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Background: Publicly funded computed tomography (CT) procedure descriptions in Australia often specify the body site, rather than indication for use. This study aimed to evaluate the relative contribution of demographic versus non-demographic factors in driving the increase in CT services in Australia., Methods: A decomposition analysis was conducted to assess the proportion of additional CT attributable to changing population structure, CT use on a per capita basis (CPC, a proxy for change in practice) and/or cost of CT. Aggregated Medicare usage and billing data were obtained for selected years between 1993/4 and 2012/3., Results: The number of billed CT scans rose from 33 per annum per 1000 of population in 1993/94 (total 572,925) to 112 per 1000 by 2012/13 (total 2,540,546). The respective cost to Medicare rose from $145.7 million to $790.7 million. Change in CPC was the most important factor accounting for changes in CT services (88%) and cost (65%) over the study period., Conclusions: While this study cannot conclude if the increase is appropriate, it does represent a shift in how CT is used, relative to when many CT services were listed for public funding. This 'scope shift' poses questions as to need for and frequency of retrospective/ongoing review of publicly funded services, as medical advances and other demand- or supply-side factors change the way health services are used., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objective: To explore impact of incident osteoarthritis (OA) on health services use by Australian women born 1946-51., Methods: Secondary analysis of Australian Longitudinal Study on Women's Health survey data linked to Medicare Australia databases (2002 to 2011). Medicare services use was compared for two groups: OA group (n=761) - reported incident OA in 2007; Never group (n=4346) - did not report arthritis in time frame. Interrupted time series regression compared health services use over time., Results: The OA group had higher health services use than the Never group. Rate of services use increased over time for both groups. Rate of increase in quarterly doctor attendances was significantly lower for the OA group after onset of OA, with no corresponding change for the Never group., Conclusions: A pre-existing higher use of health services is associated with reporting incident OA, compared to those who never report arthritis. After onset of OA, rate of doctor use reduced and allied health use increased, consistent with recommended Australian treatment guidelines., Implications: This study provides a rare insight into change in healthcare use for people reporting incident OA, against an appropriate comparison group, highlighting the importance of early diagnosis of OA to optimise effective use of health services., (© 2016 Public Health Association of Australia.)

Objectives: To explore the interaction of computed tomography (CT) use, dose and radiation risk of Australian Medicare-funded CT scanning and the impact on cancer incidence and mortality., Methods: This retrospective cohort study used records of Medicare subsidised CT scans in Australia (2006/07 to 2011/12) and Australian CT dosimetry. The annual number, rate and adjusted likelihood of CT were determined for gender, age and examination type. Incident cancer and cancer-related mortality attributable to CT in Australia were estimated using lifetime attributable risk coefficients, dosimetry and scan numbers., Results: The number of CT scans increased by 36% from 2006/07 to 2011/12. Only patients aged 0-4 years did not present an increase in CT scanning rates. Females were 11% more likely to be scanned than males. Head, abdomen/pelvis and spine CT scans were the most likely areas scanned. Females were attributed 61% of both incident cancers and cancer-related mortality from 55% of scans performed. Patients aged 15-44 years were attributed 37% of incident cancers and 30% of cancer-related mortality from 26% of CT scans., Conclusions: CT in Australia is increasing, including in groups at higher risk from ionising radiation. This presents a complex set of risk/benefit considerations for clinicians and policy makers., (© 2014 Public Health Association of Australia.)

This study aimed at analysing first-time hospitalisations for traumatic brain injury (TBI) and spinal cord injury (SCI) in Western Australia (WA), in terms of socio-demographic profile, cause of injury, relative risks and survival, using tabular and regression analyses of linked hospital discharge and mortality census files and comparing results with published standardised mortality rates (SMRs) for TBI. Participants were all 9,114 first hospital admissions for TBI or SCI from 7/2003 to 6/2008, linked to mortality census data through 12/2008, and the main outcome measures were number of cases by cause, SMRs in hospital and post-discharge by year through year 5. Road crashes accounted for 34 % of hospitalised TBI and 52 % of hospitalised SCI. 8,460 live TBI discharges experienced 580 deaths during 24,494 person-years of follow-up. The life-table expectation of deaths in the cohort was 164. Post-discharge SMRs were 7.66 in year 1, 3.86 in year 2 and averaged 2.31 in years 3 through 5. 317 live SCI discharges experienced 18 deaths during 929 years of follow-up. Post-discharge SMRs were 7.36 in year 1 and a fluctuating average of 2.13 in years 2 through 5. Use of data from model systems does not appear to yield biased SMRs. Similarly no systematic variation was observed between all-age studies and the more numerous studies that focused on those aged 14 to 16 and older. Based on two studies, SMRs for TBI, however, may be higher in year 2 post-discharge in Australia than elsewhere. That possibility and its cause warrant exploration. Expanding public TBI/SCI compensation in WA from road crash to all causes might triple TBI compensation and double SCI compensation.

Objective: Concerns about the radiation dose associated with CT scanning have led to a call for establishment of diagnostic reference levels. Self-complete surveys have been used extensively to gather this information, however, departmental Radiological Information System's/Picture Archive Communication Systems (RIS/PACS) also hold this information. We compared dosimetry derived from survey with that using RIS/PACSs., Methods: Technical data were collected from a large metropolitan tertiary hospital in WA using both data collection methods for a range of adult CT scanning examinations. Radiation dose was calculated from both datasets and the results evaluated for several indexes of inter-rater agreement., Results: Radiation dose calculated using self-report survey data differed both systematically and proportionally from that calculated using RIS/PACS data. Differences were not consistent across CT examination type and thus not amenable to simple correction. The disparity was greater and more variable for organ dose than effective dose due to reliance of survey data on "generic" anatomical start and stop limits compared with actual data available on RIS/PACS., Conclusions: The bias observed in our study indicates that care should be taken when interpreting the results of studies measuring radiation dose using self-complete surveys. The availability of electronic databases that include information required for the evaluation and monitoring of CT radiation dose provides the opportunity to capture better quality data in a cost-effective manner. We recommend that national and local databases are established that routinely capture these data so as to facilitate the development and monitoring of radiation dose associated with CT scanning., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Objectives: Controversy persists over the relationships between health care expenditure, time-to-death and age, undermining attempts to generate convincing predictions for policy. This paper explores the relationships between time-to-death (TTD), age and health care expenditure for Australian Medicare-funded, out-of-hospital services in the last five years of life, assessing if the relationship varies across different types of out-of-hospital services., Methods: Medicare Benefit Scheme claims for five years before death in Western Australia (1990-2004) pertaining to out-of-hospital primary care, specialist or diagnostic and therapeutic services were used to determine the total and mean per capita health care expenditure (HCE) according to age and TTD. Data were evaluated using univariate linear regression (age) and segmented time-trend regression analysis (time-to-death)., Results: Changes to out-of-hospital HCE in the last five years of life did not consistently show a positive association with changes in the number of decedents. Only primary care services demonstrated a linear relationship for HCE and age. For TTD, a linear relationship was observed for all three service types within each retrospective period., Conclusions: This study has identified significant differences in the relationship between age, TTD and out-of-hospital HCE across service type, further highlighting potential shortcomings in methods that use single, all-service, all-cause models to predict future HCE. These results build on our previous study and suggest that such predictions should either use separate models, or models capable of accounting for the different relationships of HCE with TTD and age across types of services in order to predict future HCE more accurately., (The Royal Society of Medicine Press Ltd 2012)

The objective ofthis study was to assess the impact of Enhanced Primary Care service utilisation on subsequent GP service regularity and frequency. The study involved a retrospective population-based longitudinal cohort using linked administrative health records of hospital and primary care services for people over the age of 65 years. Multinomial logistic regression modelling was used to evaluate changes in the relative likelihood of increased primary care service regularity and frequency in exposed and unexposed individuals adjusting for age, sex and recent chronic disease hospitalisation history. Enhanced Primary Care services significantly and substantially increased the relative likelihood of increased regularity with no corresponding higher likelihood of increased frequency of GP contact. Increased regularity was more likely with increasing age except for the oldest age group (90+ years). Some chronic disease histories (e.g. diabetes) showed a higher likelihood of improved regularity while others were less likely to produce an increased regularity (e.g. hypertension). The study suggests a capacity for modification of physician and patient behaviour using incentivised services within the current fee-for-service system in Australia.

Objective: Assess uptake of Medicare's enhanced primary care (EPC) services in Western Australia (WA) in 2001 to 2006, evaluating effect of EPC services on the regularity of contact with general practitioners (GPs) in patients aged 65+ years., Method: Whole-population cohort study using linked routinely collected health service data from State and Federal health databases. Analyses include age-standardised rate of EPC services, odds of EPC utilisation relative to other GP services using logistic regression, and total GP service regularity pre- and post-implementation of the EPC program., Results: EPC services provided to WA seniors increased 345% 2001 to 2006, comprising an increasing proportion of the total GP services (1.1 to 3.6%). Uptake of EPC services accelerated abruptly after 2004 due to greater use of 'care plans'. EPC services were associated with a history of chronic disease, especially type 2 diabetes (OR=1.74, 95% CI 1.66-1.82). Regularity of total GP services was improved with any EPC service exposure, with greater improvement occurring in the presence of annual EPC service exposure., Conclusions: EPC item uptake responded favourably to item changes from Medicare Australia. Prior exposure to EPC items increased the regularity of GP services, an outcome inversely associated with chronic disease progression.

Objective: In this study of the Western Australian population we analysed changes in the demographic determinants of PHI use across health policy eras. Specifically, we aimed to predict the probability that an individual, defined by a pre-determined set of characteristics, would utilise PHI for in-patient hospitalisation in WA in each of five health policy eras spanning 1981-2001., Methods: The WA Data Linkage System was used to extract hospital morbidity data from 1 January 1981 to 31 December 2001. Random effects logistic regression analysis was used to estimate the likelihood of utilising private health insurance in each of five health policy eras based on the timing and composition of changes in federal health care policy., Results: The use of PHI for in-patient hospitalisation fell significantly from 1981 to 1997 (61% above to 53% below the odds of being a public patient). From 1999, however, the odds of using PHI substantially increased to 16% above that of being a public patient. The likelihood of using PHI in all age fell approximately exponentially across successive health policy eras compared with that in the oldest (70+ years) age group. From 1997 onwards, the relative probabilities of average and disadvantaged individuals using PHI substantially increased compared with extremely advantaged individuals., Conclusion: Our study found that the overall likelihood of utilising PHI versus utilising Medicare for in-patient hospitalisation, adjusted for all demographic characteristics, decreased between 1981 and 1998 but increased precipitously after 1999. We also found that the determinants of using PHI have changed significantly across health policy eras. The most significant changes occurred with respect to age (the probability of PHI use by older individuals increased) and socio-economic status (the probability of PHI use by average and disadvantaged individuals increased). This shift in the effects of determinants of PHI suggests that the introduction of the recent health policies were associated with a change in both the age and socio-economic profile of individuals who utilise PHI.

Objective: To assess the effect of possession of private health insurance on hospital use and outcomes in Western Australia., Method: Hospital morbidity records were extracted from the Western Australian (WA) Data Linkage System for all 22 major diagnostic categories (MDCs) for the period 1994-99, with follow-up to the end of 2000. Multivariate modelling techniques were used to estimate the effect of possession of private health insurance on hospital admission rates, average and total length of stay (LOS), cumulative incidence of admission at 30 days and one year, and case fatality at one year., Results: Possession of private health insurance had significant effects on hospital use and outcomes, even after adjustments for age, sex, aboriginality, socioeconomic status, location and comorbidity. Non-insured patients tended to have a higher overall hospital admission rate but a lower admission rate for surgical episodes, and they generally had a longer LOS although this difference was only greater than a day in three MDCs. Case fatality was higher in non-insured patients, but there was no systematic trend with regard to readmission rates., Conclusions: The study found that for all MDCs, other than those where treatment was required on an emergency basis, patients with private health insurance had improved access to surgical procedures. Either non-insured patients were disadvantaged in their access to surgery or the higher intervention rate in privately insured patients represented supplier-/consumer-induced demand which may not always have been to the patient's advantage or both may have occurred.