Private health insurance and preventive care utilisation in Australia: A longitudinal study.

OBJECTIVES: To examine association of private health insurance (PHI) with preventive care utilisation, and the influences of chronic conditions in Australia. STUDY DESIGN: Longitudinal study. METHODS: Data were drawn from three waves (2009, 2013 and 2017) of the Household, Income and Labour Dynamics in Australia Survey. Preventive healthcare utilisation was measured as the number of six reported preventive services: cervical screening, prostate screening, breast screening, bowel cancer screening, blood pressure checks and cholesterol testing. PHI coverage included extras PHI, hospital PHI, or combined hospital and extras PHI. Associations between PHI and preventive care were estimated using Poisson regression with augmented inverse probability weighting, adjusting for chronic conditions, demographic, and socioeconomic factors. RESULTS: The cohort included 9674 individuals followed over three waves. Chronic conditions became more prevalent over time, particularly hypertension, arthritis/osteoporosis, depression or anxiety, cardiovascular disease and diabetes. Individuals with chronic conditions reported higher preventive service utilisation than those without such conditions. After adjustment, PHI was significantly associated with greater preventive care use compared with Medicare alone. Among women, hospital PHI and combined PHI were associated with a 14% higher utilisation rate (incidence rate ratio IRR 1.14, 95% confidence interval CI 1.09-1.18). Among men, hospital PHI was associated with a 12% higher rate (IRR 1.12, 95% CI 1.00-1.23), while combined PHI was associated with an 18% higher rate (IRR 1.18, 95% CI 1.11-1.25). CONCLUSIONS: PHI was associated with higher preventive care utilisation. Strengthening coordination between PHI and Medicare may improve preventive care delivery and chronic disease management in Australia.