Burgess, L, Street, DJ, Viney, R & Louviere, J 2006, 'Design of Choice Experiments in Health Economics' in Jones, AM (ed), The Elgar Companion to Health Economics, Edward Elgar Publishing, Cheltenham, UK, pp. 415-426.
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Street, DJ 2006, 'Factorial designs' in Handbook of Combinatorial Designs Second Edition, pp. 445-465.
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Obtain a 2× 3 design by deleting the last level of the first factor, for example. This gives treatment combinations {(00), (01), (02), (10), (11), (12)}. One can also obtain a 2 × 3 design by collapsing the last two levels of the first factor. This gives treatment combinations {(00), (01), (02), (10), (11), (12), (10), (11), (12)}. The second approach 21.73 In a search design the parameters in the model are divided into two sets. One is a set of unknown parameters, all of which are to be estimated. The second is a set of parameters that is known to have at most v nonzero entries. The aim of a search design is to identify and estimate these v parameters. Any design can be used as a search design, but some layouts have better properties than others. See [461, 897].
Street, DJ 2006, 'Optimality and efficiency: Comparing block designs' in Handbook of Combinatorial Designs Second Edition, pp. 540-542.
Street, DJ 2006, 'Orthogonal main effect plans' in Handbook of Combinatorial Designs Second Edition, pp. 547-549.
Belkar, R, Fiebig, DG, Haas, M & Viney, R 2006, 'Why worry about awareness in choice problems? Econometric analysis of screening for cervical cancer', HEALTH ECONOMICS, vol. 15, no. 1, pp. 33-47.
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The decision to undertake a screening test is conditional upon awareness of screening. From an econometric perspective there is a potential selection problem, if no distinction is made between aware and unaware non-screeners. This paper explores this pro
Burgess, L & Street, DJ 2006, 'The optimal size of choice sets in choice experiments', Statistics, vol. 40, no. 6, pp. 507-515.
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In this paper, we establish the optimal size of the choice sets in generic choice experiments for asymmetric attributes when estimating main effects only. We give an upper bound for the determinant of the information matrix when estimating main effects and all two-factor interactions for binary attributes. We also derive the information matrix for a choice experiment in which the choice sets are of different sizes and use this to determine the optimal sizes for the choice sets.
Goodall, S, Montgomery, A, Banks, J, Salisbury, C, Sampson, F & Pickin, M 2006, 'Implementation of Advanced Access in general practice: postal survey of practices.', Br J Gen Pract, vol. 56, no. 533, pp. 918-923.
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BACKGROUND: Advanced Access has been strongly promoted as a means of improving access to general practice. Key principles include measuring demand, matching capacity to demand, managing demand in different ways and having contingency plans. Although not advocated by Advanced Access, some practices have also restricted availability of pre-booked appointments. AIM: This study compares the strategies used to improve access by practices which do or do not operate Advanced Access. DESIGN OF STUDY: Postal survey of practices. SETTING: Three hundred and ninety-one practices in 12 primary care trusts. METHOD: Questionnaires were posted to practice managers to collect data on practice characteristics, supply and demand of appointments, strategies employed to manage demand, and use of Advanced Access. RESULTS: Two hundred and forty-five from 391 (63%) practices returned a questionnaire and 162/241(67%) claimed to be using Advanced Access. There were few differences between characteristics of practices operating Advanced Access or not. Both types of practice had introduced a wide range of measures to improve access. The proportion of doctors' appointments only available for booking on the same day was higher in Advanced Access practices (40 versus 16%, difference = 24%, 95% CI = 16% to 32%). Less than half the practices claiming to operate Advanced Access ((63/140; 45%) used all four of this model's key principles. CONCLUSION: The majority of practices in this sample claim to have introduced Advanced Access, but the degree of implementation is very variable. Advanced Access practices use more initiatives to measure and improve access than non-Advanced Access practices.
Hall, J, Fiebig, DG, King, MT, Hossain, I & Louviere, JJ 2006, 'What influences participation in genetic carrier testing? Results from a discrete choice experiment', JOURNAL OF HEALTH ECONOMICS, vol. 25, no. 3, pp. 520-537.
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This study explores factors that influence participation in genetic testing programs and the acceptance of multiple tests. Tay Sachs and cystic fibrosis are both genetically determined recessive disorders with differing severity, treatment availability, and prevalence in different population groups. We used a discrete choice experiment with a general community and an Ashkenazi Jewish sample; data were analysed using multinomial logit with random coefficients. Although Jewish respondents were more likely to be tested, both groups seem to be making very similar tradeoffs across attributes when they make genetic testing choices. © 2005 Elsevier B.V. All rights reserved.
Hall, JP 2006, 'Financing Australian healthcare.', Hospital and Healthcare, vol. -, no. March, pp. 31-31.
Kovoor, P, Lee, AKY, Carrozzi, F, Wiseman, V, Byth, K, Zecchin, R, Dickson, C, King, M, Hall, J, Ross, DL, Uther, JB & Denniss, AR 2006, 'Return to full normal activities including work at two weeks after acute myocardial infarction', AMERICAN JOURNAL OF CARDIOLOGY, vol. 97, no. 7, pp. 952-958.
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Patients are generally advised to return to full normal activities, including work, 6 to 8 weeks after acute myocardial infarction (AMI). We assessed the outcomes of early return to normal activities, including work at 2 weeks, after AMI in patients who were stratified to be at a low risk for future cardiac events. Patients were considered for randomization before discharge if they had no angina, had left ventricular ejection fraction >40%, a negative result from a symptom-limited exercise stress test for ischemia (<2 mm ST depression) at 1 week, and achieved >7 METs. Patients with left ventricular ejection fraction <40% were included only if they did not have inducible ventricular tachycardia at electrophysiologic studies. Seventy-two patients were randomized to return to normal activities at 2 weeks and 70 patients to undergo standard cardiac rehabilitation and return to normal activities at 6 weeks after AMI. There were no deaths or heart failure in either group. There was no significant difference in the incidence of reinfarction, revascularization, left ventricular function, lipids, body mass index, smoking, or exercise test results at 6 months. In conclusion, return to full normal activities, including work at 2 weeks, after AMI appears to be safe in patients who are stratified to a low-risk group. This should have significant medical and socioeconomic implications. © 2006 Elsevier Inc. All rights reserved.
Lin, CC, Moseley, AM, Refshauge, KM, Haas, M & Herbert, RD 2006, 'Effectiveness of joint mobilisation after cast immobilisation for ankle fracture: a protocol for a randomised controlled trial [ACTRN012605000143628]', BMC Musculoskeletal Disorders, vol. 7, no. 1, pp. 1-10.
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Background: Passive joint mobilisation is a technique frequently used by physiotherapists to reduce pain, improve joint movement and facilitate a return to activities after injury, but its use after ankle fracture is currently based on limited evidence.
Moore, K, Cruickshank, M & Haas, M 2006, 'Job satisfaction in occupational therapy: a qualitative investigation in urban Australia', Australian Occupational Therapy Journal, vol. 53, no. 1, pp. 18-26.
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Background: Job satisfaction has been shown to affect levels of staff retention and work productivity, but few studies have been conducted with occupational therapists in an Australian setting. Methods: Using a hermeneutical phenomenological approach, the findings from a study examining the factors that contribute to job satisfaction in occupational therapists working in Australia, are reported. Results: Job satisfaction in occupational therapy was derived from the sense of achievement felt when providing effective clinical care. Job dissatisfaction stemmed from the poor profile and status of the profession. Conclusions: Based on the study findings, there is an imperative that the profession of occupational therapy continue to use research findings to support clinicians in providing effective health care, and improve the community understanding of occupational therapy.
Moore, K, Cruickshank, M & Haas, M 2006, 'The Influence of Managers on Job Satisfaction in Occupational Therapy', British Journal of Occupational Therapy, vol. 69, no. 7, pp. 312-318.
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Promoting job satisfaction in a workplace can make a positive contribution towards the recruitment and retention of staff. The aim of this study, using a hermeneutical phenomenological approach, was to investigate what occupational therapy managers did to have a positive and a negative influence on the job satisfaction of their staff. It was clear that managers played a key role in influencing job satisfaction through their actions and behaviours. In particular, managers who demonstrated care and support towards their staff, while at the same time demonstrating that they were strong advocates and able to make decisions for the good of the department rather than for the benefit of the individual, influenced job satisfaction positively. Job dissatisfaction was strongest when managers were seen to treat staff differently, which was construed as a demonstration of bias stemming from favouritism. The results from this study suggest that staff access to benefits, such as flexible working conditions and educational funding, should be transparent and guided by clear policies.
Schrover, RJ, Adena, MA, De Abreu Lourenco, R, Prince, HM, Seymour, JF & Wonder, MJ 2006, 'Development of a predictive population survival model according to the cytogenetic response rate for patients with chronic myeloid leukemia in the chronic phase', LEUKEMIA & LYMPHOMA, vol. 47, no. 6, pp. 1069-1081.
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Simmons, C, Wright, M & Jones, V 2006, 'Full costing of business programs: benefits and caveats', International Journal of Educational Management, vol. 20, no. 1, pp. 29-42.
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PurposeTo suggest an approach to program costing that includes the approaches and concepts developed in activity based costing.Design/methodology/approachThe paper utilizes a hypothetical case study of an Executive MBA program as a means of illustrating the suggested approach to costing.FindingsThe paper illustrates both the benefits of using an activity based costing approach and the danger of allocating organizational sustaining costs to a specific program for the purpose of assessing the profitability of that program.Practical implicationsUniversity and faculty administrators will understand the benefits of activity based costing and they will understand that they should not evaluate the profitability of a program (nor make decisions about the termination of a program) on the basis of allocated organizational sustaining costs.Originality/valueThe value of the paper is to university and faculty administrators, who will be able to utilize a new approach to costing university programs.
Swinkels, A, Briddon, J & Hall, J 2006, 'Two physiotherapists, one librarian and a systematic literature review: collaboration in action', Health Information & Libraries Journal, vol. 23, no. 4, pp. 248-256.
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Abstract Aim: This paper explores the processes of collaboration between a librarian and two academic physiotherapists working on a systematic review jointly funded by the University of the West of England (UWE), Bristol, and the Royal National Hospital for Rheumatic Diseases (RNHRD), Bath, UK. The aim of this paper is to describe and evaluate some of the processes of collaboration between the three authors in their work in progress on a funded systematic literature review on the topic of hydrotherapy and pain. Methods: The vehicle for describing and analysing these processes is a joint (National Health Service Trust and University) funded systematic literature review currently in progress on the topic of hydrotherapy and pain. Results: Systematic review methodology is becoming increasingly complex and is rapidly developing its own research base. Librarian input is a key element in a successful systematic review. Conclusions: Systematic reviews play a critical role in informing healthcare delivery and research in the UK. The individual nature and inherent complexity of each review demands close collaboration between librarians, academics and clinicians. In addition to enhancing the reviews themselves, there are many other personal and institutional benefits of collaborative working. Consideration may need to be given to library staff structures and roles if these benefits are to be maximized and sustained.
Valentine, S & Page, K 2006, 'Nine to Five: Skepticism of Women’s Employment and Ethical Reasoning', Journal of Business Ethics, vol. 63, no. 1, pp. 53-61.
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Warren, E, Viney, R, Shearer, J, Shanahan, M, Wodak, A & Dolan, K 2006, 'Value for money in drug treatment: economic evaluation of prison methadone', Drug and Alcohol Dependence, vol. 84, no. 2, pp. 160-166.
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Background: Although methadone maintenance treatment in community settings is known to reduce heroin use, HIV infection and mortality among injecting drug users (IDU), little is known about prison methadone programs. One reason for this is the complexity
Wise, S 2006, 'Book Review: Work-Life Balance in the 21st Century', Work, Employment and Society, vol. 20, no. 3, pp. 610-611.
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Woods, M 2006, 'ICRM—The future: A personal view', Applied Radiation and Isotopes, vol. 64, no. 10-11, pp. 1098-1101.
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Louviere, JJ, Burke, PF, Street, D, Burgess, LB & Marley, AA 1970, 'Dicrete choice surveys: Improving completion rates and getting better data', Asia-Pacific Quantitative Methods in Marketing Conference, Sydney, Australia.
Ridley-Ellis, D & Wise, S 1970, 'Women in education and training for the Scottish wood chain', 9th World Conference on Timber Engineering 2006 Wcte 2006, pp. 2576-2579.
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The paper introduces a new project at Napier University in Edinburgh into the issues surrounding entry, progression and retention of female students for courses relating to the growing, processing and utilisation of timber for use in the built environment. Major issues surrounding the recruitment and retention of women in employment and education in the Scottish forest and timber industries are highlighted. The paper concludes by outlining some recommendations on how best to proactively tackle gender segregation in careers choice initiatives and course promotion to maximise the pool of potential future students.
van Gool, K, Gallego, G, Haas, M, Viney, R, Hall, J & Ward, R 1970, 'Incorporating economic evidence into cancer care: searching for the missing link', Australian Conference of Health Economists, Perth.
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Since the early 1980s it has been identified that even though economic evaluation is considered useful by economist it is not widely used by health care decision-makers. One of the ways to close the gap is to involve decision-makers in the process. This project was set up to gain a better understanding of the information needs for resource allocation in the field of cancer care. The results of this project are intended to aid the development and use of the NSW Cancer Institute?s Standard Cancer Treatments (CI-SCAT) website in future years. This initiative is part of the NSW 2004-2006 Cancer to ensure that clinical practice is evidence-based and research driven. The CI-SCAT Reference Group develops and approves clinical protocols to provide clinicians with chemotherapy cancer protocols, including the evidence, cost, and drug dose calculation. Members of CI-SCAT Reference Groups were surveyed in their capacity as clinicians and decision-makers in the Australian Health Care System. The survey asked about participants? knowledge, use and views of economic evaluation in decision making. It also sought information about their knowledge and views on how resource allocation decisions were made within your local area/hospital and whether participants would value greater access to various types of economic information. This paper will explore what decision-makers at a state/local level value in terms of economic evidence.
Fiebig, D, Savage, E & Viney, R 2006, 'Does the reason for buying health insurance influence behaviour? CHERE Working Paper 2006/1', CHERE Working Paper 2006/1.
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The inter-relationship between private health insurance cover and hospital utilisation is complex. The current policy approach in Australia appears to rely on relatively simple models of the relationships between health insurance coverage, and public and private hospital use. There is considerable evidence of unexplained heterogeneity among the privately insured population. Heterogeneity of preferences is likely to be important not just in determining the uptake of private health insurance, but also the impact of changes in private health insurance on the use of private treatment. A number of studies have used attitudinal variables to model heterogeneity of preferences in other contexts. This study uses the 2001 ABS National Health Survey to identify ?types? among the insured population using their stated reasons for purchasing private health insurance. We find that insurance type is significantly associated with hospital utilisation, particularly the probability of being admitted as a public or private patient. We also find that the government?s insurance incentives were more attractive to particular types of the insured population. This has implications for the effectiveness of the insurance incentives and for the design of policies that aim to reduce pressure on the public hospital system.
Haas, M 2006, 'Decision making by patients: An application of naturalistic decision making theory to cervical screening and chronic renal failure, Working Paper 2006/5', CHERE Working Paper 2006/5.
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Over their lifetime, individuals typically make many decisions about health and health care. Theoretical approaches to decision making have been dominated by a rational, analytic approach which assumes that problems are relatively fixed and well-defined and which have foreseeable and measurable endpoints. Naturalistic decision making (NDM) approaches attempt to mimic ?real world? situations where problems vary, may be defined differently by individuals with diverse perspectives and where endpoints are uncertain and complicated. In-depth interviews were conducted with 40 individuals living in the community: twenty participants had chronic renal failure and twenty were women in the target age range for cervical cancer screening. Decision making processes used by these two groups of health care consumers correspond well with the concepts of NDM. In particular, Image Theory provides a framework within which the process of decision making by health care consumers can be described, including the issues which influence what decisions are made. The findings also demonstrate the usefulness of studying decision making in ?real world? situations and in using less analytic techniques than traditional normative approaches in evaluating health care decision making. The results suggest that NDM is deserving of a wider audience in health care. Health care providers who use NDM models to understand their patients? decision making processes may improve their capacity to involve patients in decision making.
Haas, M 2006, 'Economic analysis of Tai Chi as a means of preventing falls and falls related injuries among older adults, CHERE Working Paper 2006/4', CHERE Working Paper 2006/4.
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This study has examined the costs and consequences of a randomised controlled trial of a community based Tai Chi program for people over 60 years of age. The hypothesis for the trial was that compared to non-participants, participants in the Tai Chi program would have fewer falls and may experience additional health and other benefits. In terms of resource use it was anticipated that the Tai Chi program would use additional resources in terms of running costs but was expected to save resources as a result of falls prevented. Data for this economic evaluation were collected prospectively alongside the randomised controlled trial. The aim of this evaluation was to investigate the cost-effectiveness of Tai Chi as means of preventing falls in elderly people living in the community. Costs included were those of the Tai Chi trial and health service utilisation (including GP and specialist and other consultations, tests, hospitalisations and medications). Effectiveness was measured as the number of participants in the intervention and control groups, all participants and the number of falls avoided. SPSS was used to analyse the data; Fisher?s exact and the student?s t-test were used to test differences between the intervention and control groups. From the perspective of NSW Health, the cost of providing Tai Chi as part of this trial ($81232) outweighed any costs of health service provision ($24795). Only a small proportion used health services and this mostly involved the use of over-the-counter pain relieving medication and GP consultations. Only 3 people were admitted to hospital. There were no significant differences between the study and control groups in terms of utilisation and costs except in terms of overall costs where the control group costs were significantly more than the study group (p=0.43). However, this difference was driven by the cost of one admission to hospital. In the trial 3/216 falls resulted in hospitalisation. This means that for every...
Haas, M & Fowler, S 2006, 'A synthesis of qualitative research on cervical cancer screening behaviour: Women?s perceptions of the barriers and motivators to screen and the implications for policy and practice, CHERE Working Paper 2006/7', CHERE Working Paper 2006/7.
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Cervical cancer is one of the most preventable and treatable cancers. It has been estimated that up to 90% of the most common type of cervical cancer may be prevented if cell changes are detected and treated early. Early detection is undertaken using a Pap test. In most Western countries, including Australia, and in many less developed countries, screening for cervical cancer is provided to women in the form of an organised program. These programs typically provide Pap tests free or at low cost, at the point of delivery. However, as most cancers occur in women who have never or rarely screened, increasing the rate of screening remains an important issue. Numerous studies have identified the variables associated with women rarely or never screening. Older, poorer women, women living in rural communities and those from non-European ethnic backgrounds (in Australia, especially those who do not speak English) are much less likely to screen than their younger, richer, urban-dwelling, English-speaking sisters. This type of information can be used to target women less likely to screen but does not address what women perceive to be the major barriers to their having a Pap test or what messages might be most effective in convincing them to have the test. A number of qualitative studies have examined these issues. In this project, the results of such studies have been synthesised in an attempt to answer two questions: 1. Why don?t some women have Pap tests? 2. What would work to encourage women who currently do not screen to change their behaviour? This synthesis adopted the meta-ethnographic approach as described in Campbell et al (2003). The results from 16 papers were appraised in terms of the quality of the research undertaken as well as results and conclusions. The results indicate that the majority of women have heard of or know about the Pap test. However, many were misinformed about the details of the test and its implications. Women may not think a Pap t...
Hall, JP 2006, 'Life death and dollars: Does Medicare need major surgery? CHERE Distinguished Lecture Monograph', CHERE working Paper Series.
Jones, G, Savage, E & van Gool, K 2006, 'Out-of-pocket health expenditures in Australia: A semi-parametric analysis, CHERE Working Paper 2006/15', CHERE Working Paper 2006/15.
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Out-of-pocket health expenditures in Australia are high in international comparisons and have been growing at a faster rate than most other health costs in recent years. This raises concerns about the extent to which out-of-pocket costs have constrained access to health services for low income households. Using data from the ABS Household Expenditure Survey 2003-04, we model the relationships between health expenditure shares and equivalised total expenditure for categories of out-of-pocket health expenditures and analyse the extent of protection given by concession cards. To allow for flexibility in the relationship we adopt a semi-parametric estimation technique following Yatchew (1997). We find mixed evidence for the protection health concession cards give against high out-of-pocket health expenditures. Despite higher levels of subsidy, households with concession cards have higher total health expenditure shares than other households. Surprisingly, the major drivers of the difference are not categories of expenditure where cards offer little or no protection, such as dental services and non-prescription medicines, but prescriptions costs, where concession cards guarantee a subsidy, and specialist consultations, where bulk billing rates would be expected to be higher for cardholders. This is the first detailed distributional analysis of household health expenditures in Australia.
King, M, Viney, R, Hossain, I, Smith, D, Fowler, S, Savage, E & Armstrong, B 2006, 'Men?s preferences for treatment of early stage prostate cancer: Results from a discrete choice experiment, CHERE Working Paper 2006/14', CHERE Working Paper 2006/14.
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Prostate cancer is the most common cancer in men in Australia; each year over 10,000 Australians are diagnosed with this disease. There are a number of treatment options for early stage prostate cancer (ESPC); radical prostatectomy, external beam radiotherapy, brachytherapy, hormonal therapy and combined therapy. Treatment can cause serious side-effects, including severe sexual and urinary dysfunction, bowel symptoms and fatigue. Furthermore, there is no evidence as yet to demonstrate that any of these treatments confers a survival gain over active surveillance (watchful waiting). While patient preferences should be important determinants in the type of treatment offered, little is known about patients? views of the relative tolerability of side effects and of the survival gains needed to justify these. To investigate this, a discrete choice experiment (DCE) was conducted in a sample of 357 men who had been treated for ESPC and 65 age-matched controls. The sample was stratified by treatment, with approximately equal numbers in each treatment group. The DCE included nine attributes: seven side-effects and two survival attributes (duration and uncertainty). An orthogonal fractional set of 108 scenarios from the full factorial was used to generate three versions of the questionnaire, with 18 scenarios per respondent. Multinomial logit (MNL) and mixed logit (MXL) models were estimated. A random intercept MXL model provided a significantly better fit to the data than the simple MNL model, and adding random coefficients for all attributes dramatically improved model fit. Each side-effect had a statistically significant mean effect on choice, as did survival duration. Most attributes had significant variance parameters, suggesting considerable heterogeneity among respondents in their preferences. To model this heterogeneity, we included men?s health-related quality of life scores following treatment as covariates to see whether their preferences were influence...
Radhakrishnan, M, van Gool, K, Hall, J, Delatycki, M & Massie, J 2006, 'Economic evaluation of cystic fibrosis screening: A Review of the literature, CHERE Working Paper 2006/6', CHERE Working Paper 2006/6.
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Objectives: To critically examine the economic evidence on Cystic Fibrosis (CF) screening and to understand issues relating to the transferability of findings to the Australian context for policy decisions. Methods: A systematic literature search identified 25 economic studies with empirical results on CF published between 1990 and 2005. These articles were then assessed against international benchmarks on conducting and reporting of economic evaluations, focusing on the transferability of the evidence to the local setting. Results: Six studies described only costs, 12 were cost-effectiveness studies, 6 were cost-benefit studies and one had a combined design (cost utility, cost benefit and cost effectiveness). Most of the cost-effectiveness studies compared screening versus ?no-screening? but the screening programs under consideration differed markedly. Four considered neonatal screening, three prenatal screening, three pre-conception and carrier screening, and one considered all types of screening programs. The outcome measures also varied considerably between studies. One study included a quality adjusted life year measure. Cost?benefit measures mostly included economic savings ? evaded lifetime medical costs of avoiding CF child birth. Conclusion: The variability in study design, model inputs and reporting of economic evaluations of CF carrier screening raises issues on the applicability and transferability of such evidence to the Australian context.
van Gool, K, Savage, E, Viney, R, Haas, M & Anderson, R 2006, 'Catastrophic insurance: Impact of the Australian Medicare Safety Net on fees, service use and out-of-pocket costs, CHERE Working Paper 2006/9', CHERE Working Paper 2006/9.
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Objectives: The Medicare Safety Net Policy was introduced in March 2004 to provide financial relief for those Australians who face high out-of-pocket (OOP) costs for outpatient medical services. This study evaluates the extent to which out-of-pocket costs have fallen since the introduction of the Safety Net and examines the impact of the policy on the level of service use, the amount of benefits paid by government and fees charged by medical providers. Methods: Regression modelling of time series data was used to examine whether there have been significant changes in levels of service use, fees charged and benefits paid for services provided by specialists in the two-year period following the introduction of the Safety Net. Four speciality fields were examined in this analysis: general specialists? consultations, obstetrics, pathology and diagnostic imaging. Results: The analysis indicates that the introduction of the Safety Net coincided with a substantial rise in public funding for Medicare services and a much smaller reduction in OOP costs. The policy has coincided with a small but significant change in the number of pathology and diagnostic imaging services used and in some specialty areas a substantial increase in the fees charged by providers. The net impact shows that for specialists? consultations every dollar spent on the Medicare Safety Net, $0.68 went towards higher fees and $0.32 went towards reducing OOP costs. The corresponding figures for diagnostic imaging were $0.74 and $0.26 respectively. Conclusions: The Safety Net was heralded by the government as a fundamental reform in Australia?s Medicare program. Whilst the Safety Net was introduced to help reduce out-of-pocket medical costs, this analysis shows that in its first two years of operation, there has been significant leakage of public funding towards higher provider fees. More research is needed using longer term data to assess the impact of the policy on patient and provider behavio...
van Gool, K, Savage, E, Viney, R, Haas, M & Anderson, R 2006, 'Who?s getting caught? An analysis of the Australian Medicare Safety Net, CHERE Working Paper 2006/8', CHERE Working Paper 2006/8.
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The Medicare Safety Net Policy was introduced in March 2004 to provide financial relief for those Australians who face high out-of-pocket costs incurred through out-of-hospital medical services. This study examines variation in Safety Net benefits by federal electorate and by type of medical service. The results indicate widespread variation in Safety Net benefits. There were significantly higher Safety Net benefits in electorates with relatively high median family income and lower health care needs. The study also shows that patients who use private obstetrician and assisted reproductive services are the greatest beneficiaries of the policy. Whilst the Safety Net was introduced to help reduce out-of-pocket medical costs, this analysis shows that it may be missing the intended policy target.
Viney, R & Savage, E 2006, 'Health care policy evaluation: empirical analysis of the restrictions implied by Quality Adjusted Life Years, CHERE Working Paper 2006/10', CHERE Working Paper 2006/10.
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This paper investigates the nature of the utility function for health care, defined over the probability of survival, survival duration, health state and cost of treatment. A discrete choice experiment, involving treatment choice for a hypothetical health condition is used to test restrictions on preferences in the QALY model. We find that preferences do not conform to expected utility, and there are significant interactions between health state and survival duration. Individual characteristics are significant, implying substantial differences in valuations of health states across the population. The results suggest the QALY approach distorts valuations of health outcomes.
