OBJECTIVES:

Australia public health system with its universal coverage Medicare has been recently facing challenges of growing burden of chronic health conditions. To address this challenge, private health insurance (PHI) has been promoted as a supplemental to Medicare. This study aimed to examine the roles of PHI in the universal healthcare by investigating associations among preventive care usage, chronic conditions and health insurance cover types, with a focus on estimating effects of PHI on preventive care.

METHODS:

Data were extracted from surveys on the Household Income and Labor Dynamics in Australia. We used seven services of check-up/screening tests to proxy preventive usage, including pap-smear for women, prostate for men, and breast screening, bowel cancer screening, blood pressure check-up, and cholesterol test for both genders. Ten chronic conditions were considered. Three PHI cover types from the minimum to maximum levels (extra-service, hospital, and full covers) were analyzed in a pair-wise comparison with Medicare, adjusted for confounding chronic conditions, demographics and socioeconomic characteristics.

RESULTS:

9,829 respondents were followed up in 2009, 2013 and 2017, with 5,210 females (51.4%). Hypertension, diabetes, cancer, depression/anxiety and heart diseases were most influential factors. Compared to Medicare, women under hospital covers with diabetes and depression/anxiety likely had higher rates of taking additional checkup/screening test, yet men likely lower rates. Meanwhile the women with heart disease associated with lower rates yet the men with higher rate. The extra-service cover induced slightly higher rates of preventive services (IRR=1.046, 95% CI=(1.044,1.047) from women; IRR=1.065, 95% CI=(1.063,1.067) from men). The hospital and full covers encouraged the usage by more than 10%, especially in men (IRR=1.116, 95% CI=(1.114,1.118) and IRR=1.18, 95% CI=(1.179,1.181), respectively).

CONCLUSIONS:

PHI contributed to preventive care usage significantly, thus beneficial not only for individual health, but also for health professionals to improve primary care, and for policymakers to target a healthier nation.