Inequality in out of pocket fees, government funding and utilisation of maternal health services in Australia

This study aimed to assess the distribution of service utilisation, out-of-pocket fees and government funding for maternal health care in Australia by socioeconomic group. A large linked administrative dataset was utilised. Women were grouped into socioeconomic quintiles using an area-based measure of socioeconomic status. Descriptive statistics were used to quantify the distribution of number of services, out of pocket fees, and government funding by socioeconomic quintile. Needs-adjusted concentration indices (CI_NA) were utilised to quantify inequity. The mean out of pocket fees for women of least socioeconomic advantage was $1,026 and for women of most socioeconomic advantage the mean was $2,432 (CI_NA 0.093, 95% CI: 0.088 – 0.098). However, use of many services were higher for women of most socioeconomic advantage: private obstetrician (CI_NA: 0.035, 95% CI: 0.032 – 0.038), other specialist services (CI_NA: 0.089, 95%CI: 0.083 – 0.094), and diagnostic and pathology tests (CI_NA: 0.027, 95%CI: 0.025 – 0.030). Federal government funding through Medicare was distributed towards women of most socioeconomic advantage (CI_NA: 0.036, 95%CI: 0.033 – 0.039); whereas government public hospital funding was skewed towards women of least socioeconomic advantage (CI_NA: -0.05, 95%CI: -0.057 - -0.046). Future policy changes in Australia's healthcare system need to ensure that women of least socioeconomic advantage have adequate access to maternity and early childhood care, and out of pocket fees are not an access barrier.