Long-term out of pocket expenditure of people with cancer: comparing health service cost and use for indigenous and non-indigenous people with cancer in Australia

Callander, Emily, Bates, Nicole, Lindsay, Daniel, Larkins, Sarah, Topp, Stephanie M., Cunningham, Joan, Sabesan, Sabe, and Garvey, Gail (2019) Long-term out of pocket expenditure of people with cancer: comparing health service cost and use for indigenous and non-indigenous people with cancer in Australia. International Journal for Equity in Health, 18. 32.

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Indigenous Australians diagnosed with cancer have poorer survival compared to non-Indigenous Australians. We aim to: 1) identify differences by Indigenous status in out-of-pocket expenditure for the first three-years post-diagnosis; 2) identify differences in the quantity and cost of healthcare services accessed; and 3) estimate the number of additional services required if access was equal between Indigenous and non-Indigenous people with cancer.


We used CancerCostMod, a model using linked administrative data. The base population was all persons diagnosed with cancer in Queensland, Australia (01JUL2011 to 30JUN2012) (n = 25,553). Each individual record was then linked to their Admitted Patient Data Collection, Emergency Data Information System, Medicare Benefits Schedule (MBS), and Pharmaceutical Benefits Scheme (PBS) records (01JUL2011 to 30JUN2015). We then weighted the population to be representative of the Australian population (approximately 123,900 Australians, 1.7% Indigenous Australians). The patient co-payment charged for each MBS service and PBS prescription was summed for each month from date of diagnosis to 36-months post-diagnosis. We then limited our model to MBS items to identify the quantity and type of healthcare services accessed during the first three-years.


On average Indigenous people with cancer had less than half the out-of-pocket expenditure for each 12-month period (0–12 months: mean $401 Indigenous vs $1074 non-Indigenous; 13–24 months: mean $200 vs $484; and 25–36 months: mean $181 vs $441). A stepwise generalised linear model of out-of-pocket expenditure found that Indigenous status was a significant predictor of out of pocket expenditure. We found that Indigenous people with cancer on average accessed 236 services per person, however, this would increase to 309 services per person if Indigenous people had the same rate of service use as non-Indigenous people.


Indigenous people with cancer had lower out-of-pocket expenditure, but also accessed fewer Medicare services compared to their non-Indigenous counterparts. Indigenous people with cancer were less likely to access specialist attendances, pathology tests, and diagnostic imaging through MBS, and more likely to access primary health care, such as services provided by general practitioners.

Item ID: 57685
Item Type: Article (Research - C1)
ISSN: 1475-9276
Keywords: cost; rurality; socioeconomic; Indigenous
Copyright Information: Copyright © The Author(s). 2019. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Funders: Menzies School of Health Research (MSHR), National Health and Medical Research Council (NHMRC), Cancer Council NSW (CC), Cancer Council WA
Projects and Grants: NHMRC #1041111, CC #SRP 13–01, NHMRC Early Career Fellowship #1105399, NHMRC Research Fellowship #1058244
Date Deposited: 27 Mar 2019 00:02
FoR Codes: 38 ECONOMICS > 3801 Applied economics > 380108 Health economics @ 40%
45 INDIGENOUS STUDIES > 4504 Aboriginal and Torres Strait Islander health and wellbeing > 450409 Aboriginal and Torres Strait Islander health services @ 40%
42 HEALTH SCIENCES > 4203 Health services and systems > 420311 Health systems @ 20%
SEO Codes: 92 HEALTH > 9203 Indigenous Health > 920303 Aboriginal and Torres Strait Islander Health - Health System Performance (incl. Effectiveness of Interventions) @ 50%
92 HEALTH > 9202 Health and Support Services > 920208 Health Inequalities @ 50%
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