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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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.
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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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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Gallego, G, Van Gool, K, Hall, JP & Kelleher, D 1970, 'Introduction of new health care technologies at the institutional level: how is it being done?', Workshop for Early Health Services Researchers, Sydney.
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.
Hall, JP 2006, 'Life death and dollars: Does Medicare need major surgery? CHERE Distinguished Lecture Monograph', CHERE working Paper Series.
Hall, JP, Gafni, A & Birch, S 2006, 'Health economics critiques of welfarism and their compatibility with Sen's capabilities approach. CHERE Working Paper 2006/16', 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 Doorslaer, E, Clarke, P, Savage, E & Hall, J 2006, 'Horizontal inequities in Australia?s mixed public/private health care system, CHERE Working Paper 2006/13,', CHERE Working Paper 2006/13.
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Recent OECD country comparative evidence suggests that Australia?s mixed public-private health system does a good job in ensuring high and fairly equal access to doctor, hospital and dental care services. This paper provides some further analysis of the same data from the Australian National Health Survey for 2001 to see to what extent the general finding of horizontal equity remains when the full potential of the data is realized. We extend the common core cross-country comparative analysis by expanding the set of indicators used in the procedure of standardizing for health care need differences, by providing a separate analysis for the use for general practitioner and specialist care and by differentiating between admissions as public and private patients. Overall, our analysis confirms that in 2001 Medicare largely did seem to be attaining its goal of an equitable distribution of health care access: Australians in need of care did get to see a doctor and to be admitted to a hospital. However, they were not equally likely to see the same doctor and to end up in the same hospital bed. As in other OECD countries, higher income Australians are more likely to consult a specialist, all else equal, while lower income patients were more likely to consult a general practitioner. The unequal distribution of private health insurance contributes to the phenomenon that the better-off and the less well-off do not receive the same mix of services. There is a risk that, as in some other OECD countries, the Medicare objective of equal access for equal need may be further compromised by the future expansion of the private sector in secondary care services. To the extent that such inequalities in use may translate in inequalities in health outcomes, they may be some reason for concern.
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.
