Empirical studies in socioeconomic-related health inequalities

Abstract

This thesis explores several themes involving different aspects of socioeconomic-related health inequalities. It consists of three separate parts, each with its own research questions. Part 1 examines the degree of horizontal equity in the use of medical services and pharmaceuticals offered under Australia’s universal health care system, Medicare, and the Pharmaceutical Benefits Scheme using patient-level information with linked administrative data on usage. This section also examines factors associated with adherence and persistence to prescribed chronic medications with an emphasis on exploring the impact of the concession card, which reduces co-payments for disadvantaged Australians.

Part 2 demonstrates how probabilistic simulation models - similar to those used to forecast patient outcomes under various medical interventions in health economic evaluations - can be used to inform policy issues regarding health inequalities. Specifically, we simulate the potential impacts of various policy interventions in order to determine effective ways to generate reductions in the life expectancy gap. The model incorporates socioeconomic factors and predicts the progression of interrelated and modifiable health-related behaviours over the lifetime and ultimately the occurrence of death. An innovation of the model is that it allows for correlations amongst behaviours (such as smoking and alcohol consumption).

Part 3 examines the relationship between the business cycle and health in Australia and assesses whether the health effects are spread evenly across socioeconomic groups, or alternatively if certain subgroups have different relationships, which could potentially have important consequences for health inequalities. We exploit the richness of the dataset used in this analysis to explore the underlying mechanisms that may help to explain these relationships.