Investigating the relationship between out-of-pocket costs, healthcare quality, experience and outcomes

Project description, aim, design and method

Out-of-pocket (OOP) healthcare costs account for around 17% of total health expenditure in Australia, representing an expenditure of around $4,290 per household annually.  OOP costs vary substantially by health condition, procedure, provider, and service location. Evidence of whether this variation in OOP costs is associated with indicators of healthcare quality and/or health outcomes is lacking. Through a retrospective cohort analysis of membership data, this project will address this evidence gap to produce comprehensive understanding of whether higher costs are associated with better quality of care and health outcomes.

Project aims

To determine the relationship between out-of-pocket costs and the healthcare quality, experience and outcomes.

Objectives:

1. To examine the association of out-of-pocket costs on healthcare quality and patient outcomes for four common procedures: (i) hip replacement; (ii) knee replacement; (iii) laparoscopic cholecystectomy; and (iv) radical prostatectomy.
2. To provide a comprehensive analysis of the value proposition posed by out-of-pocket costs and the implications for service providers and consumers.

Design and method

Retrospective cohort study of Medibank members aged ≥18 who underwent procedures for:

(i) hip replacement;

(ii) knee replacement;

(iii) laparoscopic cholecystectomy; and

(iv) radical prostatectomy in private hospitals in Australia between 1 January 2015 and 31 December 2020.