Health Policy 79 (2006) 16–23 Effects of financial disadvantage on use and non-use of after hours care in Australia Margaret Kelaher * , David Dunt, Susan Day, Peter Feldman Program Evaluation Unit, School of Population Health, University of Melbourne, Carlton Melbourne, Vic. 3010, Australia Abstract Policy addressing the provision of primary care after hours (AH) is currently in flux because of concerns about equity of access and cost. In this study we examine the effects of socioeconomic disadvantage on access to AH care and episodes of not seeking AH care when needed among users and non-users of AH care. The effects of health on these relationships were also explored. The total sample consisted of 5538 users of AH care and 891 non-users of AH care who were randomly selected for telephone interviews. Factors determining AH care included accessibility that is structural barriers to use of care such as distance and transport, as well as affordability and availability. Logistic regression was used to determine the impact of financial disadvantage on episodes of not seeking AH care. Barriers to use of AH care and household health were subsequently added to the models to assess their impact. The results suggested that there were inequities in access to AH care but these were a function of barriers to AH care use rather than financial disadvantage per se. Accessibility and availability were significant barriers to use of AH clinics among both user and non-user samples. Affordability was only a significant barrier among users of AH care. The study suggests that policy aimed at reducing these barriers may effectively address inequities in AH care but that to be optimally effective policy change would also need to be accompanied by changes in consumer awareness. © 2005 Elsevier Ireland Ltd. All rights reserved. Keywords: Social determinants; Health services; After hours In countries with universal health systems, the rela- tionship between social disadvantage and use of health services is a complex one. Research examining the effects of socioeconomic status on access to health care suggests that inequities tend to reside in partic- ular parts of the health system and not in others [1–3]. In Australia it is well documented that economically disadvantaged people have worse health and use more * Corresponding author. Tel.: +61 408 328 946. E-mail address: mkelaher@unimelb.edu.au (M. Kelaher). clinical health services generally [4,5] but there has been widespread concern among the Australian pub- lic, Australian and state governments as well as general practitioners (GPs) about the adequacy of after hours (AH) GP services [6,7]. Despite considerable, if incon- clusive, research on access to health services among disadvantaged populations there has been relatively lit- tle research on the influence of disadvantage on AH care (see Leibowitz et al. [8] for a review). Australia has a universal health insurance system. Primary care services may be “bulk-billed” so that 0168-8510/$ – see front matter © 2005 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.healthpol.2005.11.017