Access to health services

1 in 13

(7.6%) people aged under 65 with disability delay or do not see a GP when needed because of cost

1 in 4

(24%) people aged 15–64 with disability wait longer than they feel acceptable to get an appointment with a GP

1 in 2

(47%) people aged 5–64 with disability who need health care assistance receive only informal assistance

Introduction

Like everyone, people with disability have health-care needs, access health services to meet them, and have varying health-related experiences. They use a range of mainstream health services, such as general practitioners (GPs), medical specialists, dentists and hospitals. Their care may require coordination between different health professionals.

People with disability may also rely on informal care, such as that provided by family and friends, to meet or supplement their health-care needs.

Survey of Disability, Ageing and Carers

Data in this section are largely sourced from the Australian Bureau of Statistics’ (ABS) 2018 Survey of Disability, Ageing and Carers (SDAC). The SDAC is the most detailed and comprehensive source of data on disability prevalence in Australia.

The SDAC considers that a person has disability if they have at least one of a list of limitations, restrictions or impairments, which has lasted, or is likely to last, for at least 6 months and restricts everyday activities.

The limitations are grouped into 10 activities associated with daily living – self-care, mobility, communication, cognitive or emotional tasks, health care, reading or writing tasks, transport, household chores, property maintenance, and meal preparation. The SDAC also identifies 2 other life areas in which people may experience restriction or difficulty as a result of disability – schooling and employment.

The severity of disability is defined by whether a person needs help, has difficulty, or uses aids or equipment with 3 core activities – self-care, mobility, and communication – and is grouped for mild, moderate, severe, and profound limitation. People who always or sometimes need help with one or more core activities, have difficulty understanding or being understood by family or friends, or can communicate more easily using sign language or other non-spoken forms of communication are referred to in this section as ‘people with severe or profound disability’.

The patient experience information collected in the SDAC does not include health professionals other than GPs, medical specialists and dental professionals. Hence, it is not possible to examine from this survey whether some needs for non-hospital health services were met by other health professionals, such as nurses, pharmacists or other allied health professionals.

The patient experience information collected in the SDAC is collected from people with disability living in households. It is not collected from people without disability. Hence comparisons with people without disability cannot be directly made.


Use of mainstream health services

Table ACCESS.1 provides a snapshot of the use of mainstream health services by people with disability aged under 65 living in the community.

Table ACCESS.1: Use of selected health services by people with disability(a), 2018

Most (92% or 2.2 million) saw a GP(b)

1 in 5 (20% or 482,000) saw a GP for urgent medical care(b)

2 in 3 (63% or 1.5 million) saw a medical specialist(b)

Half (51% or 1.2 million) saw a dental professional(b)

1 in 4 (26% or 639,000) visited a hospital emergency department(b)

1 in 5 (22% or 541,000) were admitted to hospital(b)

2 in 5 (38% or 911,000) saw 3 or more health professionals for the same condition(b)

7 in 10 (71% or 644,000) had a health professional help coordinate their care when they saw 3 or more health professionals for the same condition(c)

2 in 3 (64% or 346,000) who need help with health-care activities receive informal services(d)

2 in 5 (41% or 221,000) who need help with health-care activities receive formal services(d)

(a) People with disability aged 64 and under living in households.

(b) For own health in the last 12 months.

(c) People who have seen 3 or more health professionals for the same condition for their own health in the last 12 months.

(d) People with disability aged 5–64 living in households including those who receive both formal and informal services.

Source: ABS 2019a; see also tables ACCE1, ACCE48, and ACCE56.

Females aged under 65 with disability living in households were more likely to use health services within a year than males:

  • 95% (or 1.1 million) of females saw a GP for own health compared with 89% (or 1.1 million) of males
  • 23% (or 268,000) of females saw a GP for urgent medical care compared with 17% (or 215,000)
  • 65% (or 769,000) of females saw a medical specialist compared with 60% (or 743,000)
  • 55% (or 648,000) of females saw a dental professional compared with 48% (or 586,000)
  • 28% (or 334,000) of females visited a hospital emergency department compared with 25% (or 306,000)
  • 24% (or 288,000) of females were admitted to hospital compared with 20% (or 252,000)
  • 41% (or 490,000) of females saw 3 or more health professionals for the same condition compared with 34% (or 421,000) (ABS 2019a).

Of people with disability living in households:

  • those aged 0–24 were less likely to see a GP (86% or 557,000), see a GP for urgent medical care (15% or 99,000) or be admitted to hospital (18% or 116,000) within one year than those aged 25–64 (95% or 1.7 million, 22% or 383,000 and 24% or 426,000 respectively)
  • those aged 0–24 were more likely (64% or 415,000) to see a dental professional than those aged 25–64 (46% or 819,000)
  • females aged 5–64 who need assistance with health care are more likely (29% or 75,000) than males (19% or 53,000) to receive formal assistance only, and males are more likely (53% or 150,000) than females (40% or 101,000) to receive informal assistance only (ABS 2019a).

People aged 65 and over with disability and living in households were:

  • more likely to see a medical specialist (72% or 1.3 million) or be admitted to hospital (29% or 513,000) than those aged under 65 (63% or 1.5 million and 22% or 541,000 respectively)
  • less likely to see a GP for urgent medical care (15% or 268,000) or to see 3 or more health professionals for the same conditions (31% or 545,000) than those aged under 65 (20% or 482,000 and 38% or 911,000 respectively) (ABS 2019a).

People aged 65 and over with disability living in households and who need help with health-care activities are less likely (22% or 155,000) to receive that assistance from informal providers only than those aged 25–64 (37% or 140,000) or 5–24 (66% or 111,000) (ABS 2019a).

How does the use of mainstream health services by people with disability compare with people without disability?

The patient experience information in the SDAC is collected only from people with disability and primary carers (living in households). It is not therefore possible to compare with people without disability. However, AIHW analysis of self-reported information from the ABS National Health Survey 2014–15, which uses the ABS Short Disability Module, suggests that people with disability aged under 65 have higher rates of use of:

  • GPs (93% compared with 82% of those without disability)
  • medical specialists (58% compared with 26%)
  • hospital emergency departments (20% compared with 10%) (ABS 2016a).

This is similar to AIHW analysis of self-reported information from HILDA 2017. In the last year, people with disability aged 15–64 had higher rates of use of:

  • GPs or family doctors (92% compared with 79% of those without disability)
  • mental health professionals (23% compared with 6.6%)
  • hospital overnight stays (19% compared with 7.8%)
  • hospital visits as day patient (17% compared with 9.3%) (DSS and MIAESR 2019).

In contrast to this, people with disability aged 15–64 had slightly lower rates (52%) of dentist visits than people without disability (56%) (DSS and MIAESR 2019).

How many have a regular GP?

People with disability aged 15–64 are more likely (92%) to see a particular GP or clinic when they are sick or need advice about their own health than those without disability (84%). Of people with disability:

  • people aged 65 and over are more likely (99%) to see a particular GP or clinic than people aged 15–64 (92%)
  • females aged 15–64 are more likely (94%) than males (90%) (DSS and MIAESR 2019).

Use of Medicare Benefits Schedule services

Without data linkage it is not possible to examine in detail how people with disability use health services, with the exception of self-reported survey data (such as that presented in this section). This is because health data collections generally have no ‘flag’ to identify the disability status of service recipients or patients.

To highlight how linked data can fill information gaps, this box presents data from the ABS 2011 Multi-Agency Data Integration Project (MADIP) data asset.

The 2011 MADIP includes:

  • de-identified information about everyone who participated in the Census of Population and Housing on 9 August 2011 and who had an active Medicare enrolment on that date
  • some information about the services they received in 2011 under the Medicare Benefits Schedule (MBS)
  • information from the 2011 Census of Population and Housing, Personal Income Tax data for tax returns for 2010–11
  • social security and related information to identify whether income support payments were received in September 2011 (ABS 2018).

For more information on MADIP, see ABS MADIP.

In 2011, compared with people who received no income support, people who received the Disability Support Pension (DSP) were:

  • more likely to be frequent users of MBS services – more than one-third (36%) used 30 or more MBS services, compared with 8% (Figure ACCESS.1)
  • more likely to have regular GP visits – more than half (52%) had more than 6 un-referred attendances at a GP, compared with 17%
  • more likely to have no out-of-pocket expenses – almost half (49%) had no out-of-pocket costs for all MBS services, compared with 43%
  • less likely to have out-of-pocket expenses of $100 or more – 3% were $100 or more out of pocket for unreferred GP visits, compared with 11%, and 19% were more than $100 out of pocket for all MBS services compared with 30% (ABS 2018).

Figure ACCESS.1: Number of MBS services used, by income support, age group and sex, 2011

Chart showing the proportion of people using 9 categories of number of Medicare Benefits Schedule (MBS) services in 2011. The reader can select to display the chart by whether the person receives Disability Support Pension (DSP) or no income support; by sex; and by age group in 10-year age brackets from 15–24 to 55–64, or by all ages. The chart shows women on DSP aged 55–64 are more likely (48%) to access 30 or more MBS services per year than men on DSP in the same age group (38%).

Medicare Benefits Schedule

MBS services can include, but are not limited to, GP and medical specialist consultations, pathology tests, diagnostic imaging and optometry services. They do not include public hospital services, almost all dental care, and many allied health services.

Unreferred attendances at a GP are a sub-category of the broad grouping ‘all MBS services’.


Difficulties accessing health services

Service accessibility depends on many factors. Some people with disability experience difficulties in accessing health services; barriers include:

  • unacceptable or lengthy waiting times
  • cost
  • inaccessibility of buildings
  • discrimination by health professionals.

They may also experience issues caused by lack of communication between the health professionals treating them.

Table ACCESS.2 provides a snapshot of difficulties accessing health services for people with disability aged under 65 living in the community.

Table ACCESS.2: Difficulties accessing health services for people with disability(a), 2018

1 in 4 (24% or 386,000) who see a GP wait longer than they feel is acceptable to get an appointment(b)(c)

3 in 10 (29% or 142,000) wait 1 or more days after making an appointment to see a GP for urgent medical care(b)

1 in 13 (7.6% or 172,000) who need to see a GP delay or do not go because of cost(b)

1 in 3 (31% or 285,000) who see a medical specialist wait longer than they feel is acceptable to get the appointment(b)(c)

1 in 22 (4.6% or 71,000) who need to see a medical specialist do not go mainly because of cost(b)

1 in 8 (13% or 202,000) who need to see a dental professional are placed on a public dental waiting list(b)

7 in 10 (70% or 98,000) who have been on a public dental waiting list(b) wait 1 month to more than 1 year before receiving dental care

3 in 10 (28% or 449,000) who need to see a dental professional delay or do not go because of cost(b)

1 in 28 (3.6% or 21,000) who need to go to hospital delay or do not go because of cost(b)

1 in 8 (12% or 78,000) feel a GP could have provided care for their most recent visit to a hospital emergency department(b)

1 in 5 (21% or 187,000) who see 3 or more health professionals for the same health condition report issues caused by lack of communication between health professionals(b)

1 in 29 (3.5% or 59,000) experience discrimination by health staff (GP, nurse, hospital staff)(b)(c)

1 in 8 (12% or 96,000) have difficulty accessing medical facilities (GP, dentist, hospital)(b)(d)

1 in 8 (13% or 70,000) who need help with health-care activities have no source of assistance (formal or informal)(e)

1 in 5 (18% or 100,000) who need help with health-care activities have their need for assistance only partly met or not met at all(e)

(a) People with disability aged 64 and under living in households, unless indicated otherwise.

(b) In the last 12 months.

(c) People with disability aged 15–64 living in households.

(d) People with disability aged 5–64 living in households who need assistance or have difficulty with communication or mobility.

(e) People with disability aged 5–64 living in households.

Source: ABS 2019a; see also tables ACCE5, ACCE10, ACCE14, ACCE18, ACCE22, ACCE26, ACCE30, ACCE34, ACCE38, ACCE40, ACCE52, ACCE56, ACCE60, ACCE66, and ACCE70.

People aged 25–64 with disability are more likely than older or younger people to delay or not see a health professional when needed because of the cost.

  • Those aged 25–64 (8.9% or 150,000) are more likely to delay or not see a GP when needed to because of the cost than those aged under 25 (4.3% or 24,000) or aged 65 and over (1.2% or 21,000).
  • Those aged 25–64 (34% or 395,000) are more likely to delay or not see a dental professional than those aged under 25 (12% or 55,000) or aged 65 and over (11% or 110,000) (ABS 2019a).

How does access to health services by people with disability compare with people without disability?

As the patient experience information in the ABS SDAC is collected only from people with disability and their carers, it is not possible to make comparisons with people without disability.

While not directly comparable, information from the ABS Patient Experience Survey, which looks at the use of health services by the general Australian population, suggests that people with disability are more likely to face barriers such as cost when accessing some types of health services. For example, in the last 12 months:

  • According to the 2018 SDAC, of people with disability aged 15–64:
    • 8.7% delay or do not see a GP when needed because of cost
    • 32% delay or do not see a dental professional when need because of cost (ABS 2019a).
  • According to the 2018–19 Patient Experience Survey, of the general Australian population aged 15–64:
    • 4.1% delay or do not see a GP when needed because of cost
    • 20% delay or do not see a dental professional when needed because of cost (ABS 2019b).

Remoteness

People with disability aged under 65 living in the community in Outer regional and remote areas are less likely to see a GP (90% or 207,000), medical specialist (59% or 136,000), or dentist (45% or 105,000) than those living in Major cities (93% or 1.5 million, 65% or 1.1 million and 53% or 855,000) (Figure ACCESS.2). At the same time, they are more likely to visit a hospital emergency department (29% or 68,000 compared with 25% or 407,000).

How is remoteness defined?

The remoteness categories used in the ABS SDAC are defined by the Australian Statistical Geography Standard Remoteness Structure (ABS 2016b) which divides Australia into 5 classes of remoteness on the basis of a measure of relative access to services. Very remote areas are out of scope for SDAC.

Figure ACCESS.2: Use of selected health services by people with disability, by remoteness, 2018

Column chart showing the proportion of people with disability using 4 categories of health service in 3 categories of remoteness, from Major cities to Outer regional and remote. The chart shows people with disability living in Outer regional and remote areas are less likely (45%) to visit dental professionals than those living in Major cities (53%).

Table ACCESS.3 provides a snapshot of use of health services by people with disability aged under 65 living in the community in Outer regional and remote areas compared with those living in Major cities and Inner regional areas.

Table ACCESS.3: Access to health services in Major cities, Inner regional areas and Outer regional and remote areas by people with disability(a), 2018

 


Major cities


Inner regional


Outer regional and remote

Visit a hospital emergency department for care they feel could be provided by a GP(b)(c)

10.5%

17.0%

11.8%*

Go to a hospital emergency department instead of a GP(b)(c), and time of day or day of week is the main reason

11.4%

17.9%

14.7%

Wait longer than they feel acceptable for an appointment with a GP(b)(d)

21.2%

28.1%

34.2%

Wait longer than 1 day to see a GP for urgent medical care(b)(e)

28.9%

30.4%

36.4%

Face difficulties caused by lack of communication between health professionals (b)(f)

19.4%

20.4%

32.3%

Receive only informal assistance for health-care activities(g)

44.9%

48.6%

53.8%

Have difficulty accessing medical facilities (GP, dentist or hospital)(b)(h)

11.5%

10.6%

12.8%

Wait longer than they feel acceptable for an appointment with a medical specialist(b)(i)

29.9%

33.9%

36.6%

Wait 6 months or more on public dental waiting list before receiving dental care(b)(j)

34.6%

23.6%

63.9%

Experience discrimination from health staff (GP, nurse, hospital staff)(b)(k)

2.7%

3.9%

8.0%

 * Relative standard error of 25%–50% and should be used with caution.

(a) People with disability living in households.

(b) In the last 12 months.

(c) People aged 64 and under who have been to hospital emergency department in the last 12 months, for most recent visit to emergency department.

(d) People aged 15–64 who saw a GP in the last 12 months.

(e) People aged 64 and under with disability living in households who saw a GP for urgent medical care in the last 12 months.

(f) People aged 64 and under who saw 3 or more health professionals for the same health condition.

(g) People aged 5–64 who needed help with health-care activities.

(h) People aged 5–64 who need assistance or have difficulty with communication or mobility.

(i) People aged 15–64 who saw a medical specialist in the last 12 months.

(j) People aged 64 and under who had been on a public dental waiting list in the last 12 months, excluding people who are still waiting.

(k) People aged 15–64.

Source: ABS 2019a; see also tables ACCE13, ACCE17, ACCE25, ACCE37, ACCE43, ACCE47, ACCE55, ACCE59, ACCE69, and ACCE73.

The higher rate of use of hospital emergency departments for non-hospital services in Outer regional and Remote areas partly occurs within a broader context of health services supply – type, volume and geographical distribution. Data from the National Health Workforce Data Set show that the number of health professionals per 100,000 people generally decreases as remoteness increases. In 2017, the rate of medical specialists, allied health professionals and dentists decreased with remoteness (AIHW 2019).

Other factors for understanding these differences include a higher proportion of people with disability living in Outer regional and Remote areas reporting that:

  • they receive only informal assistance when they need help with health care
  • they have experienced issues caused by a lack of communication between health professionals
  • they have experienced discrimination from health staff (including GP, nurse, and hospital staff) (ABS 2019a).

This suggests that some people with disability in these areas may use a hospital emergency department as their point of contact with the health system because of the unavailability of other health services or a lack of communication or understanding about what services are available.


Level of disability

People aged under 65 with severe or profound disability living in the community are more likely than those with other disability status to use health services, particularly medical specialists (70% or 502,000 compared with 59% or 1.0 million) (Figure ACCESS.3).

This group is also more likely to:

  • see 3 or more health professionals for the same condition (47% or 333,000) than those with other disability status (34% or 579,000)
  • visit a hospital emergency department (31% or 221,000 compared with 25% or 421,000)
  • have a health professional help coordinating their care (74% or 245,000 compared with 69% or 399,000), for those who had to see 3 or more health professionals for the same condition
  • face difficulties caused by lack of communication among health professionals (24% or 78,000 compared with 19% or 107,000), for those who had to see 3 or more health professionals for the same condition
  • experience disability discrimination from health staff (8.9% or 29,000 compared with 2.0% or 28,000) (ABS 2019a).

Those with severe or profound disability are slightly less likely than those with other disability status to report cost as the reason they delay seeing or do not see a GP (6.0% or 40,000 compared with 8.4% or 133,000) or dental professional (22% or 103,000 compared with 30% or 344,000).

People aged 5–64 with severe or profound disability who need assistance with health care are more likely (56% or 207,000) to receive informal assistance only than those with other disability status (25% or 42,000), and less likely (15% or 57,000) to receive formal assistance only (42% or 71,000).

Figure ACCESS.3: Patient experience of people with disability, by service and disability status, 2018  

Bar chart showing the proportion of people against categories of use of health services. The reader can select to display the chart by 5 types of health service and by disability status. The chart shows people with severe or profound disability are more likely (24%) to see a general practitioner for urgent medical care than others with disability (18%).

Source data tables:​ Access to health services (XLSX, 500 kB)


Disability group

Disability group

Disability group is a broad categorisation of disability. It is based on underlying health conditions and on impairments, activity limitations and participation restrictions. It is not a diagnostic grouping, nor is there a one-to-one correspondence between a health condition and a disability group.

The ABS SDAC broadly groups disabilities depending on whether they relate to functioning of the mind or the senses, or to anatomy or physiology. Each disability group may refer to a single disability or be composed of a number of broadly similar disabilities. The SDAC identifies 6 separate groups based on the particular type of disability; these are:

  • sensory and speech (sight, hearing, speech)
  • intellectual (difficulty learning or understanding)
  • physical (including breathing difficulties, chronic or recurrent pain, incomplete use of limbs and more)
  • psychosocial (including nervous or emotional conditions, mental illness, memory problems, and social or behavioural difficulties)
  • head injury, stroke or acquired brain injury
  • other (restrictions in everyday activities due to other long-term conditions or ailments) (ABS 2019a).

The use of health services and the experience of access difficulties varies by disability group for people with disability living in households.

People aged under 65 with intellectual disability are less likely to use most health services, apart from dental care, than any other disability group, with rates of health services use lower than the average for all people with disability aged under 65:

  • 86% (or 458,000) of people with intellectual disability saw a GP, compared with 92% (or 2.2 million) for all disability groups
  • 58% (or 308,000) saw a medical specialist, compared with 63% (or 1.5 million) for all disability groups
  • 16% (or 85,000) were admitted to hospital, compared with 22% (or 541,000)
  • 32% (or 170,000) saw 3 or more health professionals for the same condition, compared with 38% (or 911,000) (ABS 2019a).

At the same time, people with intellectual disability aged under 65 are more likely to see a dental professional (57% or 306,000) compared with the average rate for all people with disability (51% or 1.2 million) (ABS 2019a).

One of the possible reasons why people with intellectual disability are more likely to see a dental professional than some other disability groups is that they are less likely to delay or not go because of the cost. Of people aged under 65 who need to see a dental professional, those with intellectual disability (17% or 64,000) or sensory disability (22% or 84,000) are less likely to delay or not go because of the cost than those with psychosocial disability (31% or 159,000), physical disability (32% or 301,000), or head injury, stroke or acquired brain injury (34% or 37,000) (ABS 2019a).

Of people with disability aged 5–64 who need help with health-care activities:

  • those with intellectual disability (61% or 119,000) are more likely to receive that assistance from informal providers only than those with psychosocial disability (51% or 146,000), sensory disability (48% or 69,000), head injury, stroke or acquired brain injury (47% or 31,000) or physical disability (41% or 164,000)
  • those with intellectual disability are more likely (84% or 162,000) to have their need for help with health-care activities fully met than those with sensory disability (73% or 106,000) (ABS 2019a).

Aboriginal and Torres Strait Islander people

National Aboriginal and Torres Strait Islander Health Survey

Data in this section are sourced from the Australian Bureau of Statistics’ (ABS) 2018–19 National Aboriginal and Torres Strait Islander Health Survey (NATSIHS). The NATSIHS was designed to collect information about the health and wellbeing of Aboriginal and Torres Strait Islander people of all ages in non-remote and remote areas of Australia, including discrete Indigenous communities.

The NATSIHS uses the ABS Short Disability Module to identify disability. While this module provides useful information about the characteristics of people with disability relative to those without, it is not recommended for use in measuring disability prevalence.

In the NATSIHS a person is considered to have disability if they have one or more conditions (including long-term health conditions) which have lasted, or are likely to last, for at least 6 months and restrict everyday activities. Disability is further classified by whether a person has a specific limitation or restriction and then by whether the limitation or restriction applies to core activities or only to schooling or employment.

The level of disability is defined by whether a person needs help, has difficulty, or uses aids or equipment, with 3 core activities – self-care, mobility, and communication – and is reported for mild, moderate, severe, and profound limitation.

Around 140,000 Aboriginal and Torres Strait Islander people with disability face problems accessing health services. The most common barriers to accessing services are:

  • cost (33%)
  • being too busy (including with work, personal and family responsibilities) (33%)
  • dislikes (including service/professional, being afraid or embarrassed) (25%)
  • decision not to seek care (30%)
  • waiting time too long or service not being available at the time required (26%) (ABS 2019c).

One in 7 (14%) Aboriginal and Torres Strait Islander people with disability named transport or distance as a barrier to accessing health services. This was especially prevalent for GP visits:

  • of Aboriginal and/or Torres Strait Islander people with disability who in the last 12 months made a decision not to go to the GP when needed, 15% did not go because of transport or distance
  • for hospital visits, this figure was 12%
  • for visits to the dentist, 10% (for people aged 2 and over)
  • for visits to other health professionals, 9.8% (ABS 2019c).

 Health expenses

Household, Income and Labour Dynamics in Australia Survey

Data in this section are sourced from the Household, Income and Labour Dynamics in Australia (HILDA) Survey. The HILDA Survey is a nationally representative, household-based longitudinal study of Australian households and individuals conducted in annual waves since 2001. Members of selected households who are Australian residents and aged 15 or over are invited to participate in a personal face-to-face interview. This section presents cross-sectional analyses of the 17th wave (2017). In 2017 almost 18,000 people from around 10,000 households participated in the HILDA survey.

The HILDA Survey defines disability as an impairment, long-term health condition or disability that restricts everyday activities and has lasted, or is likely to last, for a period of 6 months or more. This is similar to the definition of disability used by the ABS Short Disability Module. In this section people who always or sometimes need help or supervision with at least one core activity because of their disability are referred to as people with ‘severe or profound disability’. Core activities include self-care, mobility and communication. People who have a disability but do not always or sometimes need help or supervision with at least one core activity are referred to as people with ‘other disability’. The HILDA Survey does not collect information on level of disability in every wave. The most recent collection was in the 17th wave (2017) (Summerfield et al. 2019; Wilkins et al. 2019).

 

What are out-of-pocket expenses?

Out-of-pocket expenses occur when services are not bulk-billed and are also known as gap payments.

People with disability aged 15–64 who saw a family doctor or GP in the previous 12 months are less likely (35%) to have had out-of-pocket expenses for consultations than those without disability (44%). Older people with disability aged 65 and over are less likely (24%) to have had out-of-pocket expenses than younger people aged 15–64 (35%). Of those aged 15–64 with disability:

  • people with severe or profound disability are less likely (26%) to have had out-of-pocket expenses than those with other disability status (36%)
  • females are more likely (38%) to have had out-of-pocket expenses than males (31%)
  • those living in Major cities are less likely (33%) than those living in Inner regional areas (40%)
  • people with physical disability are more likely (34%) than those with intellectual disability (19%) (DSS and MIAESR 2019).
 

What is remoteness?

The remoteness categories used in HILDA are based on the Australian Statistical Geography Standard Remoteness Area framework (Summerfield et al. 2019).

 

Disability group

Disability group is a broad categorisation of disability. It is based on underlying health conditions and on impairments, activity limitations and participation restrictions. It is not a diagnostic grouping, nor is there a one-to-one correspondence between a health condition and a disability group.

The HILDA Survey collects information on 17 disability types, which have been combined into the following 6 disability groups:

  • sensory: includes sight, hearing, and speech problems
  • intellectual: includes difficulty learning or understanding things
  • physical: includes difficulty breathing, blackouts, chronic pain, limited use of arms or fingers, difficulty gripping things, limited use of feet or legs, physical restrictions, and disfigurement or deformity
  • psychosocial: includes nervous or emotional conditions, and mental illness
  • head injury, stroke or other brain damage
  • other: includes long-term conditions that are restrictive despite treatment or medication, and other long-term conditions.

What is private health insurance?

Private health insurance is a voluntary form of insurance that covers a wider range of health-care options than the public system. Depending on the type of cover, private health insurance can fully or partly cover the costs of hospital services and/or the costs of other general treatments (PHIO 2021).

Types of private health insurance

Private health insurance can include hospital cover only, extras cover only (such as dental care, physiotherapy, chiropractic services, and podiatry), or both hospital and extras cover.

People with disability aged 15–64 are less likely (47%) to have some form of private health insurance than those without disability (59%). Older people with disability aged 65 and over are more likely (54%) to have private health insurance than those aged 15–64. Of people aged 15–64 with disability:

  • those with severe or profound disability are less likely (35%) to have private health insurance than those with other disability status (49%)
  • females are more likely (50%) than males (44%)
  • those living in Major cities are more likely (53%) than those living in Inner regional areas (37%), or Outer regional, remote or very remote areas (31%)
  • those with physical disability are more likely (44%) than those with intellectual (28%) or psychosocial disability (36%) (DSS and MIAESR 2019).

Most (81%) people with disability aged 15–64 who have private health insurance have both hospital and extras cover. This is similar to those without disability (81%). Older people aged 65 and over with disability are more likely (17%) to have hospital cover only than those aged 15–64 (6.7%) (DSS and MIAESR 2019).