Health, ageing and private health insurance: baseline results from the 45 and Up Study cohort
- Equal contributors
1 National Centre for Epidemiology and Population Health, Australian National University, ACT 0200, Australia
2 The Sax Institute, PO Box 123, Broadway NSW 2007, Australia
3 School of Medicine, University of Western Sydney, Campbelltown Campus, Locked Bag 1797, Penrith South DC NSW 1797, Australia
Australia and New Zealand Health Policy 2009, 6:16 doi:10.1186/1743-8462-6-16Published: 13 July 2009
This study investigates the relationships between health and lifestyle factors, age and private health insurance (PHI) in a large Australian population-based cohort study of people aged 45 years and over; the 45 and Up Study. Unlike previous Australian analyses of relationships between health, lifestyle and PHI, it incorporates adjustment for multiple confounding socioeconomic and demographic factors. Recruitment into the 45 and Up Study began in February 2006 and these analyses relate to the first 103,042 participants who joined the study prior to July 2008.
The proportion with PHI decreased with increasing age. The factors independently and most strongly associated with having PHI were: higher income; higher educational attainment; not holding a health care concession card; not being of Aboriginal/Torres Strait Islander origin; being a non-smoker; high levels of self-rated health and functional capacity; and low levels of psychological distress. These factors increased the probability of having PHI by 16% to 125%, compared to individuals without these characteristics. PHI coverage was significantly but only marginally higher in people reporting non-melanoma skin cancer (adjusted RR 1.04, 95%CI 1.03–1.05), prostate cancer (1.09, 1.06–1.11) or an enlarged prostate (1.07, 1.06–1.09), those reporting a family history of a range of conditions (e.g. 1.02, 1.01–1.03 for a family history of heart disease; 1.03, 1.02–1.04 for a family history of prostate cancer) and lower in people reporting diabetes (0.92, 0.91–0.94) or stroke (0.91, 0.88–0.94), compared to people who did not have these medical or family histories. PHI was higher in those reporting certain surgical procedures with RRs (95%CI) of 1.12 (1.09–1.15) for hip replacement, 1.10 (1.08–1.13) for knee replacement and 1.12 (1.09–1.15) for prostatectomy, compared to those not reporting these interventions.
Compared to the rest of the study population, those with PHI are richer, better educated, more health conscious, in better health and more likely to use certain discretionary health services. Hence, PHI use is generally highest among those with the least need for health care. Whether or not people have PHI is more strongly associated with demographic and lifestyle factors than with health status.