title: Effects of financial disadvantage on use and non-use of after hours care in Australia.
abstract: Policy addressing the provision of primary care after hours (AH) is currently in flux because of concerns about equity of access and cost. In this study we examine the effects of socioeconomic disadvantage on access to AH care and episodes of not seeking AH care when needed among users and non-users of AH care. The effects of health on these relationships were also explored. The total sample consisted of 5538 users of AH care and 891 non-users of AH care who were randomly selected for telephone interviews. Factors determining AH care included accessibility that is structural barriers to use of care such as distance and transport, as well as affordability and availability. Logistic regression was used to determine the impact of financial disadvantage on episodes of not seeking AH care. Barriers to use of AH care and household health were subsequently added to the models to assess their impact. The results suggested that there were inequities in access to AH care but these were a function of barriers to AH care use rather than financial disadvantage per se. Accessibility and availability were significant barriers to use of AH clinics among both user and non-user samples. Affordability was only a significant barrier among users of AH care. The study suggests that policy aimed at reducing these barriers may effectively address inequities in AH care but that to be optimally effective policy change would also need to be accompanied by changes in consumer awareness.
authors.affiliation: Program Evaluation Unit, School of Population Health, University of Melbourne, Carlton Melbourne, Vic. 3010, Australia. mkelaher@unimelb.edu.au
authors.forename: Margaret
authors.initials: M
authors.lastname: Kelaher
authors.forename: David
authors.initials: D
authors.lastname: Dunt
authors.forename: Susan
authors.initials: S
authors.lastname: Day
authors.forename: Peter
authors.initials: P
authors.lastname: Feldman
mesh_terms: D039602:After-Hours Care / Q000191:economics / Q000706:statistics & numerical data*; D001315:Australia; D017047:Cost Sharing; D019538:Health Care Surveys; D006291:Health Policy; D006297:Health Services Accessibility / Q000458:organization & administration*; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D009313:National Health Programs / Q000191:economics / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D011203:Poverty / Q000523:psychology / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires