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The profiles of public and private patients in maternal healthcare: a longitudinal study to examine adverse selection

Published online by Cambridge University Press:  14 June 2019

Jananie William*
Affiliation:
Research School of Finance, Actuarial Studies and Statistics, Australian National University, Australia2601
Bronwyn Loong
Affiliation:
Research School of Finance, Actuarial Studies and Statistics, Australian National University, Australia2601
Catherine Chojenta
Affiliation:
Research Centre for Generational Health & Ageing, The University of Newcastle, Australia2308
Deborah Loxton
Affiliation:
Research Centre for Generational Health & Ageing, The University of Newcastle, Australia2308
*
*Corresponding author. Email: jananie.william@anu.edu.au

Abstract

In this article, we investigate differences in the profiles of patients within the Australian mixed public-private maternal health system to examine the extent of adverse selection. There are conflicting influences on adverse selection within the private health sector in Australia due to government regulations that incentivise lower risk segments of the population to purchase community-rated private health insurance. We use a two-phase modelling methodology that incorporates statistical learning and logistic regression on a dataset that links administrative and longitudinal survey data for a large cohort of women. We find that the key predictor of private patient status is having private health insurance, which itself is largely driven by sociodemographic factors rather than health-or pregnancy-related factors. Additionally, transitioning between the public-private systems for a subsequent pregnancy is uncommon; however, it is primarily driven by changes in private health insurance when it occurs. Other significant factors when transitioning to the private system for a second pregnancy are hypertension, increased access to specialists and stress related to previous motherhood experiences. Consequently, there is limited evidence of adverse selection in this market, with targeted financial incentives likely outweighing the impact of community rating even during childbearing years where private health service use increases.

Type
Paper
Copyright
© Institute and Faculty of Actuaries 2019 

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