Street, D, Burgess, LB, Viney, RC & Louviere, JJ 2008, 'Designing Discrete Choice Experiments for Health Care' in Ryan, M, Gerard, K & Amaya-Amaya, M (eds), Using Discrete Choice Experiments to Value Health and Health Care, Springer, Dordrecht, The Netherlands, pp. 47-72.
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As noted in Chapter 1, the application of discrete choice experiments (DCEs) in health economics has seen an increase over the last few years.While the number of studies using DCEs is growing, there has been relatively limited consideration of experimental design theory and methods. Details of the development of the designed experiment are rarely discussed. Many studies have used small fractional factorial designs (FFDs), generated with commercial design software packages, e.g. orthogonal main effects plans (OMEPs), sometimes manipulated in ad hoc ways (e.g. randomly pairing up scenarios or taking one scenario from the design and combining it with every other scenario). Such approaches can result in designs with unknown statistical design properties, in particular with unknown correlations between parameter estimates.
Anderson, R, Haas, MR & Shanahan, M 2008, 'The cost-effectiveness of cervical screening in Australia: What is the impact of screening at different intervals or over a different age-range?', Australian and New Zealand Journal of Public Health, vol. 32, no. 1, pp. 43-52.
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To estimate the cost-effectiveness of altering the currently recommended interval and age range for cervical screening of Australian women. METHODS: The cost and effectiveness estimates of alternative screening strategies were generated using an established decision model. This model incorporated a Markov model (of the natural history of cervical cancer and pre-cancerous lesions) and decision trees which: 'mapped' the various pathways to cervical cancer screening; the follow-up of abnormal Pap test results; and the management of confirmed lesions. The model simulated a hypothetical large cohort of Australian women from age 15 to age 85 and calculated the accumulated costs and life-years under each screening strategy. RESULTS: Our model estimated that moving from the current two-yearly screening strategy to annual screening (over the same age range) would cost $379,300 per additional life-year saved. Moving from the current strategy to three-yearly screening would yield $117,100 of savings per life-year lost (costs and effects both discounted at 5% per year), with a relatively modest (<5%) reduction in the total number of life-years saved by the program. CONCLUSIONS: Although moving to annual screening would save some additional lives, it is not a cost-effective strategy. Consideration should be given to increasing the recommended interval for cervical screening. However, the net value of any such shift to less effective (e.g. less frequent) and less costly screening strategies will require better evidence about the cost-effectiveness of strategies that encourage non-screeners or irregular screeners to have a Pap test more regularly.
Bewick, BM, Gill, J, Mulhern, B, Barkham, M & Hill, AJ 2008, 'Using electronic surveying to assess psychological distress within the UK university student population: a multi-site pilot investigation', E-Journal of Applied Psychology, vol. 4, no. 2, pp. 1-5.
Bewick, BM, Mulhern, B, Barkham, M, Trusler, K, Hill, AJ & Stiles, WB 2008, 'Changes in undergraduate student alcohol consumption as they progress through university', BMC PUBLIC HEALTH, vol. 8.
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Bewick, BM, Trusler, K, Barkham, M, Hill, AJ, Cahill, J & Mulhern, B 2008, 'The effectiveness of web-based interventions designed to decrease alcohol consumption - A systematic review', PREVENTIVE MEDICINE, vol. 47, no. 1, pp. 17-26.
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Bewick, BM, Trusler, K, Mulhern, B, Barkham, M & Hill, AJ 2008, 'The feasibility and effectiveness of a web-based personalised feedback and social norms alcohol intervention in UK university students: A randomised control trial', ADDICTIVE BEHAVIORS, vol. 33, no. 9, pp. 1192-1198.
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Doiron, D, Hall, JP & Jones, G 2008, 'Is there a crisis in nursing retention in New South Wales?', Australia and New Zealand Health Policy, vol. 5, no. 19, pp. 1-12.
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Background There is a severe shortage of nurses in Australia. Policy makers and researchers are especially concerned that retention levels of nurses in the health workforce have worsened over the last decade. There are also concerns that rapidly growing private sector hospitals are attracting qualified nurses away from the public sector. To date no systematic analysis of trends in nursing retention rates over time has been conducted due to the lack of consistent panel data. Results A 1.4 percentage point improvement in retention has led to a 10% increase in the overall supply of nurses in NSW. There has also been a substantial aging of the workforce, due to greater retention and an increase in mature age entrants. The improvement in retention is found in all types of premises and is largest in nursing homes. There is a substantial amount of year to year movement in and out of the workforce and across premises. The shortage of nurses in public hospitals is due to a slowdown in entry rather than competition from the rapidly growing private sector hospitals.
Gallego, G, Fowler, S & Van Gool, K 2008, 'Decision makers' perceptions of health technology decision making and priority setting at the institutional level', Australian Health Review, vol. 32, no. 3, pp. 520-527.
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This study describes health care decision makers' perceptions about decision making processes for the introduction, diffusion and prioritisation of new health technologies at the regional and institutional level. The aim of the study was to aid the design of a new process of technology assessment and decision making for the Northern Sydney and Central Coast Area Health Service (NSCCAHS). Twelve in-depth, semi-structured interviews were conducted with senior health service managers, nurse managers and senior medical clinicians in the NSCCAHS. Interviewees described prioritisation and decision-making processes as "ad hoc". Safety and effectiveness were considered the most important criteria in decision making but budgetary consideration often drove decisions about the uptake and diffusion of new technologies. Current dissatisfaction with decision- making processes creates opportunities for reform, including the introduction of consistent local technology assessments.
Gerard, K, Salisbury, C, Street, D, Pope, C & Baxter, H 2008, 'Is fast access to general practice all that should matter? A discrete choice experiment of patients' preferences', Journal of Health Services Research and Policy, vol. 13, no. 2, pp. 3-10.
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Objectives: To determine the relative importance of factors that influence patient choice in the booking of general practice appointments for two health problems. Methods: Two discrete choice experiments incorporated into a survey of general practice patients and qualitative methods to support survey development. Results: An overall response of 94% (1052/1123) was achieved. Factors influencing the average respondent's choice of appointment, in order of importance, were: seeing a doctor of choice; booking at a convenient time of day; seeing any available doctor; and having an appointment sooner rather than later (acute, low worry condition). This finding was the same for an ongoing, high worry condition but in addition the duration of the appointment was also of (small) value. Patients traded off speed of access for more convenient appointment times (a willingness to wait an extra 2.5-3 days longer to get a convenient time slot for an acute low worry/ongoing, high worry condition, respectively). However, contrary to expectation, patients were willing to trade off speed of access for continuity of care (e.g. willingness to wait five days longer to see the doctor of their choice for an acute, low worry condition). Preferences varied by a person's gender, work and carer status. Conclusions: Patients hold strong preferences for the way general practice appointment systems are managed. Contrary to current policy on improving access to primary care patients value a more complex mix of factors than fast access at all costs. It is important that policy-makers and practices take note of these preferences.
Ghaly, S, Lourenco, RDA & Abbott, JA 2008, 'Audit of endometrial biopsy at outpatient hysteroscopy', AUSTRALIAN & NEW ZEALAND JOURNAL OF OBSTETRICS & GYNAECOLOGY, vol. 48, no. 2, pp. 202-206.
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Haas, MR 2008, 'No difference in cost-effectiveness of intensive group training for chronic back pain compared with usual physiotherapy care [Commentary]', Australian Journal of Physiotherapy, vol. 54, pp. 144-144.
Hall, J.P. 2008, 'Don't panic on private insurance', Medical observer, vol. May 23, pp. 22-22.
Hall, JP & Viney, RC 2008, 'National health reform needs strategic investment in health services research', Medical Journal of Australia, vol. 188, no. 1, pp. 33-35.
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With new funding for the National Health and Medical Research Council (NHMRC) to provide an evidence base for policy and practice reform, it is timely to revisit Australia's recent experiences with health services research and policy development. We provide a broad review of the contribution of Australian health services research to the development of health policy over the past 20 years. We conclude that three preconditions are necessary to influence policy: political will; sustained funding to encourage methodological rigour and build decision makers' confidence; and the development of sufficient capacity and skills.
Jones, G, Savage, EJ & Van Gool, K 2008, 'The distribution of household health expenditures in Australia', The Economic Record, vol. 84, no. Special, pp. 99-114.
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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 2003-2004, 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 Yatchew's semi-parametric estimation technique. This is the first detailed distributional analysis of household health expenditures in Australia. 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 do not have lower out-of-pocket expenditures than non-cardholder households except for the highest expenditure quintile. Cards provide most protection for GP out-of-pocket expenditures
Kenny, PM, King, MT, Viney, RC, Boyer, M, Pollicino, C, McLean, J, Fulham, MJ & McCaughan, BC 2008, 'Quality of life and survival in the 2 years after surgery for non-small-cell lung cancer', Journal of Clinical Oncology, vol. 26, no. 2, pp. 233-241.
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Purpose Although surgery for early-stage non-small-cell lung cancer ( NSCLC) is known to have a substantial impact on health-related quality of life (HRQOL), there are few published studies about HRQOL in the longer term. This article examines HRQOL and survival in the 2 years after surgery. Patients and Methods Patients with clinical stage I or II NSCLC (n = 173) completed HRQOL questionnaires before surgery, at discharge, 1 month after surgery, and then every 4 months for 2 years. HRQOL was measured with a generic cancer questionnaire (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire [ EORTC-QLQ] C30) and a lung cancer-specific questionnaire (EORTC QLQ-LC13). Data were analyzed to examine the impact of surgery and any subsequent therapy, and to describe the trajectories of those who remained disease free at 2 years and those with recurrent cancer diagnosed during follow-up. Results Disease recurred within 2 years for 36% of patients and 2-year survival was 65%. Surgery substantially reduced HRQOL across all dimensions except emotional functioning. HRQOL improved in the 2 years after surgery for patients without disease recurrence, although approximately half continued to experience symptoms and functional limitations. For those with recurrence within 2 years, there was some early postoperative recovery in HRQOL, with subsequent deterioration across most dimensions.
Lin, C, Haas, MR, Moseley, A, Herbert, R & Refshauge, K 2008, 'Cost and utilisation of healthcare resources during rehabilitation after ankle fracture are not linked to health insurance, income, gender, or pain: An observational study', Australian Journal of Physiotherapy, vol. 54, no. 3, pp. 201-208.
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Lin, C, Moseley, A, Haas, MR, Refshauge, K & Herbert, R 2008, 'Manual therapy in addition to physiotherapy does not improve clinical or economic outcomes after ankle fracture', Journal of Rehabilitation Medicine, vol. 40, no. 6, pp. 433-439.
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physiotherapy, ankle fracture, economic issues
Louviere, JJ, Islam, T, Wasi, N, Street, D & Burgess, LB 2008, 'Designing Discrete Choice Experiments: Do Optimal Designs Come At A Price?', Journal of Consumer Research, vol. 35, no. 2, pp. 360-375.
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In discrete choice experiments, design decisions are crucial for determining data quality and costs. While high statistical efficiency designs are desirable, they may come at a price if they increase the cognitive burden for respondents. We address this problem by designing 44 experiments that systematically vary numbers of attributes and attribute level differences. Our results for two product categories suggest that respondents systematically are less consistent in answering choice questions as statistical efficiency increases. This relationship holds regardless of the number of attributes and is statistically significant even if one accommodates preference heterogeneity. Implications for practice and future research are discussed.
Louviere, JJ, Street, D, Burgess, LB, Wasi, N, Islam, T & Marley, AA 2008, 'Modeling the choices of individual decision-makers by combining efficient choice experiment designs with extra preference information', Journal of Choice Modelling, vol. 1, no. 1, pp. 128-163.
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Radhakrishnan, YM, Van Gool, K, Hall, JP, Delatycki, M & Massie, RJ 2008, 'Economic evaluation of cystic fibrosis screening: A review of the literature', Health Policy, vol. 85, no. 2, pp. 133-147.
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Objectives To critically examine the economic evidence regarding cystic fibrosis (CF) carrier screening and to understand issues relating to the transferability of international findings to any national context for policy decisions. Methods A systematic literature search identified 14 studies (out of 29 economic studies on CF) focusing on preconception or prenatal screening between 1990 and 2006. These studies were then assessed against international benchmarks on conducting and reporting of economic evaluations, costing methodology used and focusing on the transferability of the evidence to national contexts. Results The primary outcome measures varied considerably between studies and there was considerable ambiguity and variation on how costs were estimated. The Incremental Cost Effectiveness Ratio (ICER) and net savings, for preconception and prenatal screening were inconsistent and varied significantly, even after adjusting for timing and exchange rates. Differences in screening participation rates, reproductive choices, test sensitivity, cost of test and lifetime cost of care make up a large part of the ICER variations.
Sampson, F, Pickin, M, O'Cathain, A, Goodall, S & Salisbury, C 2008, 'The impact of same day appointments on patient satisfaction with appointment systems', British Journal of General Practice, vol. 58, no. 554, pp. 641-643.
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Following recent concerns about patients' inability to book appointments in advance, this study examined the relationship between the proportion of GP appointments reserved for same-day booking, and patient satisfaction with appointment systems. In a survey of 12 825 patients in 47 practices, it was found that a 10% increase in the proportion of same-day appointments was associated with an 8% reduction in the proportion of patients satisfied. Practices should be wary of increasing the level of same-day appointments to meet access targets.
Scuffham, P, Whitty, J, Mitchell, A & Viney, RC 2008, 'The use of QALY weights for health state valuation and QALY calculations: A review of industry submissions requesting listing on the Australian Pharmaceutical Benefits Scheme 2002 to 2004', Pharmacoeconomics, vol. 26, no. 4, pp. 297-310.
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Street, D & Burgess, LB 2008, 'Some open combinatorial problems in the design of stated choice experiments', Discrete Mathematics, vol. 308, no. 13, pp. 2781-2788.
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Stated choice experiments are widely used in many areas and the optimal allocation of options to choice sets can make a substantial difference to the cost of running such an experiment. In this paper we describe some open problems in the design of optima
Van Doorslaer, E, Clarke, P, Savage, EJ & Hall, JP 2008, 'Horizontal inequities in Australia's mixed public/private health care system', Health Policy, vol. 86, no. 1, pp. 97-108.
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Recent comparative evidence from OECD countries suggests that Australia's mixed publicprivate 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 examine whether 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 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 are more likely to consult a general practitioner. The unequal distribution of private health insurance coverage by income 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 principle 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, there may be some reason for concern.
Chenoweth, L, Haas, MR, Jeon, Y, Stein-Parbury, MJ, Anstey, K, Brodaty, H, King, MT, Luscombe, G & Norman, R 2008, 'Can we improve well-being and quality of care for people with dementia by providing person-centred care?', 13th National Health Outcomes Conference, 13th National Health Outcomes Conference, University of Wollongong, Canberra, Australia, pp. 1-11.
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To test the effectiveness and cost-effectiveness of two models of nursing care, person-centred care (PCC) and Dementia Care Mapping (DCM), relative to Usual Care (UC), in improving well-being and quality of care and reducing agitation and other behaviourial disturbances, for people with Demetia in residential care facilities.
Cronin, PA, Vu, M, Haas, MR & Savage, EJ 2008, 'Economic Analysis of NSW Health Survey: Misperceptions of Self-Assessed Body Mass', Population Health Conference, Brisbane.
Cronin, PA, Vu, M, Haas, MR & Savage, EJ 2008, 'Economic Analysis of NSW Health Survey: Misperceptions of Self-Assessed Body Mass', Australian Conference of Health Economists, Adelaide.
Fiebig, DG, Haas, MR, Hossain, I & Viney, RC 2008, 'Decisions about Pap tests: what influences women and providers?', 13th National Health Outcomes Conference, Canberra.
Gallego, G, Goodall, S & Norman, R 2008, 'The implementation of economic evaluation for blood and blood products in Australia: the challenges ahead', Australian Conference of Health Economists, Adelaide.
Goodall, S, Norman, R & Gallego, G 2008, 'The Cost-effectiveness of Iodine Fortification in Australia', Australian Academy of Science symposium: Iodine Deficiency in Australia: A Call for Action, Canberra.
Goodall, S, Norman, R & Gallego, G 2008, 'The Cost-effectiveness of Mandatory Iodine Fortification in Australia', Public Health Nutrition in Australia: Principles to Practice, reality to Rhetoric, Adelaide.
Goodall, S, Vu, M & Hall, JP 2008, 'Analysis of the economic evaluations conducted by the Medical Services Advisory Committee (MSAC)', Australian Conference of Health Economists, Adelaide.
Haas, MR 2008, 'Gardasil in Australia', Meeting of the International Network Health Policy and Reform, Ljubljana, Slovenia.
Haas, MR 2008, 'Health Services Research and the Health Services Research Association of Australia and New Zealand', Emerging Researchers Conference, University of Sydney.
Haas, MR 2008, 'Planning for prevention in obesity: what do we know?', Health Policy and Research Exchange, Sydney.
Haas, MR 2008, 'Weigh too much', UTS Speaks, University of Technology, Sydney.
Haas, MR & Viney, RC 2008, 'Economic evaluation: connecting costs and outcomes', Australian Health Outcomes Conference, Canberra.
Haas, MR, Norman, R, Walkley, J & Brennan, L 2008, 'Evaluating the cost-effectiveness of Cognitive Behavioural Therapy for Overweight/Obese Adolescents', Health Outcomes Conference, Canberra.
Hall, J.P. & Kenny, P. 2008, 'The training and job decisions of nurses', Faculty of Nursing Midwifery and Health Research Showcase, University of Technology Sydney.
Haywood, P, Van Gool, K, Haas, MR & Ward, R 2008, 'A pragmatic approach to economic evaluation in an age of evidence based clinical guideline production', Australian Conference of Health Economists, Adelaide.
Hossain, I., Hall, J.P., Fiebig, D.G. & King, M.T. 2008, 'How do preferences elicited through DCEs vary over time and with changing experience? The case of preferences for asthma medications', Australian Conference of Health Economists, Adelaide.
Jones, G, Savage, E & Van Gool, K 2008, 'The distribution of household health expenditures in Australia', Economic Record.
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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 2003-2004, 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 Yatchew's semi-parametric estimation technique. This is the first detailed distributional analysis of household health expenditures in Australia. 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 do not have lower out-of-pocket expenditures than non-cardholder households except for the highest expenditure quintile. Cards provide most protection for GP out-of-pocket expenditures. © 2008 Economic Society of Australia.
Kenny, P., Hall, J.P., Zapart, S., Davis, P. & Hossain, I. 2008, 'Informal care and home-based palliative care: a discrete choice experiment to assess the carers' preferences for support services', Quality of Life Research, Springer, Montevideo, Uruguay.
Kenny, P.M., Hall, J.P., Zapart, S., Davis, P. & Hossain, I. 2008, 'Informal care and home-based palliative care: a discrete choice experiment to assess the carers' preferences for support services', Uruguay.
King, M.T., Viney, R.C., Hossain, I., Smith, D., Fowler, S. & Savage, E.J. 2008, 'Men's preferences for treatment for early stage prostate cancer: results from a discrete choice experiment', 13th National Health Outcomes Conference, Canberra.
King, MT, Viney, RC, Norman, R, Cronin, PA, Street, D, Brazier, JE & Ratcliffe, J 2008, 'Valuation of EQ-5D health states using discrete choice experiments: effect of excluding implausible states', International Society for Quality of Life Research (ISOQOL) Conference, Montevideo, Uruguay.
Knox, SA, Fiebig, DG, Viney, RC, Haas, MR, Weisberg, E, Street, D, Bateson, D & Cheung, SS 2008, 'Choosing how not to get pregnant: evidence from a discrete choice experiment', 30th Australian Conference Of Health Economists, Adelaide.
Norman, R, Goodall, S, Gallego, G & Hall, JP 2008, 'The trade-off between equality of outcome and efficiency in healthcare: A discrete choice experiment', Australian Conference of Health Economists, Adelaide.
Oliver, D, Wise, S & Buchanan, J 2008, 'Corporate memory or corporate senility? Renewing skills in a State monopoly', International Labour Process Conference, Dublin.
Van Gool, K., Savage, E.J. & Viney, R.C. 2008, 'An analysis of the Medicare Safety Net', UTS Health Research Showcase, University of Technology, Sydney.
Viney, R.C. 2008, 'Assessing QALYs: the EQ-5D', Quality of Life Workshop, University of Sydney.
Viney, R.C. 2008, 'Developing and implementing pharmacoeconomic guidelines: lessons from Australia (plenary)', International Society of Pharmacoeconomics and Outcomes Research Asia-Pacific Congress, Seoul, Korea.
Viney, R.C. 2008, 'Does cost-effectiveness enhance access?', CREATE08 (Clinical Research and Trials Excellence) Conference, Malaysia.
Viney, R.C. 2008, 'Health economics and the PBS: an overview', Association of Regulatory and Clinical Scientists Annual Scientific Congress, Sydney.
Viney, R.C., King, M.T., Savage, E.J. & Hossain, I. 2008, 'Quantifying the trade-off between quality of life and survival in prostate cancer: Results from a choice experiment', Centre for Applied Economics Research 5th Summer Workshop in Health Economics, UNSW, Sydney.
Viney, RC, Norman, R, King, MT, Cronin, PA, Street, D, Brazier, JE & Ratcliffe, J 2008, 'Application of discrete choice experiments to value multi-attribute health states for use in economic evaluation', Australian Conference of Health Economists, Adelaide.
Viney, RC, Norman, R, King, MT, Cronin, PA, Street, D, Ratcliffe, J & Brazier, JE 2008, 'Application of discrete choice experiments to value multi-attribute health states for use in economic evaluation', 13th National Health Outcomes Conference, Canberra.
Gallego, G, Goodall, S & Cameron, A MSAC 2008, Sacral nerve stimulation for urinary indications: Application 1115, pp. 1-120, Canberra.
Goodall, S & Cameron, A MSAC 2008, Endoscopic argon plasma coagulation of gastrointestinal bleeding and oesophageal stents: Application 1106, pp. 1-184, Canberra.
Goodall, S & Cameron, A MSAC 2008, Endovenous laser therapy for varicose veins: Application 1113, pp. 1-124, Canberra.
Goodall, S & Scott, A Melbourne Institute of Applied Economic and Social Research, The University of Melbourne 2008, Is Hospital Treatment in Australia Inequitable? Evidence from the HILDA Survey Melbourne Institute Working Paper 5/08, pp. 1-36, Melbourne, Australia.
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The pursuit of equity is a key objective of many health care systems, including Australiaâs Medicare. Using the Household, Income and Labour Dynamics in Australia (HILDA) survey, we measured the extent of inequity in the utilisation of hospital services. We used methodology developed by the ECuity project for measuring horizontal inequity indices. We examine income-related health care inequities in both inpatient and day patient access and utilisation, whilst controlling for morbidity, demographic and socio-economic variables. The probability of hospital inpatient admission appeared equitable, but the probability of a day patient visit demonstrated a pro-rich distribution. Even more pronounced were the findings on the quantity of visits. The positive horizontal inequality indices indicate a degree of inequity favouring the rich, especially for inpatient utilisation. The pro-rich distribution of the probability of a day patient visit was associated with whether individuals held private health insurance. These results suggest that in Australia, which has a universal and comprehensive health system, the rich and poor are not treated equally according to need. Further research should investigate whether the causes of inequities lie in the preferences of individuals or the preferences of health care providers.
Goodall, S, Norman, R & Haas, MR NSW Bureau of Crime Statistics and Research 2008, The costs of NSW Drug Court, Crime and Justice Bulletin, pp. 1-35, Sydney, Australia.
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In 2001, the Bureau of Crime Statistics and Research (BOCSAR) and the Centre for Health Economics Research and Evaluation (CHERE) undertook an analysis of the cost-effectiveness of the NSW Drug Court. In the intervening years, a number of changes have been made to the system, and the role the Drug Court undertakes has changed as the population it serves has changed. The aim of this report is to estimate the cost of these changes to the NSW Drug Court.
Haas, MR, Hall, JP, Gallego, G, Goodall, S, Norman, R, Van Gool, K & Viney, RC CHERE, University of Technology, Sydney 2008, Development of an evaluation framework and methodology for national blood supply change proposals: Final report, pp. 1-105, Sydney.
Haas, MR, Hall, JP, Gallego, G, Goodall, S, Norman, R, Van Gool, K & Viney, RC CHERE, University of Technology, Sydney 2008, Framework and methodology for national blood supply change proposals: Part 2, pp. 1-33, Sydney.
Norman, R, Goodall, S & Cameron, A MSAC 2008, Deep brain stimulation for essential tremor and dystonia: Application 1109, pp. 1-190, Canberra.
Haas, MR, Hall, JP, Viney, RC, Gallego, G, Goodall, S, Norman, R & Van Gool, K 2008, 'A model for best practice HTA, CHERE Working Paper 2008/1'.
Kenny, PM, Hall, JP & King, MT 2008, 'Variation in the costs of healthcare for chronic disease in Australia: The case of asthma, CHERE Working Paper 2008/7'.
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Objectives Individuals with chronic conditions represent a high healthcare cost group and understanding the cost variation among individuals is important for developing appropriate policy. This study aimed to investigate the sources of variation in the cost of healthcare for a cohort of people with asthma. It examines the costs to the health system and patient out-of-pocket costs. Methods A longitudinal observational study of asthma-related healthcare costs in a cohort of people with asthma (n=252). Participants were followed for three years using six-monthly postal surveys and individual administrative data. The factors associated with health system and patient out-of-pocket costs were investigated using generalised linear mixed models. Results There was substantial variability around the average costs of healthcare for asthma which were associated with asthma-related health measures and socio-demographic variables. The health system costs were less for those living in regional areas relative to Sydney residents and both the health system and patient out-of-pocket costs were highest in the oldest age group and lowest for children. The health system and patient out-of-pocket costs were highest for the high income group while the middle income group had the lowest total cost. Conclusions Our findings suggest that variations should be explored in developing strategies for chronic disease management and that Australia has achieved reasonable equity in access. However, out-of-pocket costs may be a deterrent for the middle income group, which should be a general concern for policies targeting the most disadvantaged group to the exclusion of concern with universal access.
Norman, R & Viney, RC 2008, 'The effect of discounting on quality of life valuation using the Time Trade-Off, CHERE Working Paper 2008/3'.
Norman, R, Haas, MR, Chenoweth, L, Jeon, Y, King, MT, Brodaty, H, Stein-Parbury, J & Luscombe, G 2008, 'Dementia Care Mapping and Patient-Centred Care in Australian Residential Homes: An Economic Evaluation of the CARE Study, CHERE Working Paper 2008/4'.
Vu, M, Savage, EJ, Van Gool, K, Haas, MR & Birch, S 2008, 'Breast screening in NSW, Australia: predictors of non-attendance and irregular attendance, CHERE Working Paper 2008/6'.
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BreastScreen Australia provides free mammography services to women in the target age group of 50 to 69 years. The program uses a variety of measures to recruit women to the service and, subsequently, encourage them to screen at two year intervals. One of the stated aims of the program is to provide equitable access to all women in the target age group. This paper analyses the extent to which systematic variation can be observed amongst women in terms of their screening behaviour, focusing on those who have never screened or are irregular screeners. Data on self reported utilisation of breast screening services was obtained from the 2002/04 NSW Health Surveys. A multinomial logit (MNL) model was used to examine the role of socioeconomic status, cultural background, education and region of residence on breast screening behaviour. The results show that lower income is associated with a woman never screening or screening irregularly. Region of residence is an important predictor of screening behaviour, although the degree of remoteness was not influential in determining participation. A higher number of hours worked was associated with women being more likely to screen irregularly. These results provide evidence of persistent and systematic variation in screening uptake and regular participation. The results also point towards targeted recruitment and retainment strategies that may provide the greatest potential benefits.