Original Research

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


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Courtney Ryder
1,2,3,4 PhD, Associate Professor and Discipline Lead Injury Studies * ORCID logo

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Shane D'Angelo
1,2 MBA, Research Fellow

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

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Tamara Mackean
1,2,3 FAFPHM, A/Prof and Discipline Lead for Aboriginal and Torres Strait Islander Health ORCID logo

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Nayia Cominos
1 PhD, Senior Lecturer ORCID logo

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Julieann Coombes
3 PhD, Senior Research Fellow Guuna-maana ORCID logo

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Keziah Bennett-Brook
3 BA-BCMS, Program Head Guuna-maana

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Darryl Cameron

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Emily Gloede
1 BClinSci, Doctor of Medicine Student

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Shahid Ullah
1,2 PhD, A/Prof and Teaching Program Director Public Health ORCID logo

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Jacqueline Stephens
1,2 PhD, Associate Professor Public Health ORCID logo


1 College of Medicine and Public Health, Flinders University, GPO Box 2100, SA 5001, Australia

2 Flinders Health and Medical Research Institute, Flinders University, GPO Box 2100, SA 5001, Australia

3 The George Institute for Global Health Australia, UNSW, PO Box M201, Missenden Rd, NSW 2050, Australia

4 School of Population Health, UNSW, Sydney, NSW 2052, Australia

5 Far West Community Partnerships, PO Box 730, Ceduna, SA 5690, Australia

6 Moorundi Aboriginal Community Controlled Health Service, South Australia Health, Murray Bridge, Australia

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.