Health care financing and public responses: use of private insurance in Western Australia during 1980-2001.

OBJECTIVES: The aim was to identify and explain trends and cut points in payment classification (privately insured or otherwise) for episodes of hospitalisation in Western Australia.
METHODS: Hospital morbidity data from 1980 to 2001 were used to produce trend lines of the proportion of hospital separations in each payment category in each year in age and clinical subgroups.
RESULTS: The most significant changes in payment classification over time were found in all groups between 1980 and 1984, corresponding to a period when free public hospital care in Australia was abolished (Sep 1981 to Feb 1984). The trend associated with this policy change rebounded significantly just before the introduction of Medicare in 1984. These observations were consistent over all age groups except in the oldest group (70+ years). This trend was more pronounced for the surgical subgroup compared with other broad clinical categories. More recently, a trend towards increasing public episodes was reversed from 2000 following introduction of incentives for private health cover and sanctions against deferred uptake in younger people.
CONCLUSION: The public appeared to adopt a short-term crisis reaction to major policy change but then reversed towards past patterns of behaviour. The implications for policy makers include the need to understand the underlying culture of the population; to realise that attitudes become fixed as people age; and to recognise the difference in the effectiveness of incentive- and deterrent-based policies.