Hall, J 1996, 'Consumer utility, social welfare, and genetic testing - A response to ''Genetic testing: An economic and contractarian analysis''', JOURNAL OF HEALTH ECONOMICS, vol. 15, no. 3, pp. 377-380.
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In a recent issue of this journal, Tabarrok provided an economic analysis of genetic testing (Tabarrok, 1994). As genetic research progresses, the identification of individuals at risk of particular diseases, early treatment for those affected and the avoidance of inherited genetic disorders will become more frequent. As Tabarrok states (p. 76) "this ... is accompanied by benefits and costs". His analysis then proceeds to identify the costs and benefits of genetic testing, describe the moral dilemmas and inefficiencies created by testing and propose a solution to the testing problem.The essence of his analysis is this. First, the benefits of genetic testing are improved health, which will be achieved through effective and often earlier therapy, the avoidance of additionaI risks by susceptible individuals and, through pre-pregnancy and antenatal testing, what is in effect selective breeding. Second, the cost of testing will be relatively low. Third, the individual faced with the option of testing has a small probability of a high loss as those with "'bad genes"
Hall, J 1996, 'The challenge of health outcomes.', J Qual Clin Pract, vol. 16, no. 1, pp. 5-15.
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The health outcomes initiative can be seen as another passing phase in health-care management or taken as a serious challenge to the planning, management and evaluation of health services. This paper explores those challenges. Implementation of the health outcomes initiative will require the application of valid, reliable and appropriately sensitive measures, the use of a broad approach to research, development and monitoring in such a way that it is an intrinsic part of service delivery, the adoption of policy and practice that is firmly based on evidence of outcomes, and the development of an approach to research that emphasises generalizability.
Richardson, J, Hall, J & Salkeld, G 1996, 'The measurement of utility in multiphase health states', INTERNATIONAL JOURNAL OF TECHNOLOGY ASSESSMENT IN HEALTH CARE, vol. 12, no. 1, pp. 151-162.
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To examine the validity of the additive quality-adjusted life year model used to evaluate a multiphase health state, data from a pilot study of mammography were used to determine whether the values assigned to a multiphase postmastectomy health state cou
Viney, R, Haas, MR & Seymour, J 1996, 'Seeing through the smoke: Using economic evaluation to allocate health promotion resources to prevent smoking', Health Promotion Journal of Australia, vol. 6, no. 1, pp. 7-15.
Haas, M & Hall, J CHERE 1996, Clinical budgeting for allied health: some options and issues in a hospital setting, CHERE Discussion Paper No 30, Sydney.
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Structural and micro-economic reforms have been recommended for hospitals as part of an overall scheme of health care reform. One of the recommended reforms, clinical budgeting, is a health services adaptation of transfer pricing, which is used routinely in commercial enterprises. It involves the holding of budgets by clinical departments which are then used to 'pay' for services provided by other departments. Clinical budgeting raises new issues about the contracting process, the monitoring of the contract in action and contestability (i.e. potential competition for the supply of goods and/or services). In 1991, at Westmead Hospital, a pilot study was proposed to investigate the impact of changed funding arrangements within a hospital department. This first stage has been reported by Iskander et al (1993). This paper sets out the options which were developed for funding arrangements, including a negotiated service agreement between a service department (Speech Pathology) and a clinical department (Geriatric Medicine). Each option was rated against specific criteria. The (financial) risks and benefits to SP and GM of implementing the options were assessed by examining the impact on GM and SP of a decrease in the budget (e.g. a productivity cut), an increase in throughput (i.e. an increase in activity), an externally influenced increase in costs (e.g. a wage rise) and an externally influenced new demand (e.g. a radical new treatment). A modification of the existing organisational structure was considered the most appropriate and feasible to trial. That is, the SP budget remains with SP, as SP are ultimately responsible for their service delivery. In addition, the contract between GM and SP will be more explicit. A negotiated service agreement between GM and SP will set out a mechanism for describing, agreeing to and regulating the volume and mix of SP services available to GM, taking into account quality and outcomes of care. This option recognises the s...
Viney, R, Jan, S & Haas, M CHERE 1996, Delivery of less urgent ambulatory care in a hospital setting - Report the NSW Department of Health, CHERE Project Report No 2, Sydney.
