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Type: Journal article
Title: Healthcare expenditure on Indigenous and non-Indigenous Australians at high risk of cardiovascular disease
Author: Angell, B.
Laba, T.-.L.
Lung, T.
Brown, A.
Eades, S.
Usherwood, T.
Peiris, D.
Billot, L.
Hillis, G.
Webster, R.
Tonkin, A.
Reid, C.
Molanus, B.
Rafter, N.
Cass, A.
Patel, A.
Jan, S.
Citation: International Journal for Equity in Health, 2017; 16(1):108-1-108-7
Publisher: BioMed Central
Issue Date: 2017
ISSN: 1475-9276
Statement of
Blake Angell, Tracey-Lea Laba, Tom Lung, Alex Brown, Sandra Eades, Tim Usherwood, David Peiris, Laurent Billot, Graham Hillis, Ruth Webster, Andrew Tonkin, Christopher Reid, Barbara Molanus, Natasha Rafter, Alan Cass, Anushka Patel, and Stephen Jan
Abstract: Background: In spite of bearing a heavier burden of death, disease and disability, there is mixed evidence as to whether Indigenous Australians utilise more or less healthcare services than other Australians given their elevated risk level. This study analyses the Medicare expenditure and its predictors in a cohort of Indigenous and non-Indigenous Australians at high risk of cardiovascular disease. Methods: The healthcare expenditure of participants of the Kanyini Guidelines Adherence with the Polypill (GAP) pragmatic randomised controlled trial was modelled using linear regression methods. 535 adult (48% Indigenous) participants at high risk of cardiovascular disease (CVD) were recruited through 33 primary healthcare services (including 12 Aboriginal Medical Services) across Australia. Results: There was no significant difference in the expenditure of Indigenous and non-Indigenous participants in non-remote areas following adjustment for individual characteristics. Indigenous individuals living in remote areas had lower MBS expenditure ($932 per year P < 0.001) than other individuals. MBS expenditure was found to increase with being aged over 65 years ($128, p = 0.013), being female ($472, p = 0.003), lower baseline reported quality of life ($102 per 0.1 decrement of utility p = 0.004) and a history of diabetes ($324, p = 0.001), gout ($631, p = 0.022), chronic obstructive pulmonary disease ($469, p = 0.019) and established CVD whether receiving guideline-recommended treatment prior to the trial ($452, p = 0.005) or not ($483, p = 0.04). When controlling for all other characteristics, morbidly obese patients had lower MBS expenditure than other individuals (-$887, p = 0.002). Conclusion: The findings suggest that for the majority of participants, once individuals are engaged with a primary care provider, factors other than whether they are Indigenous determine the level of Medicare expenditure for each person.
Keywords: Healthcare expenditure; Australia; Indigenous health; chronic disease; cardiovascular disease
Rights: © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
RMID: 0030077535
DOI: 10.1186/s12939-017-0610-2
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