Archives of Osteoporosis

, 8:152

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

  • S. L. Brennan
  • M. A. Kotowicz
  • B. Sarah
  • W. D. Leslie
  • P. R. Ebeling
  • C. J. Metge
  • A. G. Dobbins
  • J. A. Pasco
Original Article

DOI: 10.1007/s11657-013-0152-1

Cite this article as:
Brennan, S.L., Kotowicz, M.A., Sarah, B. et al. Arch Osteoporos (2013) 8: 152. doi:10.1007/s11657-013-0152-1

Abstract

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.

Keywords

Bone densitometry Osteoporosis Policy evaluation Referral practices Reimbursement Sex 

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2013

Authors and Affiliations

  • S. L. Brennan
    • 1
    • 2
    • 3
  • M. A. Kotowicz
    • 1
    • 2
  • B. Sarah
    • 4
  • W. D. Leslie
    • 5
  • P. R. Ebeling
    • 1
    • 3
  • C. J. Metge
    • 6
  • A. G. Dobbins
    • 2
  • J. A. Pasco
    • 1
    • 2
  1. 1.NorthWest Academic CentreThe University of Melbourne, Sunshine HospitalSt AlbansAustralia
  2. 2.School of MedicineDeakin UniversityGeelongAustralia
  3. 3.Australian Institute for Musculoskeletal ScienceSunshine HospitalSt AlbansAustralia
  4. 4.Department of Medicine, Clinical TrialsBarwon HealthGeelongAustralia
  5. 5.Department of MedicineUniversity of ManitobaWinnipegCanada
  6. 6.Winnipeg Regional Health AuthorityWinnipegCanada

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