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Behind Health Equity

"The Australian healthcare system is based upon equal access and opportunity to treatment regardless of personal wealth. However, this is not always the case."
Health Equity in Victoria
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While the Australian healthcare system tries to give equal access to various treatments to all Australians, in practice this is not accurate.

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If you need surgery and live in Melbourne’s northern and eastern suburbs, the regional Olivia Newton-John Cancer Centre at the Austin Hospital can’t give you access to the newest surgical techniques using robots, because it doesn’t have a robot.

 

 

But anyone in your community or your workplace who can afford to be privately insured can get robotic surgery, no problem. Private hospitals – even small ones - have robots in their operating rooms. When it comes to the public hospitals, however, Peter MacCallum is the only Cancer Centre that has a robot.

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What about the people in the community who simply cannot afford private health insurance? Or to pay for an out-of-pocket robotic prostatectomy? Unfortunately, the way the Australian health system is set up these patients are simply left out.

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The above graph shows the correlation between open prostatectomies and less financially advantaged patients against robotic prostatectomies and more financially well off people. As seen above, those who are more financially advantaged have a far higher likelihood of being treated with minimally invasive robotic surgery, than those from the less economically well off groups in our society. This is an example of how the Australian health system ultimately fails to provide equivalent care to all Australians. 

 

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The evidence
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Much research has already been undertaken investigating the parity in healthcare between those who have private or public health insurance (e.g. ref Hall SE, D'Arcy C, Wisniewski ZS, Semmens J.  Prostate Cancer: socio-economic, geographical and private-health insurance effects on care and survival. BJU Int 2005, 95: 51-58) . While there is no doubt that the Australian healthcare framework is a world-class design system of universal health care, many people fail to get the same standard of care as other Australians. This includes people from lower socio-economic, rural and indigenous backgrounds.

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Data sources

  • Postcode to electoral division correspondence (aph.gov.au website, 2009)

  • Population by electoral division 2011 census (ABS)

  • Vote by electoral division 2016 election (AEC)

 

Figure 1

  • The y-axis is the number of men in each electorate who received RALP as per the registry, per 1000 men aged 40-79.

  • The x-axis is the % of 2 party preferred ALP vote in the 2016 federal election. Hence the blue electorates are held by the coalition, red by the ALP.

  • Each dot is an electorate in Victoria. Not shown are Indi (Independent) and Melbourne (Green) where the runner up was the coalition.

  • The purple dashed line is a fitted quadratic curve.

    • The higher the ALP vote, the lower the relative number of men who received RALP.

  • This speaks to a differential in healthcare access, i.e. less or delayed screening, as well as impeded access overall to a treatment available in the private sector. It is an issue particularly affecting voters in the Labor base.

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Figure 1

Figure 2

  • This is a map of the federal electorate of metropolitan Melbourne.

  • The five shades of orange represent electorate quintiles of RALP per 1000 men aged 40-79.

    • The darkest orange are the electorates in the bottom fifth of this measure.

  • The red dot is the location of the Austin.

  • The Austin has a western and northern catchment that is underserved by PCa and RALP treatment.

    • This is especially true along the “Bell Street corridor” of Batman and Wills.

Figure 2​

As indicated through the above graph, where the darker shades indicate a higher frequency of robotic treatment, there is a wedge of the northern suburbs of Melbourne where there is little to no access to such treatment. The Olivia Newton-John Cancer Wellness and Research Centre at the Austin Hospital is perfectly placed to fill a void within the northern and eastern suburbs of Melbourne for public access to robotic surgery.

Figure 3

  • The y-axis is the number of RALP divided by number of open RP in each electorate

  • The x-axis is the 2016 vote as above

  • The pink shaded region and purple diamonds show the electorates that are marginal (+/- 5%) and have a ratio indicating more open RP.

  • This indicates that in men that have access to screening, diagnosis and surgical treatment, there is no longer a relationship with voting.

    • There is nothing inherent among the men in ALP electorates that precludes them from receiving RALP should they have adequate access to it.

  • All marginal electorates in Victoria have a RALP : open RP ratio less than one. They are all in the pink zone.

    • Providing access to RALP treatment may give an electoral benefit.

Figure 3

Figure 4

  • Again, this is a map of the Melbourne metropolitan electorates.

  • It shows 5 of the 7 electorates identified in the pink zone of figure 3.

    • Corangamite and Bendigo are rural

  • The Austin is ideally placed to serve these places.

    • It is located within one (Jagajaga) and three lie in the eastern catchment along the “Eastlink corridor”.

Figure 4

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