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Challenges and solutions in constructing a microsimulation model of the use and costs of medical services in Australia

  1. Sharyn Lymer  Is a corresponding author
  2. Laurie Brown  Is a corresponding author
  3. Ann Harding  Is a corresponding author
  4. Alicia Payne  Is a corresponding author
  1. University of Canberra, Australia
  2. Department of Treasury, Langton Crescent, Australia
Research article
Volume 4(3) Winter 2011
Cite this article as: S. Lymer, L. Brown, A. Harding, A. Payne; 2011; Challenges and solutions in constructing a microsimulation model of the use and costs of medical services in Australia; International Journal of Microsimulation; 4(3); 17-31. doi: 10.34196/ijm.00057
1 figure and 10 tables

Figures

Figure 1
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Distribution of number of short term health conditions per person.

Data source: HealthMod; ABS 1995 NHS.

Tables

Table 1
Medicare subsidised medical services and benefits paid by MBS category (processed by Medicare Australia July 2005 to June 2006).
MBS Category No. Services (‘000,000) Benefit ($m) No. Services per 1,000 pop. Benefit ($) per 1,000 pop.
1 Professional Attendances 1,260.5 5,266.0 6,118.3 255,602.7
2 Diagnostic Procedures and Investigations 43.3 251.2 210.3 12,190.9
3 Therapeutic Procedures 153.4 1,790.6 744.7 86,914.5
4 Oral and Maxillofacial Services (by Approved Dental Practitioners) 0.7 8.5 3.6 414.4
5 Diagnostic Imaging Services 149.2 1,609.4 724.3 78,118.7
6 Pathology Services 828.9 1,641.8 4,023.3 79,693.0
7 Cleft Lip and Cleft Palate 0.1 1.3 0.3 61.9
8 Miscellaneous Services 37.5 407.4 181.9 19,776.4
Total 2,473.7 10,976.3 12,006.9 532,772.5

  1. Source: Medicare Australia website @ www.medicareaustralia.gov.au

Table 2
Closeness of match – age group (percentage distribution).
Age Group (years) – STINMOD /01A Age Group (years) – NHS
0–4 5–9 10–14 15–19 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65–69 70–74 75+
0–4 79.0 18.6 2.4 . . . . . . . . . . . . .
5–9 14.4 65.4 20.1 . . . . . . . . . . . . .
10–14 4.6 17.7 77.7 . . . . . . . . . . . . .
15–19 . . . 69.7 13.4 7.7 5.2 0.8 0.8 0.4 1.1 0.8 0.1 0.1 . .
20–24 . . . 26.2 28.1 18.0 8.1 5.2 6.7 3.3 1.0 1.9 1.0 0.3 0.1 .
25–29 . . . 7.1 15.2 32.8 22.0 5.7 3.8 5.1 3.3 1.5 2.6 0.8 0.2 .
30–34 . . . 2.1 6.6 9.1 40.6 21.2 6.2 6.4 3.8 1.2 0.8 0.8 0.6 0.6
35–39 . . . 1.2 2.7 5.8 6.7 45.0 19.4 7.6 5.0 2.6 1.3 0.9 0.6 1.0
40–44 . . . 0.9 1.9 3.5 5.3 10.6 43.6 15.3 10.1 3.1 2.1 1.5 1.4 0.5
45–49 . . . 0.9 1.2 1.6 1.7 4.6 14.2 38.2 20.4 7.4 2.6 3.1 2.4 1.7
50–54 . . . 0.1 1.0 0.8 1.0 2.8 5.8 11.9 32.4 30.4 7.5 2.4 1.1 2.9
55–59 . . . . 0.4 0.3 1 1.0 2 4.7 8.6 31.8 36.1 6.4 2.8 4.8
60–64 . . . . 0 . 0.0 0.2 0.5 1.5 2.3 5.4 39.0 41.8 5.0 4.2
65–69 . . . . . . 0.1 0.2 0.3 0.5 1.0 2.3 6.2 31.7 50.3 7.4
70–74 . . . . 0.1 0.1 . 0.1 0.2 1 1.7 3.6 3.2 3.3 37.5 49.3
75+ . . . . . . . 0.0 0.3 0.0 0.9 1.4 3.2 1.5 3.2 89.2
All 9.1 8.5 6.6 6.5 4.7 5.8 7.1 8.0 7.9 6.8 6.1 5.3 4.8 3.9 3.8 5.3
Table 3
Closeness of match – equivalent income deciles (percentage distribution).
Equivalent income decile – STINMOD/01A Equivalent Income decile – NHS
1 2 3 4 5 6 7 8 9 10
1 69.9 16.4 13.3 0 0.1 0.1 0.2 . . .
2 20.5 46.3 33 . . 0.1 0.1 . . .
3 7.1 24.9 67.5 . . 0.3 0.3 . . .
4 . . . 39.4 22.6 28.4 9.6 . . .
5 . . . 19.1 29.1 23.7 28.0 . . .
6 . . . 12.3 20.3 37.4 30.0 . . .
7 . . . 2.4 9.7 18.0 69.9 . . .
8 . . . . . . . 67.7 30.3 1.9
9 . . . . . . . 18.6 47.3 34.1
10 . . . . . . . 12.3 23.6 64.1
Table 4
Closeness of match – number of persons in household (percentage distribution).
Number of persons in household – STINMOD/01A Number of persons in household – NHS
1 2 3 4 5 6+
1 67.0 14.9 8.0 4.4 3.0 2.6
2 10.0 75.8 9.7 3.3 0.9 0.3
3 3.4 16.5 54.1 23.2 2.5 0.3
4 1.8 1.4 17.1 61.2 14.9 3.7
5 1.5 0.9 2.6 35.1 44.6 15.4
6+ 9.1 12.8 1.3 26.6 2.4 18.2 7.5 25 29.4 11.7 50.2
All 12.8 26.6 18.2 25 11.7 5.7
Table 5
Closeness of match – income unit type (percentage distribution).
Income Unit Type -STINMOD/01A Income Unit Type – NHS
Lone person Couple Couple with kids Single with kids Other
Lone person 69.7 . . . 30.3
Couple . 100 . . .
Couple with kids . . 100 . .
Single with kids . . . 100 .
Other 55.2 . . . 44.8
All 18 7.1 23.1 42.4 9.4
Table 6
Prevalence and long-term characteristics of health condition groups, 1995.
Health Name Condition Group Prevalence per 100 population Prevalence as a LTC per 100 population % LTC (either only or with acute bouts)
1 arthritis 14.72 14.58 99.05
2 asthma 11.30 11.09 98.10
3 diabetes 2.47 2.45 99.15
4 heart and circulatory 21.42 20.02 93.45
5 mental health 5.80 4.00 69.04
6 cancer 2.10 1.78 84.58
7 injury and poisoning 6.39 0.60 9.43
8 other muscular 17.01 12.48 73.36
9 other endocrine 10.47 7.81 74.66
10 respiratory 32.26 23.12 71.66
11 visual disturbances 0.27 0.19 72.43
12 other eye and adnexa 49.71 48.87 98.31
13 ear and mastoid 12.48 11.36 91.09
14 nervous system 3.50 2.65 75.81
15 infectious disease 3.73 1.03 27.66
16 digestive 10.56 7.66 72.60
17 dental 5.06 0.12 2.44
18 genito-urinary 6.38 3.60 56.34
19 skin and subcutaneous 9.87 3.80 38.45
20 blood diseases 2.05 1.67 81.67
21 pregancy and childbirth 0.88 0.15 17.05
22 sign and symptoms 24.24 7.30 30.12
23 preventative 31.92 0.02 0.06
24 congential 0.37 0.34 90.04
25 disability nec 1.16 1.12 96.55
26 unspecified symptoms 4.03 2.56 63.52

  1. Note: LTC = Long Term Condition; NEC = not elsewhere classified.

  2. Source: ABS 1995 NHS.

Table 7
Likelihood of having a short-term health condition.
Variable Crude Odds Ratio Comment on crude odds ratio Odds Ratio (adjusted for age and sex) Odds ratio (adjusted for age, sex and SAHS)
Age group (treated as a continuous variable) 1.129 Significant, appears to have close to linear relationship
Sex 1 Male vs 2 Female 0.60 Significant
Equivalent Income decile Significant as a group but non linear
 0 NA 0.759 0.753 0.707
 1 1st decile 0.630 0.742 0.661
 2 0.881 0.844 0.693
 3 1.078 0.948 0.767
 4 0.988 0.963 0.837
 5 0.769 0.863 0.777
 6 0.675 0.747 0.682
 7 0.713 0.810 0.752
 8 0.812 0.894 0.846
 9 0.810 0.858 0.827
 10 10th decile 1 1 1
Self Assessed Health Status Significant as a group
 0 NA 0.040 0.113
 1Excellent 0.056 0.081
 2 0.082 0.116
 3 0.111 0.146
 4 0.264 0.307
 5 Poor 1 1
Marital Status Significant as a group
 1 Married 2.122 0.911 0.977
 2 de facto 1.759 1.081 1.100
 3 separated 2.186 0.992 0.986
 4 divorced 2.697 1.040 1.084
 5 widowed 6.316 1.258 1.259
 6 never married 1 1 1
Income unit type
 1 Married with dep kids 0.467 0.509 0.522
 2 Married without dep kids 1.208 0.677 0.672
 3 Single parent with dep kids 0.447 0.509 0.507
 4 Single 0.749 0.569 0.555
 5 Out of scope 0.707 0.641 0.623
 9 Incomplete unit 1 1 1
Education Significant
 0 Not have higher 1 1 1
qualification 1.46 0.877 0.80
 1 Has higher qualification
Labour force status Significant as a group
 0 NA 0.639 0.977 1.528
 1 Unemployed 0.769 0.819 0.955
 2 Employed 0.580 0.712 0.698
 3 Not in labour force 1 1 1
Concession card holder (under 1995 rules) Significant as a group
 0 NA 0.630 1.245 0.080
 1 Covered 2.525 1.744 1.494
 2 Not covered 1.241 1.176 1.203
 3 Don’t Know 1 1 1
Government benefit recipient 1 Yes vs 2 No 2.522 Significant 1.406 1.110

  1. Source: ABS 1995 NHS.

Table 8
Distribution of frequency of a doctor’s visit, 2001.
Frequency of Doctor’s Visit HealthMod No.% NHS95 No.% Absolute Difference % Diff.
1 3,533,937 77.35 3,231,795 76.83 302,142 9.35
2 828,385 18.13 732,739 17.42 95,646 13.05
3 142,938 3.13 144,020 3.42 1,082 0.75
4 49,542 1.08 60,825 1.45 11,283 18.55
5 9,593 0.21 17,051 0.41 7,458 43.74
6 748 0.02 7,735 0.18 6,987 90.33
7 2,201 0.05 5,620 0.13 3,419 60.83
8 0 0.00 281 0.01 281 100.00
9 and over 1,213 0.03 6,507 0.15 5,294 81.36
Table 9
Primary reasons for a doctor’s visit, 2001.
Condition Group Name HealthMod NHS95 Absolute Difference % Diff.
No. % No. %
1 Arthritis 83,102 1.8 80,294 1.92 2,808 3
2 Asthma 92,614 2.0 85,203 2.04 7,411 9
3 Diabetes 50,058 1.1 36,357 0.87 13,701 38
4 Heart & Circulatory Dis. 222,438 4.9 248,960 5.95 26,522 11
5 Mental Health 237,551 5.2 101,921 2.44 135,630 133
6 Cancer 47,680 1.0 67,662 1.62 19,982 30
7 Injury and Poisoning 404,858 8.9 230,795 5.52 174,063 75
8 Other Musculoskeletal 484,887 10.6 258,942 6.19 225,945 87
9 Other endocrine 82,916 1.8 68,879 1.65 14,037 20
10 Respiratory 661,795 14.5 713,950 17.07 52,155 7
12 Eye and adnexa 70,612 1.5 71,758 1.72 1,146 2
13 Ear and mastoid 114,307 2.5 128,297 3.07 13,990 11
14 Nervous system 99,963 2.2 47,965 1.15 51,998 108
15 Infectious disease 145,684 3.2 103,486 2.47 42,198 41
16 Digestive 125,438 2.7 151,064 3.61 25,626 17
18 Genitor-urinary 85,042 1.9 131,022 3.13 45,980 35
19 Skin and subcutaneous 200,967 4.4 233,831 5.59 32,864 14
20 Blood disease 11,717 0.3 14,214 0.34 2,497 18
21 Pregnancy and childbirth 40,170 0.9 76,677 1.83 36,507 48
22 Signs and symptoms 273,554 6.0 252,137 6.03 21,417 8
23 Preventative 1,024,505 22.4 1,041,530 24.9 17,025 2
24 Congenital abnormality 7,624 0.2 4,127 0.1 3,497 85
25 Disability 204 0.0 2,383 0.06 2,179 91
26 Other 872 0.0 31,047 0.74 30,175 97
Table 10
Total doctor services, by broad type of service, 2001.
BTOS Name Medicare Aust. HealthMod Absolute Difference % Difference
0101 Un-referred attendances – GP 91,952,523 95,998,090 4,045,567 4.4
0102 Un-referred attendances -enhanced primary care 323,056 503,860 180,804 56.0
0103 Un-referred attendances – other 8,059,031 9,321,414 1,262,383 15.7
0200 Specialist attendances 19,656,169 19,164,702 491,467 −2.5
0300 Obstetrics 1,470,160 1,459,591 10,569 −0.7
0400 Anaesthetics 2,140,921 1,979,525 161,396 −7.5
0700 Operations 6,039,494 6,726,906 687,412 11.4
0800 Assistance at operations 279,281 309,925 30,644 11.0
1000 Radiotherapy and therapeutic nuclear medicine 642,033 599,165 42,868 −6.7
1100 Miscellaneous 5,525,245 5,436,272 88,973 −1.6
Total 134,617,753 141,499,450 6,881,697 5.1

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