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

William, Jananie; Loong, Bronwyn; Chojenta, Catherine; Loxton, Deborah

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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...[Show more]

dc.contributor.authorWilliam, Jananie
dc.contributor.authorLoong, Bronwyn
dc.contributor.authorChojenta, Catherine
dc.contributor.authorLoxton, Deborah
dc.date.accessioned2019-12-18T04:16:49Z
dc.date.available2019-12-18T04:16:49Z
dc.identifier.issn1748-4995
dc.identifier.urihttp://hdl.handle.net/1885/195753
dc.description.abstractIn 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.
dc.format.mimetypeapplication/pdf
dc.language.isoen_AU
dc.publisherFaculty of Actuaries and Institute of Actuaries
dc.rights© 2019 Institute and Faculty of Actuaries
dc.sourceAnnals of Actuarial Science
dc.subjectPrivate health insurance
dc.subjectmaternal health
dc.subjectadverse selection
dc.titleThe profiles of public and private patients in maternal healthcare: A longitudinal study to examine adverse selection
dc.typeJournal article
local.description.notesImported from ARIES
local.identifier.citationvolumeOnline
dcterms.dateAccepted2019-05-13
dc.date.issued2019-06-14
local.identifier.absfor111799 - Public Health and Health Services not elsewhere classified
local.identifier.absfor150204 - Insurance Studies
local.identifier.absfor140208 - Health Economics
local.identifier.ariespublicationu1027566xPUB124
local.publisher.urlhttps://www.cambridge.org
local.type.statusPublished Version
local.contributor.affiliationWilliam, Jananie, College of Business and Economics, ANU
local.contributor.affiliationLoong, Bronwyn, College of Business and Economics, ANU
local.contributor.affiliationChojenta, Catherine, University of Newcastle
local.contributor.affiliationLoxton, Deborah, University of Newcastle
local.bibliographicCitation.startpage1
local.bibliographicCitation.lastpage9
local.identifier.doi10.1017/S1748499519000083
dc.date.updated2019-08-04T08:17:56Z
dcterms.accessRightsOpen Access
dc.provenancehttp://sherpa.ac.uk/romeo/issn/1748-4995/..."Publisher's version/PDF may be used on author's personal website, departmental website or institutional repository, on publication" from SHERPA/RoMEO site (as at 18/12/19)
CollectionsANU Research Publications

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