Use, access to, and impact of Medicare services for Australian women: Findings from the Australian Longitudinal Study on Women s Health Julie Byles

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1 Use, access to, and impact of Medicare services for Australian women: Findings from the Australian Longitudinal Study on Women s Health Julie Byles See alswh.org.au

2 This presentation Introduce ALSWH Latest report: GP visits across life course Drivers of greater use of GP services in older age Chronic disease End of life See

3 Australian Longitudinal Study on Women s Health Four cohorts, over 58,000 women Recruited through Medicare in 2013 Now in 1996 now in 1996 now in 1996 now Recruited through Social networking 41% Major Cities 39% Inner Regional 18% Outer Regional 2% V/Remote Funded by Australian Government Department of HEALTH

4 Trends in physical function Vigorous activities Walk 1km Climb stairs Carry groceries Walk 100m Can t Bath/ feed self >50% drive car ~77% live in house 19% live in apartment 17% provide care 9% need help with daily tasks <35% drive car ~ 58% live in house 20% live in apartment 15% retirement village 13% provide care 34% need help with daily tasks in 1996 now See:

5 Linked data PILOT MF 2017 Source Year 1 MBS 1996 PBS 2002/2012 APDC/Hosp Perinatal Cancer RAC 1996 HACC 2001 ACAP 2003 NDI/COD (NSW*,QLD, WA, SA, ACT) 1996 (NSW*,QLD, WA, ACT,) 1996 (NSW*, QLD, WA, VIC, SA+)

6 Increase in number of GP visits across four cohorts* (BTOS A B M) cohort cohort cohort around 15/year More visits: Major cities >regional/remote Mean MBS claims /year 9 /year Less than Yr12 education Difficulty manage on income Health care card 4/year Average age Original ALSWH cohorts cohort Figure 3-1. Mean annual number of GP services by women across the life course ( , , , cohorts). 1 Major Report L 2017 * DVA gold card holder not included

7 Figure Number of GP services for each four-month period from January for the Figure 3-20 shows the sequence of attendances for women in the cohort, with the proportion Variation in number of GP services for each fourmonth period from January participants. for the cohort of women in the cohort having more than 9 claims remaining steady over time, the proportion having 5-8 claims reducing slightly, and a great reduction in the proportion having 1-4 claims. However, the major change in this cohort is attrition due to death, with an increasing rate of GP visits among the surviving 9+ claims 5-8 claims Deaths 1-4 claims 0 No claims Time 72 years 90 years Died Unreferred >=9 Unreferred 5-8 Unreferred 1-4 No Claims

8 Women in the cohort were profiled into five subgroups of health service use (Figure 3-21) with 5 sequence profiles Group 1 classified as early mortality (25%), Group 2 as frequent GP Service users (12%), Group 3 as later mortality (17%), Group 4 regular GP service users (40%). and Group 5 as infrequent GP service users (6%) cohort (25%) (12%) (17%) deaths 1-4 claims 1-4 claims (40%) (6%) claims No claims Time Died Unreferred >=9 Unreferred 5-8 Unreferred 1-4 No Claims

9 Sociodemographic Factors associated with more GP visits Determinants of GP use Major city* Lower education Difficulty Manage$* * * * * Health Care Card Partnered Asterisk shows effect before adjustment Multivariable GEEs: 0-1 services (reference), 2-4 services, 5-6 services, and more than 7 services per survey year.

10 Health risks associated with more GP visits Determinants of GP use Worse SR health O/Obese - - Ex-smoker - - Smoker - - Alcohol (rare)

11 No. of conditions No. of conditions No. of conditions No. of conditions BP BP BP BP Heart Heart Asthma Low Iron Asthma Low Iron Asthma Asthma COPD - Diabetes Diabetes Depression Joint pain Joint pain Arthritis Incont UTI STD PMT UTI STD Breast Ca Dementia Incont

12 Prevalence of diabetes Major Report J 2015

13 GP visits and diabetes Major Report J 2015

14 Diabetes ACC/HbA1c ACC HbA1c Diabetes Uptake of DACC and HbA1c test for women who have reported diabetes within the cohort

15 Diabetes ACC/HbA1c ACC HbA1c Diabetes Uptake of DACC and HbA1c test for women who have reported diabetes within the cohort

16 75+ Health Assessments Initial Consecutive Past 2000 Figure health assessments for women within the cohort from : Cumulative percentages of no assessment, first or consecutive assessment, no follow-up assessments and death.

17 75+ Health Assessments Initial Consecutive Past Less if widowed Less if difficulty managing on income More if private health insurance More if more GP visits Less over time (AJ Primary Health Care 2017) 2000 Figure health assessments for women within the cohort from : Cumulative percentages of no assessment, first or consecutive assessment, no follow-up assessments and death.

18 MBS items HA or No HA ---- Higher if HA, but decline with older age (not what we saw on slide 5 15 visits/year) Less than 4 visits/ year

19 6.4. Last year of life Until the age of 80, there was little difference in the number of GP services used by women in the cohort who were in their last 12 months of life and those who were not (Figure 6-13). However, from Mean annual number of GP services by women the age of 81, the number of GP services by women in their last 12 months of life was much higher than for other women of the same age who were not in their last year of life. This difference became greater in the cohort, classified according to with increases in age, largely due to progressively fewer services being used by surviving women at oldest ages. whether women are in the last year of life cohort Last year of life 15 Mean MBS claims 10 5 Not Last year of life Age 12 months before death No Yes Figure Mean annual number of GP services by women in the cohort, classified according to whether women are in the last year of life.

20 Conclusion GP visits increase with age, after age 60 BUT... Varied patterns of high use, and low use Driven by disease (need), and other factors including area, education, income (inequity), marital status May increase with next generation if more disease Less than expected use of CDM (DACC) Health assessments well used, associated with higher use of other Medicare services Else - Service use declines with age, unless in last year of life See: