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Examining the impact of reimbursement on referral to bone density testing for older adults: 8 years of data from the Barwon Statistical Division, Australia

Brennan, S L, Kotowicz, M A, Sarah, B, Leslie, W D, Ebeling, P R, Metge, C J, Dobbins, A G and Pasco, J A 2013, Examining the impact of reimbursement on referral to bone density testing for older adults: 8 years of data from the Barwon Statistical Division, Australia, Archives of Osteoporosis, vol. 8, no. 152, pp. 1-6, doi: 10.1007/s11657-013-0152-1.

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Title Examining the impact of reimbursement on referral to bone density testing for older adults: 8 years of data from the Barwon Statistical Division, Australia
Author(s) Brennan, S L
Kotowicz, M AORCID iD for Kotowicz, M A orcid.org/0000-0002-8094-1411
Sarah, B
Leslie, W D
Ebeling, P R
Metge, C J
Dobbins, A G
Pasco, J AORCID iD for Pasco, J A orcid.org/0000-0002-8968-4714
Journal name Archives of Osteoporosis
Volume number 8
Issue number 152
Start page 1
End page 6
Total pages 6
Publisher Springer
Place of publication London, UK
Publication date 2013
ISSN 1862-3522
1862-3514
Keyword(s) Bone densitometry
Sex
Reimbursement
Referral practices
Policy evaluation
Osteoporosis
Summary Summary
In 2007, Medicare Australia revised reimbursement guidelines for dual energy X-ray absorptiometry (DXA) for Australians aged ≥70 years; we examined whether these changes increased DXA referrals in older adults. Proportions of DXA referrals doubled for men and tripled for women from 2003 to 2010; however, rates of utilization remained low.

Introduction
On April 1, 2007 Medicare Australia revised reimbursement guidelines for DXA for Australians aged ≥70 year; changes that were intended to increase the proportion of older adults being tested. We examined whether changes to reimbursement increased DXA referrals in older adults, and whether any sex differences in referrals were observed in the Barwon Statistical Division.

Methods
Proportions of DXA referrals 2003–2010 based on the population at risk ascertained from Australian Census data and annual referral rates and rate ratios stratified by sex, year of DXA, and 5-year age groups. Persons aged ≥70 years referred to the major public health service provider for DXA clinical purposes (n = 6,096; 21 % men).

Results

DXA referrals. Proportions of DXA referrals for men doubled from 0.8 % (2003) to 1.8 % (2010) and tripled from 2.0 to 6.3 % for women (all p < 0.001). For 2003–2006, referral ratios of men/women ranged between 1:1.9 and 1:3.0 and for 2007–2010 were 1:2.3 to 1:3.4. Referral ratios <2007:≥2007 were 1:1.7 for men aged 70–79 years (p < 0.001), 1:1.2 for men aged 80–84 years (p = 0.06), and 1:1.3 for men 85+ years (p = 0.16). For women, the ratios <2007:≥2007 were 1:2.1 (70–79 years), 1.1.5 (80–84 years), and 1:1.4 (85+ years) (all p < 0.001).

Conclusions
DXA referral ratios were 1:1.6 (men) and 1:1.8 (women) for 2007–2010 vs. 2003–2006; proportions of referrals doubled for men and tripled for women from 2003 to 2010. Overall, rates of DXA utilization remained low. Policy changes may have had minimal influence on referral; thus, ongoing evaluation over time is warranted.
Language eng
DOI 10.1007/s11657-013-0152-1
Field of Research 110399 Clinical Sciences not elsewhere classified
Socio Economic Objective 920116 Skeletal System and Disorders (incl. Arthritis)
HERDC Research category C1 Refereed article in a scholarly journal
Grant ID NHMRC 628582
Copyright notice ©2013, Springer
Persistent URL http://hdl.handle.net/10536/DRO/DU:30059670

Document type: Journal Article
Collection: School of Medicine
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Created: Tue, 21 Jan 2014, 13:42:04 EST by Jane Moschetti

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