Original Research

Experiences and impacts of out-of-pocket healthcare expenditure on remote Aboriginal families


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Courtney Ryder
(Aboriginal) BSc, BEng(Biomed)(Hons), PhD, A/Prof and Discipline Lead Injury Studies * ORCID logo

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Shane D'Angelo
GradCertPopHlthPrac, MBA, Research Fellow

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Patrick Sharpe
Cert III & IV PHC, Cert III & IV IndL, Cert III & IV ACM, Executive Officer

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Tamara Mackean
BSci (med), MBBS, MPH, Discipline Lead for Aboriginal and Torres Strait Islander Health ORCID logo

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Nayia Cominos
MAAL, PhD, Applied Linguist ORCID logo

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Julieann Coombes
PhD, Senior Research Fellow ORCID logo

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Keziah Bennett-Brook
BA-BCMS, Chair Research Committee

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Darryl Cameron
AdvDipN, MPH, Close the Gap Project Officer

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Emily Gloede

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Shahid Ullah
PhD, Associate Professor in Biostatistics ORCID logo

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Jacqueline Stephens
PhD, Epidemiologist

ACCEPTED: 16 January 2024

early abstract:

Purpose: Aboriginal Australians face significant health disparities, with hospitalisation rates 2.3 times greater, and longer hospital length of stay than non-Indigenous Australians. This additional burden impacts families further through out-of-pocket healthcare expenditure (OOPHE), which are additional healthcare expenses not covered by universal taxpayer insurance. Aboriginal patients traveling from remote locations are likely to be impacted further by OOPHE. The objective of this study was to examine the impacts and burden of OOPHE for rurally based Aboriginal individuals.
Methods: Participants were recruited through South Australian community networks to participate in this study. Decolonising methods of yarning and deep listening were used to centralise local narratives and language of OOPHE. Qualitative analysis software was used to thematically code transcripts and organise data.
Findings: A total of four yarning sessions were conducted with 10 participants, with seven themes identified: travel, barriers to healthcare, personal and social loss, restricted autonomy, financial strain, support initiatives and protective factors. Sleeping rough, selling assets, not attending appointments were used to mitigate or avoid OOPHE. Government initiatives, such as the patient assistance transport scheme, did little to decrease OOPHE burden on participants. Family connections, Indigenous knowledges and engagement with cultural practices were protective against OOPHE burden.
Conclusion: Aboriginal families are significantly burdened by OOPHE when needing to travel for healthcare. Radical change of government initiative and policies through to health professional awareness is needed to ensure equitable healthcare access which does not create additional financial hardship in communities already experiencing economic disadvantage.