use of primary health care and we should acknowledge and protect these achievements at the same time as seeking to make further improvements”, Professor Mark Harris, director of the University of NSW Centre for Primary Health Care and Equity, wrote.

The research found that CDDS, which is due to wind up on 1 December to be replaced with a broader scheme, was one of the more progressive of areas of Medicare expenditure, with the two lowest income groups receiving two and a half times the funding of that received by the highest income group.

However, the benefits of the CDDS did not extend those living in rural areas, who were 69% less likely to use the scheme than those based in cities. “This suggests that limited availability of CDDS services in regional/remote locations is a major barrier to the scheme’s uptake”, the researchers wrote.

Professor Harris wrote that in the past 30 years access to dental care had consistently been in inverse proportion to socioeconomic disadvantage.

He said while the MJA study found evidence that dental care provided under the CDDS was more equitable, the linking of the scheme to chronic disease meant that patients in high need but without chronic disease did not have access to the scheme.

The CDDS had also been criticised for providing less needed care, such as crown and bridge work, he wrote.

It was yet to be seen how the equity of access to dental care would be affected by the introduction of the new dental health package, Professor Harris said.

The Dental Health Reform package will be rolled out from 1 January next year. It will include basic dental services for children, funding for adult public dental services through the states and some funding for dental infrastructure in outer-urban, regional and rural centres.

The researchers also found a greater uptake of chronic care items by people with one or more comorbid conditions and among those who self-reported below-average health. About 37% of people in the lowest income band reported below-average health, compared with 15% in the highest income quartile.

Professor Harris wrote that the average size of specialist co-payments had also increased in the past 20 years, and patients on low-incomes were less likely to seek specialist care than those on higher incomes.

The researchers noted several limitations in their survey, including the self-reporting of income levels and the fact that it captured equity only among older patients who had consulted a GP.

– Nicole MacKee

1. MJA 2012; Online 26 November
2. MJA 2012; Online 26 November

Posted 26 November 2012