Predictors of health care use in Australian cancer patients
Received 13 March 2019
Accepted for publication 7 June 2019
Published 24 July 2019 Volume 2019:11 Pages 6941—6957
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Amy Norman
Peer reviewer comments 2
Editor who approved publication: Professor Nakshatri
Rezwanul Hasan Rana,1,2 Khorshed Alam,1,2 Jeff Gow,1,3 Nicholas Ralph4–6
1School of Commerce, University of Southern Queensland, Toowoomba, Australia; 2Centre for Health, Informatics and Economic Research, University of Southern Queensland, Queensland, Australia; 3School of Accounting, Economics and Finance, University of Kwazulu-Natal, Durban, South Africa; 4Health Systems & Psycho-Oncology, Cancer Council Queensland, Queensland, Australia; 5School of Nursing, University of Southern Queensland, Queensland, Australia; 6St Vincent’s Private Hospital, Queensland, Australia
Objective: The purpose of this study is to measure health care utilization in Australian cancer patients based on their demographic, geographic and socioeconomic backgrounds.
Method: A total of 13,609 participants (aged 15 and over) from 7,230 households were interviewed as part of Wave 13 of the national Household, Income and Labour Dynamics in Australia (HILDA) survey. Five hundred and seventeen participants indicated a current cancer diagnosis with 90% of those receiving active treatment at the time of interview. Independent sample t-tests, Pearson Chi-sq tests, Kruskal‒Wallis H test, binary logistic regression and a zero-inflated Poisson regression were used to examine inequality in health care use.
Results: Demographic and sociocultural factors such as advancing age, gender, low income, low education status, rurality, no private health insurance, increased psychological distress and less access to specialist care are associated with lower health care utilization among cancer patients. However, models of care such as general practitioner-led cancer care is preferable in younger individuals with cancer, while accessing specialist care is associated with lower rates of hospitalization and higher levels of psychological distress increases hospital length of stay.
Conclusions: The findings of lower health care utilization by those cancer patients with characteristics of disadvantage have implications for policy development and intervention design. Broadly, policies targeting structural social inequities are likely to increase health care utilization among the most affected/disadvantaged populations. Further investigation is needed to identify potential links between health care utilization and cancer outcomes as a step toward targeted interventions for improving outcomes in the adversely affected groups.
Keywords: cancer, health care utilization, primary preventive care, inequality, psychological distress, HILDA
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