title: Using administrative data to look at changes in the level and distribution of out-of-pocket medical expenditure: An example using Medicare data from Australia.
abstract: OBJECTIVE
  Australia's universal health insurance system Medicare generates very large amounts of data on out-of-pocket expenditure (OOPE), but only highly aggregated statistics are routinely published. Our primary purpose is to develop indices from the Medicare administrative data to quantify changes in the level and distribution of OOPE on out-of-hospital medical services over time.
  
  
  METHODS
  Data were obtained from the Australian Hypertension and Absolute Risk Study, which involved patients aged 55 years and over (n=2653). Socio-economic and clinical information was collected and linked to Medicare records over a five-year period from March 2008. The Fisher price and quantity indices were used to evaluate year-to-year changes in OOPE. The relative concentration index was used to evaluate the distribution of OOPE across socio-economic strata.
  
  
  RESULTS
  Our price index indicates that overall OOPE were not rising faster than inflation, but there was considerable variation across different types of services (e.g. OOPE on professional attendances rose by 20% over a five-year period, while all other items fell by around 14%). Concentration indices, adjusted for demographic factors and clinical need, indicate that OOPE tends to be higher among those on higher incomes.
  
  
  CONCLUSIONS
  A major challenge in utilizing large administrative data sets is to develop reliable and easily interpretable statistics for policy makers. Price, quantity and concentration indices represent statistics that move us beyond the average.
authors.affiliation: Centre for Health Policy, School of Global and Population Health, University of Melbourne, Melbourne, Australia.
authors.forename: Xinyang
authors.initials: X
authors.lastname: Hua
authors.affiliation: Department of Economics, University of Antwerp, Antwerpen, Belgium.
authors.forename: Guido
authors.initials: G
authors.lastname: Erreygers
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Chalmers
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, Australia.
authors.forename: Tracey-Lea
authors.initials: TL
authors.lastname: Laba
authors.affiliation: Centre for Health Policy, School of Global and Population Health, University of Melbourne, Melbourne, Australia. Electronic address: philip.clarke@unimelb.edu.au.
authors.forename: Philip
authors.initials: P
authors.lastname: Clarke
mesh_terms: D000368:Aged; D001315:Australia; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009313:National Health Programs / Q000706:statistics & numerical data*; D011320:Primary Health Care; D019472:Universal Health Insurance
keywords: Concentration index; Out of pocket expenditure; Price index