Professor Alex Collie, School of Public Health and Preventative Medicine Monash University
Why are we interested in the health of DSP and Newstart recipients?
It is clear that people receiving social assistance benefits are, on average, not as healthy as non-recipients. For example, being out of work and receiving unemployment benefits is linked with higher mortality and morbidity. Mental health conditions are more common among Australians receiving the Newstart Allowance (NSA), parenting payments and the Disability Support Pension (DSP) compared with non-recipients.
By definition, people receiving the DSP have long-standing and significant medical conditions and disabilities. Recent changes to DSP policy have increased the number of people receiving the NSA with poor health and limited work capacity. There are now nearly 200,000 NSA recipients with work capacity restrictions. Combined with the nearly 750,000 DSP recipients, the number of chronically ill or disabled working age Australians receiving income support through these two schemes approaches 1 million.
Despite these staggering numbers, we know very little about the health status of Australian benefit recipients. Recent studies focus on specific sub-groups (e.g., defined by their condition or disability) or on a specific health outcome (e.g., mental health). We have limited information about the number and pattern of health conditions in DSP and NSA recipients, or the extent of co-morbidity. We know even less about the extent and patterns of health service use in these groups.
It is important that we understand these things. Effective health service delivery may support reductions in disability and improvements in the ability to participate in work. In turn, delivering appropriate health services to benefit recipients requires knowledge of the nature and patterns of health conditions in these groups.
Analysis of the National Health Survey
Using data from the 2014/15 National Health Survey, we recently described and compared the self-reported health conditions, health service use and medicines use in DSP and NSA recipients, compared with people whose primary income was from wages (“wage earners”). We included data from over 9000 people, including 638 DSP recipients and 442 NSA recipients.
Our analysis found that people receiving DSP benefits are at much greater risk of ill health than wage earners across a range of disease categories, are more likely to report having multiple health conditions, are significantly more likely to be hospitalised, are heavy users of healthcare services and have higher self-reported rates of medicine use and polypharmacy compared to wage earners.
For example, more than two in every five (42.6%) DSP recipients visited a General Practitioner more than 10 times in the previous 12 months, compared to less than 5% of wage earners and 19% of NSA recipients. More than one quarter (25.7%) of DSP recipients reported being admitted as a hospital inpatient in the previous 12 months compared with less than 10% of wage earners and 16% of NSA recipients. DSP recipients were at 2 to 3 times the risk of visiting a hospital than wage earners, while NSA recipients were at 1.5 to 2 times increased risk than wage earners.
Similar to the DSP group, Australians receiving the NSA report an increased prevalence of disease in multiple categories, have a higher rate of multi-morbidity, are more likely to use some health services and be hospitalised, and have a higher rate of multiple episodes of health service use than wage earners. While the magnitude of these effects are not as large as those observed for DSP recipients, our findings confirm a significantly increased burden of ill health in NSA recipients.
For both DSP and NSA recipients, the largest differences from wage earners are in the areas of mental and behavioural health. For example, both groups are more likely to report mood disorders, anxiety disorders, depression, and post-traumatic stress disorder. Both groups are significantly more likely to have access psychological and counselling services than wage earners.
So what are the implications?
The differences in health status between benefit recipients and wage earners are stark, and demonstrate the substantial burden of disease and disability in both the DSP and NSA groups.
Recent policy initiatives in these groups have focused on approaches to assessment and eligibility, delivery of case management services, employment service provision, and mutual obligation requirements. This study suggests a potentially fruitful avenue of innovation would be to focus on health improvement. For example it would be valuable to focus on the delivery of effective health services to this population, or to sub-groups with the greatest room for improvement in health and reduction in disability.
There are examples of international policy initiatives in this field. For example, the UK government has created a cross government Work and Health Unit that is jointly sponsored by the UK Department of Health and Department of Work and Pensions. The aim of the unit is to “improve the health and employment outcomes for disabled people and those with health conditions” including through the provision of healthcare to people with disability and work limitations. Similarly, Norway has a cross-government Directorate of Health and Social Affairs that operates under the joint auspices of the Ministry of Health and Care Services and the Ministry of Labour and Social Affairs. In contrast, there is currently little apparent coordination between Australian social security and healthcare systems.
The full report from our health study will be released in September via www.dspstudy.com.
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 Butterworth P, Burgess PM, Whiteford H. Examining welfare receipt and mental disorders after a decade of reform and prosperity: analysis of the 2007 National Survey of Mental Health and Wellbeing. Aust N Z J Psychiatry. 2011;45(1):54-62.