Australia is a proud of it’s universal health care system. But while the ideal of Medicare has been implemented, there is more to be done.

“People assume our health care is free, but it’s not,” says Dr Jane Desborough.

Australia’s health care system is set up to be progressive, which means that people who can afford more, pay more. But sometimes it doesn’t work this way.

“People living with chronic illnesses incur numerous costs. While those on the lowest income level may have the majority of these costs covered by subsidies, people who earn just that little bit more may not be eligible for these subsidies,” says Dr Desborough.

“We know people living with chronic illness and on lower incomes may forego essential treatments in order to prioritise basic needs such as food and housing. They might trade-off one medication for another resulting in sub-optimal disease management, or even work less so that they're eligible for subsidies.”

In Australia, 47% of the population has one or more chronic diseases, and 20% have multiple. Some estimates indicate that individuals with multiple chronic illnesses can spend up to six times the amount spent by those without a chronic illness, and those on lower incomes are fifteen times more likely than those on higher incomes to incur catastrophic health care costs (>10% of household income).

Dr Desborough is looking forward to exploring this in greater depth, and to use evidence to inform policy and hopefully make access to healthcare and medicines more equitable in Australia. She has been awarded a Discovery Early Career Researcher Award* to do just that.

People living with chronic illness are firmly front-and-centre of this research. Desborough will work with them directly as members of her research team and on the project steering committee, and through interviews to better understand their experiences of managing out of pocket costs for healthcare and medicines. 

“My project will provide critical information describing how out of pocket expenses impact people’s lives. It will explore the challenges people experience in managing the affordability of certain health services or medicines. It will also describe the choices that people make, which are reflective of the value they place on aspects of their health and life.”

Through working with policymakers, advocating for changes in the healthcare system to meet people’s priorities, Dr Desborough will work to ensure that this evidence will inform better models of healthcare financing that will reduce disparities in the ability to pay out of pocket costs for healthcare and medicines. Particularly for disadvantaged and vulnerable groups such as people on low incomes or those ineligible for subsidised healthcare and medicines.

And it’s not just our health that will benefit from the changes. Effective management of chronic disease in primary care could avert some 250,000 hospital admissions in Australia annually, saving an estimated $322 million, not to mention the savings for individuals and families, including losses in productivity and wages.

Dr Desborough’s study is designed to complement and extend a current NHMRC-funded whole-of-population linked data study, Using whole-of-population linked data to strengthen evidence for improving health and health care in Australia: Equity of out-of-pocket costs for Medicare services and prescription medicines, led by Associate Professor Rosemary Korda, NCEPH ANU, and in collaboration with the Australian Bureau of Statistics. Ass/Prof. Korda’s study aims to assess the extent to which OOP costs are related to ability to pay.

“If we can get this right, it will enhance and save lives, and it will save money for the healthcare system. That’s health and wealth for the whole community.”

* The Discovery Early Career Researcher Award scheme provides focused research support for early career researchers in both teaching and research, and research-only positions. It is awarded through the Australian Research Council.

By Liz Drummond.