How fair is Medicare? The income-related distribution of Medicare benefits with special focus on chronic care items

Rachel J Knott, Alan Cass, Emma L Heeley, John P Chalmers, David P Peiris and Philip M Clarke
Med J Aust 2012; 197 (11): 625-630. || doi: 10.5694/mja12.10514


Objective: To use patient-level data, clinical information and linked Medicare records to assess the distribution of benefits (rebates) across income groups, including benefits relating to chronic conditions such as the Chronic Disease Dental Scheme (CDDS).

Design, setting and participants: Nationally representative, cluster-stratified survey (the Australian Hypertension and Absolute Risk Study) involving 322 general practitioners who each collected clinical data on 15–20 patients aged ≥ 55 years who presented between 1 April 2008 and 30 June 2008 and who consented to have their information linked with Medicare administrative records over 12 months.

Main outcome measures: Distribution of total out-of-hospital Medicare expenditure quantified using concentration indices and determinants of use calculated by odds ratios.

Results: There were 2862 patients in the study. After controlling for need, the concentration index for overall funding was slightly progressive (pro-poor) at 0.008 (95% CI, 0.009 to 0.008). Medicare expenditure on chronic care-related services consistently contributed to progressivity of the overall scheme, particularly services under the CDDS with a need-adjusted concentration index of 0.205 (95% CI, 0.208 to 0.201). Uptake of chronic care items varied by locality and comorbid conditions (there was greater uptake by patients with one or more comorbid conditions).

Conclusions: Chronic care items, particularly dental items, have primarily been used by individuals from lower income households. Uptake of chronic care items contributes to the overall progressivity of Medicare.

  • Rachel J Knott1
  • Alan Cass2
  • Emma L Heeley2
  • John P Chalmers2
  • David P Peiris2
  • Philip M Clarke1

  • 1 Melbourne School of Population Health, University of Melbourne, Melbourne, VIC.
  • 2 The George Institute for Global Health, University of Sydney, Sydney, NSW.


We thank the 532 general practitioner investigators who participated in the study. Those who submitted data for 15 or more patients were eligible for 40 Category 1 points for the Royal Australian College of General Practitioners Quality Improvement and Continuing Professional Development Program. The study was supported by an unrestricted educational grant from Servier Australia. Rachel Knott’s PhD studies were partly funded by National Health and Medical Research Council (NHMRC) Capacity Building Grant (571372). Alan Cass is a recipient of a Senior Research Fellowship from the NHMRC. Philip Clarke holds an NHMRC Career Development Award.

Competing interests:

The AusHEART study was conducted as a collaborative project between the George Institute for Global Health and Servier Australia. Emma Heeley and Philip Clarke have received travel grants from Servier. Alan Cass has received an honorarium for speaking at a national education meeting sponsored by Servier. John Chalmers has received research grants and lecture fees from Servier.


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