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The profiles of public and private patients in maternal healthcare: a longitudinal study to examine adverse selection

Published online by Cambridge University Press:  14 June 2019

Jananie William Open the ORCID record for Jananie William [Opens in a new window] ,
Bronwyn Loong ,
Catherine Chojenta  and
Deborah Loxton
Jananie William*
Affiliation:
Research School of Finance, Actuarial Studies and Statistics, Australian National University, Australia2601
Bronwyn Loong
Affiliation:
Research School of Finance, Actuarial Studies and Statistics, Australian National University, Australia2601
Catherine Chojenta
Affiliation:
Research Centre for Generational Health & Ageing, The University of Newcastle, Australia2308
Deborah Loxton
Affiliation:
Research Centre for Generational Health & Ageing, The University of Newcastle, Australia2308
*
*Corresponding author. Email: jananie.william@anu.edu.au
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Abstract

In this article, we investigate differences in the profiles of patients within the Australian mixed public-private maternal health system to examine the extent of adverse selection. There are conflicting influences on adverse selection within the private health sector in Australia due to government regulations that incentivise lower risk segments of the population to purchase community-rated private health insurance. We use a two-phase modelling methodology that incorporates statistical learning and logistic regression on a dataset that links administrative and longitudinal survey data for a large cohort of women. We find that the key predictor of private patient status is having private health insurance, which itself is largely driven by sociodemographic factors rather than health-or pregnancy-related factors. Additionally, transitioning between the public-private systems for a subsequent pregnancy is uncommon; however, it is primarily driven by changes in private health insurance when it occurs. Other significant factors when transitioning to the private system for a second pregnancy are hypertension, increased access to specialists and stress related to previous motherhood experiences. Consequently, there is limited evidence of adverse selection in this market, with targeted financial incentives likely outweighing the impact of community rating even during childbearing years where private health service use increases.

Keywords

Private health insurancematernal healthadverse selection
Type
Paper
Information
Annals of Actuarial Science , Volume 14 , Issue 1 , March 2020 , pp. 129 - 137
Copyright
© Institute and Faculty of Actuaries 2019 

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References

Adams, N., Gibbons, K. S. & Tudehope, D. (2017). Public-private differences in short-term neonatal outcomes following birth by prelabour caesarean section at early and full term. Australia & New Zealand Journal of Obstetrics and Gynaecology, 57(2), 176–185.10.1111/ajo.12591CrossRefGoogle ScholarPubMed
Adams, N., Tudehope, D., Gibbons, K. & Flenady, V. (2018). Perinatal mortality disparities between public care and private obstetrician-led care: a propensity score analysis. BJOG: An International Journal of Obstetrics & Gynaecology, 125(2), 149–158.10.1111/1471-0528.14903CrossRefGoogle ScholarPubMed
Australian Institute of Health and Welfare. (2017a). Australia’s mothers and babies 2015 – in brief. Perinatal Statistics Series no. 33. Cat no. PER 91. Canberra: AIHW.Google Scholar
Australian Institute of Health and Welfare. (2017b). Private health insurance use in Australian hospitals, 2006–07 to 2015–16: Australian hospital statistics. Health Services Series no. 81. Cat. no. HSE 196. Canberra: AIHW.Google Scholar
Australian Institute of Health and Welfare. (2018). Australia’s mothers and babies 2016 – in brief. Perinatal Statistics Series no. 34. Cat. no. PER 97. Canberra: AIHW.Google Scholar
Australian Prudential Regulatory Authority. (2018). Private Health Insurance Quarterly Statistics. Australian Prudential Regulatory Authority, Sydney.Google Scholar
Australian Taxation Office. (2018a). Medicare levy surcharge. Available online at the address https://www.ato.gov.au/Individuals/Medicare-levy/Medicare-levy-surcharge/ [09-Feb-2018].Google Scholar
Australian Taxation Office. (2018b). Private health insurance rebate. Available online at the address https://www.ato.gov.au/Individuals/Medicare-levy/Private-health-insurance-rebate/ [accessed 13-Feb-2018].Google Scholar
Brown, W., Bryson, L., Byles, J., Dobson, A., Lee, C., Mishra, G. & Schofield, M. (1998). Women’s Health Australia: recruitment for a national longitudinal cohort study. Women Health, 28, 23–40.Google ScholarPubMed
Buchmueller, T. (2008). Community rating, entry-age rating and adverse selection in private health insurance in Australia. The Geneva Papers on Risk and Insurance – Issues and Practice, 33(4), 588–609.10.1057/gpp.2008.24CrossRefGoogle Scholar
Centre for Health Record Linkage. Data dictionaries for Centre for Health Record Linkage. Available online at the address http://www.cherel.org.au/data-dictionaries [accessed Nov 2016].Google Scholar
Dahlen, H., Tracy, S., Tracy, M., Bisits, A., Brown, C. & Thornton, C. (2012). Rates of obstetric intervention among low-risk women giving birth in private and public hospitals in NSW: a population-based descriptive study. BMJ Open, 2. doi: e001723CrossRefGoogle Scholar
Dahlen, H., Tracy, S., Tracy, M., Bisits, A., Brown, C. & Thornton, C. (2014). Rates of obstetric intervention and associated perinatal mortality and morbidity among low-risk women giving birth in private and public hospitals in NSW (2000– 2008): a linked data population-based cohort study. BMJ Open, 4(e004551). doi: e001723Google ScholarPubMed
Dobson, A. J., Hockey, R., Brown, W. J., Byles, J. E., Loxton, D. J., McLaughlin, D. & Mishra, G. D. (2015). Cohort profile update: Australian Longitudinal Study on Women’s Health. International Journal of Epidemiology, 44(5), 1547a–1547f.10.1093/ije/dyv110CrossRefGoogle ScholarPubMed
Einarsdóttir, K., Haggar, F., Langridge, A. T., Gunnell, A. S., Leonard, H. & Stanley, F. J. (2013a). Neonatal outcomes after preterm birth by mothers’ health insurance status at birth: a retrospective cohort study. BMC Health Services Research, 13, 40.10.1186/1472-6963-13-40CrossRefGoogle Scholar
Einarsdóttir, K., Haggar, F., Pereira, G., Leonard, H., de Klerk, N., Stanley, F. J. & Stock, S. (2013b). Role of public and private funding in the rising caesarean section rate: a cohort study. BMJ Open, 3(5), e002789.CrossRefGoogle Scholar
Einarsdóttir, K., Kemp, A., Haggar, F. A., Moorin, E. M., Gunnell, A. S., Preen, D. B., Holman, C. D. (2012). Increase in caesarean deliveries after the Australian Private Health Insurance Incentive Policy Reforms. PLoS One, 7(7).10.1371/journal.pone.0041436CrossRefGoogle Scholar
Einarsdóttir, K., Stock, S., Haggar, F., Hammond, G., Langridge, A. T., Preen, D. B., Stanley, F. J. (2013c). Neonatal complications in public and private patients: a retrospective cohort study. BMJ Open, 3(5), e002786.CrossRefGoogle Scholar
Fisher, J., Smith, A. & Astbury, J. (1995). Private health insurance and a healthy personality: new risk factors for obstetric intervention? Psychosomatic Obstetrics & Gynecology, 16(1), 1–9.Google Scholar
Harley, K., Willis, K., Gabe, J., Short, S. D., Collyer, F., Natalier, K. & Calnan, M. (2011). Constructing health consumers: private health insurance discourses in Australia and the United Kingdom. Health Sociology Review, 20(3), 306–320.10.5172/hesr.2011.20.3.306CrossRefGoogle Scholar
Hindle, D. & McAuley, I. (2004). The effects of increased private health insurance: a review of the evidence. Australian Health Review, 28(1), 119–138.10.1071/AH040119CrossRefGoogle Scholar
Hoy, M. & Lun, E. (2017). Adverse selection and insurance. In eLS, John Wiley & Sons. doi: 10.1002/9780470015902.a0026687Google Scholar
Jang, W., Flatley, C., Greer, R. M. & Kumar, S. (2017). Comparison between public and private sectors of care and disparities in adverse neonatal outcomes following emergency intrapartum cesarean at term – a retrospective cohort study. PLoS One, 12(11), e0187040.10.1371/journal.pone.0187040CrossRefGoogle ScholarPubMed
Natalier, K. & Willis, K. (2008). Taking responsibility or averting risk? A socio-cultural approach to risk and trust in private health insurance decisions. Health, Risk & Society, 10(4), 399–411. doi: 10.1080/13698570802167413CrossRefGoogle Scholar
Nippita, T., Lee, Y., Patterson, J., Ford, J., Morris, J., Nicholl, M. & Roberts, C. (2015). Variation in hospital caesarean section rates and obstetric outcomes among nulliparae at term: a population-based cohort study. BJOG: An International Journal of Obstetrics & Gynaecology, 122(5), 702–711.CrossRefGoogle ScholarPubMed
Palangkaraya, A., Yong, J., Webster, E. & Dawkins, P. (2009). The income distributive implications of recent private health insurance policy reforms in Australia. European Journal of Health Economics, 10(2), 135–148.10.1007/s10198-008-0111-8CrossRefGoogle ScholarPubMed
Powers, J. & Loxton, D. (2010). The impact of attrition in an 11-year prospective longitudinal study of younger women. Annals of Epidemiology, 20, 318–321.10.1016/j.annepidem.2010.01.002CrossRefGoogle Scholar
Read, A., Prendiville, W., Dawes, V. & Stanley, F. (1994). Cesarean section and operative vaginal delivery in low-risk primiparous women, Western Australia. American Journal of Public Health, 84(1), 37–42.CrossRefGoogle Scholar
Roberts, C. L., Tracy, S. & Peat, B. (2000). Rates for obstetric intervention among private and public patients in Australia: population based descriptive study. British Medical Journal, 321(7254), 137–141.CrossRefGoogle ScholarPubMed
Robson, S., Laws, P. & Sullivan, E. (2009). Adverse outcomes of labour in public and private hospitals in Australia: a population-based descriptive study. The Medical Journal of Australia, 190(9), 474–477.CrossRefGoogle ScholarPubMed
Segal, L. (2004). Why it is time to review the role of private health insurance in Australia. Australian Health Review, 27(1), 3–15.10.1071/AH042710003CrossRefGoogle ScholarPubMed
Shorten, A. & Shorten, B. (2000). Women’s choice? The impact of private health insurance on episiotomy rates in Australian hospitals. Midwifery, 16(3), 202–212.Google ScholarPubMed
Shorten, A. & Shorten, B. (2002). Perineal outcomes in NSW public and private hospitals: analysing recent trends. Australian Journal of Midwifery, 15(2), 5–10.10.1016/S1445-4386(02)80011-8CrossRefGoogle ScholarPubMed
The Department of Health. (2018a). Lifetime Health Cover. Available online at the address http://www.health.gov.au/internet/main/publishing.nsf/content/health-privatehealth-lhc-providers-general.htm [accessed 9-Feb-2018].Google Scholar
The Department of Health. (2018b). Private Health Insurance Reform Rules 2018. Available online at the address https://www.health.gov.au/internet/main/publishing.nsf/Content/private-health-insurance-reform-rules-2018 [accessed 10-Jan-2018].Google Scholar
Thomas, G. (2017). Loss Coverage: Why Insurance Works Better with Some Adverse Selection. Cambridge University Press, Cambridge.10.1017/9781316178843CrossRefGoogle Scholar
Walker, A. E., Percival, R., Thurecht, L. & Pearse, J. (2007). Public policy and private health insurance: distributional impact on public and private hospital usage. Australian Health Review, 31(2), 305–314.10.1071/AH070305CrossRefGoogle ScholarPubMed
William, J., Chojenta, C., Martin, M. & Loxton, D. (2018a). An actuarial investigation into maternal hospital cost risk factors for public patients. Annals of Actuarial Science, 12(1), 106–129.10.1017/S174849951700015XCrossRefGoogle Scholar
William, J., Chojenta, C., Martin, M. & Loxton, D. (2018b). An actuarial investigation into maternal out-of-hospital cost risk factors. Annals of Actuarial Science, 1–35.CrossRefGoogle Scholar
Willis, K. & Lewis, S. (Producer). (2016). Which are better, public or private hospitals? The Conversation. Available online at the address https://theconversation.com/which-are-better-public-or-private-hospitals-54338 [accessed 9-Feb-2018].Google Scholar
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