Hospital admissions by socio-economic status: does the 'inverse care law' apply to older Australians?
OBJECTIVE
To investigate whether the 'inverse care law' applies to New South Wales (NSW) hospital admissions--especially to older people with high socio-economic status (SES).


METHODS
Cross-sectional study analysing inequalities in public and private hospital admission rates by SES, defined in terms of age, sex and family income/size at the small geographic area level.


METHODS
Admissions to NSW public and private hospitals in 1999-2000 (1.8 million admissions against a NSW population of 6.4 million).


METHODS
Inequalities in hospitalisation rates were expressed as rate ratios across the most and least disadvantaged 20% of the NSW population.


RESULTS
Public hospital admission rates for people aged 0-60 years were 24-35% higher for the most disadvantaged 20% of the NSW population than for the least disadvantaged 20%. For 70+ year-olds the direction of this difference was reversed--being 14% lower for the most disadvantaged 20% of the population (5% higher for public patients). For private hospitals this reversal prevailed for all age groups (23-49% lower). For all hospitals it was 16% and 27% lower for 60-69 and 70+ year-olds respectively, with higher admission rates for top SES 60+ year-olds most pronounced for renal dialysis, chemotherapy, colonoscopies and other diagnostic scopes, rehabilitation and follow-up, and cataract operations.


CONCLUSIONS
While the 'inverse care law' did apply to 60+ year-olds, it did not apply either to younger NSW hospital users or to public patients in public hospitals.


CONCLUSIONS
Awareness of these SES-level differentials should result in greater equality of access to hospital services, especially by older people.
Walker
Agnes
A
Australian Centre for Economic Research on Health, Australian National University, Australian Capital Territory. agnes.walker@anu.edu.au
Pearse
Jim
J
Thurecht
Linc
L
Harding
Ann
A
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility; D016304:Hospitals, Private / Q000706:statistics & numerical data*; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D010343:Patient Admission / Q000191:economics*; D012737:Sex Factors; D017062:Small-Area Analysis; D012923:Social Class; D012959:Socioeconomic Factors; D014600:Utilization Review