title: Health care utilisation and out-of-pocket expenditure associated with back pain: a nationally representative survey of Australian women.
abstract: BACKGROUND
  Back pain impacts on a significant proportion of the Australian population over the life course and has high prevalence rates among women, particularly in older age. Back pain care is characterised by multiple practitioner and self-prescribed treatment options, and the out-of-pocket costs associated with consultations and self-prescribed treatments have not been examined to date.
  
  
  OBJECTIVE
  To analyse the extent of health care practitioner consultations and self-prescribed treatment for back pain care among Australian women, and to assess the self-reported costs associated with such usage.
  
  
  METHODS
  Survey of 1,310 women (response rate 80.9%) who reported seeking help for back pain from the '1946-51 cohort' of the Australian Longitudinal Study on Women's Health. Women were asked about their use of health care practitioners and self-prescribed treatments for back pain and the costs associated with such usage.
  
  
  RESULTS
  In the past year 76.4% consulted a complementary and alternative practitioner, 56% an allied health practitioner and 59.2% a GP/medical specialist. Overall, women consulted with, on average, 3.0 (SD = 2.0) different health care practitioners, and had, on average, 12.2 (SD = 9.7) discrete health care practitioner consultations for back pain. Average self-reported out-of-pocket expenditure on practitioners and self-prescribed treatments for back pain care per annum was AU$873.10.
  
  
  CONCLUSIONS
  Multiple provider usage for various but distinct purposes (i.e. pain/mobility versus anxiety/stress) points to the need for further research into patient motivations and experiences of back pain care in order to improve and enhance access to and continuity of care. Our results suggest that the cost of back pain care represents a significant burden, and may ultimately limit women's access to multiple providers. We extrapolate that for Australian working-age women, total out-of-pocket expenditure on back pain care per annum is in excess of AU$1.4 billion, thus indicating the prominence of back pain as a major economic, social and health burden.
authors.affiliation: School of Social Science, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Emma R
authors.initials: ER
authors.lastname: Kirby
authors.affiliation: School of Social Science, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Alex F
authors.initials: AF
authors.lastname: Broom
authors.affiliation: Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.
authors.forename: David W
authors.initials: DW
authors.lastname: Sibbritt
authors.affiliation: Faculty of Health, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Refshauge
authors.affiliation: School of Social Science, University of Queensland, Brisbane, Queensland, Australia ; Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.
authors.forename: Jon
authors.initials: J
authors.lastname: Adams
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia; D001416:Back Pain / Q000191:economics* / Q000523:psychology* / Q000628:therapy; D000529:Complementary Therapies; D003625:Data Collection; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D055815:Young Adult