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August 2005 - March 2015
Publications
Publications (95)
Developing country vaccine manufacturers (DCVMs) supply over half of the vaccines used in developing country immunisation programs. Decisions by developing countries to establish vaccine manufacturing should be based on economic viability, however reliable assessments of vaccine production costs are lacking. This study aimed to quantify the cost of...
Purpose
To evaluate the cost-effectiveness of BRCA testing in women with breast cancer, and cascade testing in family members of BRCA mutation carriers.
Methods
A cost-effectiveness analysis was conducted using a cohort Markov model from a health-payer perspective. The model estimated the long-term benefits and costs of testing women with breast c...
Australian Centre for Economic Research on Health, Research Report No.7, September 2009
Objectives
To compare patterns of care and peri‐operative outcomes of robot‐assisted radical prostatectomy (RARP) with other surgical approaches, and to create an economic model to assess the viability of RARP in the public case‐mix funding system.
Patients and Methods
We retrospectively reviewed all radical prostatectomies (RPs) performed for loc...
Internationally there is limited empirical evidence on the impact of overweight and obesity on health service use and costs. We estimate the burden of hospitalisation-admissions, days and costs-associated with above-normal BMI.Population-based prospective cohort study involving 224,254 adults aged ≥45y in Australia (45 and Up Study). Baseline quest...
To understand the trends in any physician services market it is necessary to understand the nature of both supply and demand, but few studies have jointly examined supply and demand in these markets. This study uses aggregate panel data on general practitioner (GP) services at the Statistical Local Area level in Australia spanning eight years to es...
Using data from Australian Taxation Statistics and Household Expenditure Surveys we analyze the distribution of health care financing in Australia over almost four decades. We compute Kakwani Progressivity indices for four sources of health care financing: general taxation, Medicare Levy payments, Medicare Levy Surcharge payments, and direct consum...
To investigate variation, and quantify socioeconomic inequalities, in the uptake of primary bariatric surgery in an obese population.
Prospective population-based cohort study of 49 364 individuals aged 45-74 2012s with body mass index (BMI) ≥ 30 kg/m2. Data from questionnaires (distributed from 1 January 2006 to 31 December 2008) were linked to ho...
We used five National Health Surveys (NHSs) in order to measure horizontal inequity (equal health care for equal need) in health-care utilization in Australia over five time points from 1983 to 2005. The direct standardization method was used to estimate the horizontal inequity indices for six measures of health-care utilization. The results sugges...
Australia has a universal, compulsory, public health insurance scheme that includes insurance rebates for private fee-for-service medical practitioner services. Recent sweeping changes to the rebates for general practitioner (GP) services provide an opportunity to observe the effects of widespread insurance changes on the behaviour of GPs and aggre...
Purpose
This paper uses a unique nationwide survey data derived from the 2003 Utilisation of Health Services Survey (UHSS) in Iran ( n =16,935) to analyse inequities of health care utilisation.
Design/methodology/approach
Concentration indices are used to measure socioeconomic inequality in actual use of the five types of health services, and in u...
To determine the wait times and healthcare costs around the time of non-small cell lung cancer (NSCLC) diagnosis for a large, population-based cohort of patients.
Data on baseline demographics, diagnostic and staging tests, timelines of investigations, and frequency of physician visits and hospital admissions were obtained from a provincial cancer...
In April 2007, Australia introduced a risk equalisation (RE) scheme (de facto a claims equalisation scheme), which replaced an extant reinsurance scheme that had operated since 1976. This scheme is one of a number of policy measures that the Australian Government has instituted to support the voluntary private health insurance (PHI) market which is...
Chronic diseases affect around 80% of older Australians, are main causes of premature death, and account for 70% of health expenditures. The novel features, building and validation of an Australian prototype model-system which simulates interventions that target several chronic diseases are described. Chronic disease progression models are linked t...
A vaccine has recently been licensed in many countries that protects against the human papillomavirus types 6, 11, 16, and 18. Types 6 and 11 account for approximately 90% of anogenital warts (AGWs). We describe the 20-year trends in the incidence and prevalence of AGWs in Manitoba, Canada.
We used linked population-based hospital and physician dat...
The impact of a health shock (malaria) on household consumption patterns is investigated using a system of demand equations. After controlling for the overall levels of total expenditure by a household, the presence of a self-reported malarious individual in a household reduces consumption of luxury items and increases consumption of health care an...
Type 2 diabetes is rapidly growing as a proportion of the disease burden in Australia as elsewhere. This study addresses the cost effectiveness of an integrated approach to assisting general practitioners (GPs) with diabetes management. This approach uses a centralized database of clinical data of an Australian Division of General Practice (a netwo...
To review the literature on the effectiveness of competency-based education (CBE) as a means of equipping the Australian general practice workforce to deliver optimal chronic disease outcomes to articulate policy options for the Australian context.
Systematic review of the literature (1991-2005) using a narrative approach followed by analysis of th...
To present and compare socioeconomic status (SES) rankings of households using consumption and an asset-based index as two alternative measures of SES; and to compare and evaluate the performance of these two measures in multivariate analyses of the socioeconomic gradient in malaria prevalence.
Data for the study come from a survey of 557 household...
To determine whether asking general practitioners to offer chlamydia screening at the same time as Pap screening increases chlamydia screening rates.
A pragmatic cluster randomised controlled trial.
Doctors from 31 general practices in the Australian Capital Territory performing more than 15 Pap smear screens per year, and all women aged 16-39 year...
Malaria's relationship with socioeconomic status at the macroeconomic level has been established. This is the first study to explore this relationship at the microeconomic (household) level and estimate the direction of association. Malaria prevalence was measured by parasitemia, and household socioeconomic status was measured using an asset based...
To determine the economic burden of malaria in a rural Tanzanian setting and identify any differences by socioeconomic status and season.
Interviews of 557 households in south eastern Tanzania between May and December 2004, on consumption and malaria-related costs.
Malaria-related expenses were significantly higher in the dry, non-malarious season...
The conceptually correct measure of benefit is willingness-to-pay for the output of the project or the additional consumers' surplus arising from a project. The authors examine the conditions under which the 'cost savings' and 'willingness-to-pay' measures of benefit coincide. -from Authors
Australia's national health insurance scheme (Medicare) provides coverage against the cost of a wide range of inpatient and outpatient health care services for all resident Australian citizens. Yet over 40% of the population purchase subsidised private health insurance which, under the current scheme, does not affect any entitlements for those cove...
The paper discusses models of health insurance, including compulsory (social) health insurance, voluntary insurance, and community-based financing schemes. It illustrates the features of these models in terms of coverage, funding, sustainability, payment mechanisms, public-private mix, risk protection, and cost-containment properties, and outlines...
Recent avoidable mortality trends in Australia suggest that health care has made a substantial contribution to reducing mortality. This study investigates if the benefits of health care have been distributed equally by comparing declines in avoidable with non-avoidable mortality over time by socioeconomic status (SES).
We calculated avoidable and n...
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Background: Knowledge of waiting times and costs involved in diagnosis will help to define more effective diagnostic services. The use of administrative databases for such health services research provides a large, population-based cohort and permits an accurate calculation of costs. Methods: Patients diagnosed with NSCLC in Manitoba, Canada f...
Using the concept of avoidable mortality, international studies suggest that healthcare has been effective in reducing mortality. This paper provides an analysis of avoidable mortality in Australia and compares trends with those of Western Europe.
Using unit-record mortality data, we calculated avoidable mortality rates in Australia for 1968-2001....
To estimate the average annual cost of managing a patient with chronic hepatitis B (CHB) disease in Australia.
Little is known about the prevalence or economic burden of hepatitis B viral (HBV) infection in Australia, despite it being recognized as a significant cause of morbidity and mortality.
A retrospective analysis of 149 patients with CHB dis...
Mycobacterium ulcerans gives rise to severe skin ulceration that can be associated with considerable illness. The cost of diagnosis, treatment, and lost income has never been assessed in Australia. A survey of 26 confirmed cases of the disease in Victoria was undertaken. Data were collected on demographic details, diagnostic tests, treatment, time...
Pneumococcal conjugate vaccine, 7 valent (PCV7) is the most costly vaccine yet considered for publicly funded programs. In mid 2001, Australia funded PCV7 for high-risk groups only (indigenous children and children with certain underlying medical conditions). World wide, non-industry-funded studies and studies using cost-utility measures are sparse...
he use of predictive genetic tests in setting premiums for life insurance is a controversial issue. Critics argue inter alia that this is 'discriminatory', that it will lead to the creation of a 'genetic underclass', and that it can lead to individuals being coerced to obtain information that they might not otherwise wish to have. Advocates argue t...
From the introduction of Australia's national health insurance scheme (Medicare) in 1984 until recently, the proportion of the population covered by private health insurance declined steadily. Following an Industry Commission inquiry into the private health insurance industry in 1997, a number of policy changes were effected in an attempt to revers...
The economics of screening is part of the broader area of the economics of prevention, and is concerned with the allocation of resources to screening activities when confronted with the problem of scarcity.
One important aspect of the economics of screening is the economic evaluation of screening programs. Economic evaluation involves a systematic...
To undertake an economic evaluation of the options for vaccination of adolescents using meningococcal polysaccharide vaccine based on Victorian data.
Cost-effectiveness and cost-benefit analyses of three options for vaccination were undertaken for hypothetical populations aged 15-19 years. Baseline analyses assumed a single year of programme implem...
Disease due to serogroup C Neisseria meningitidis is life-threatening and potentially preventable by vaccination. In 1999, the UK instigated mass vaccination after a sustained increase in serogroup C meningococcal disease. In the same year, Victoria, Australia experienced a similar change in disease epidemiology. It is timely to undertake an econom...
Australia has a compulsory, tax-financed publicly provided national health insurance scheme (Medicare). This scheme provides cover against the cost of specified medical services provided by approved private medical practitioners, and ensures inpatient treatment is provided to public patients in public hospitals free of charge. This paper provides e...
Using data collected from a private Canberra colposcopy service, we examined the direct costs, to women and government, of the gynaecological care of women with cervical cytological abnormalities and determine the potential savings of implementing the Commonwealth recommendations for the clinical care of women with screen-detected abnormalities. We...
To compare the costs and effectiveness of directly observed therapy (DOT) vs self-administered therapy (SAT) for the treatment of active tuberculosis.
Decision analysis.
We used published rates for failure of therapy, relapse, and acquired multidrug resistance during the initial treatment of drug-susceptible tuberculosis cases using DOT or SAT. We...
This study is motivated by the results of the SOLVD treatment trial (N Engl J Med 1991; 325: 293-302) which demonstrated the clinical efficacy of enalapril in the treatment of congestive heart failure but did not undertake an economic evaluation of enalapril therapy.
To undertake a cost-effectiveness analysis of enalapril maleate versus placebo, in...
Using the theory of multiproduct cost functions, a treatment cost function is derived for diseases which progress through a number of stages. The output classes are conceived as the stages at detection of the disease, with the unit of output within each class being the treated case. The derivation clarifies the assumptions underlying various specif...
The aim of the study was to determine if there is a relationship between the stage of breast cancer at the time of detection and the costs of treatment and to assess whether any such relationship would have an influence on the cost of a mammographic screening programme.
A retrospective analysis of the stage at presentation for primary breast cancer...
List of Figures. List of Tables. Preface. 1. Introduction. Part A: Theoretical Considerations. 2. The Economic Theory of Production and Cost in the Multiproduct Firm. 3. The Concept, Measurement and Classification of Hospital Output. Part B: Empirical Results. 4. The Queensland Public Hospital System -- an Overview. 5. The Effect of Case Mix on Hos...
This and the following chapter are concerned generally with demonstrating the relevance of hospital cost analysis to appraising hospital performance and determining hospital payments. The present chapter shows how an econometric approach to these problems might be adopted using estimated cost equations and the cost per case/cost per day/length of s...
The empirical analysis of cost behaviour in any industry must confront the problem of defining output, and such an analysis of hospitals is no exception. While this problem can be a difficult one to resolve for any industry, it is particularly acute for studies of service industries which, by their nature, produce intangible outputs.
Is the production of inpatient treatment subject to economies or diseconomies of scale? The following oft quoted response by Berki (1972) to this question foreshadows the difficult task ahead: “… depending on the methodologies and definitions used, economies of scale exist, may exist, may not exist, or do not exist, but in any case, according to th...
Suppose there are two firms identical in all respects except that one is a public enterprise while the other is a private enterprise. Will this difference in ownership cause one firm to achieve a higher level of productive efficiency than the other and, if so, which form of ownership is more conducive to the attainment of productive efficiency? Thi...
This chapter addresses the perplexing question of the reasons for interstate differences in public hospital costs between two States in Australia. At the outset, one may well question the wisdom of such a venture. To say that the Commonwealth Grants Commission (CGC)—a body vitally concerned with interstate comparisons—has found this area bothersome...
This chapter reports the empirical results from an analysis of the effects of case mix on hospital costs using data on Queensland public hospitals. Section 5.2 explains the specification of the multiproduct cost function adopted for this analysis—a non joint, input-output separable average cost function with overall constant returns to scale. A des...
This short chapter provides an overview of the development of the public hospital system in Queensland, Australia, highlighting some distinctive characteristics of this State’s system in comparison with that in other States. It is descriptive in nature, aiming to provide some institutional background to the hospital system which is the subject of m...
So far the empirical work in this study has failed to take into account another output commonly produced by hospitals—teaching. As will be seen in Section 7.2, this activity has certainly not been ignored in other studies of hospital costs. Indeed, an attempt has even been made to construct a specific theoretical model of the teaching hospital (see...
Although the single product firm often dominates theoretical treatises and textbooks on the economics of the firm, the importance of the multiproduct firm has long been recognised by economists. The first treatment of a firm producing more than one output appeared in John Stuart Mill’s Principles of Political Economy (1st edn 1848). This presentati...
Economists interested in empirically estimating hospital cost functions face a dilemma. Flexible functional form multiproduct cost functions which allow non-jointness, input/output separability, and overall and product-specific economies and diseconomies of scale to be incorporated as testable rather than maintained hypotheses entail an exponential...
Health economics is a relatively recent addition to the economics domain—twenty years ago it was described as being “as yet only in its adolescence” (Cooper and Culyer 1973, p.7). Since then, however, it has grown quickly, with the first journal devoted solely to this branch of economics—the Journal of Health Economics —being launched in 1982, and...
: Since 1981, the financing of the‘ ACT has been subject to five inquiries by the Commonwealth Grants Commission. These inquiries have incorporated the ACT into the fiscal equalisation process between Australian states and territories. and have significantly affected the ACT'S general revenue grants from the commonwealth. The inquiries produced evi...
The Commonwealth Grants Commission has, over the past ten years, been concerned with assessing the per capita relativities to be applied to the distribution of general revenue grants to the states in Australia to achieve fiscal equalization. In arriving at these assessments, the commission has developed a number of approaches to the treatment of sp...
It is generally agreed that the final output of the health care system is expected to be an improvement in health status. The various components of the health care system produce a wide variety of intermediate outputs which are almost invariably used as inputs into another production function which may again produce intermediate outputs and so on,...
Commonwealth government tax expenditures arise because departures from the tax structure produce favourable tax treatment of particular types of activities or taxpayers. Such tax concessions can be used in the same way as direct expenditures to give effect to government policies, and in fact are often used as substitutes for direct expenditures. Al...
The common problem illustrated in this paper is how to select, from a pool of possible projects, those which justify specific attention. Here, the projects are developments of therapeutic devices; the special attention is the checking on their safety. A theoretical model is developed which assigns scores to each project—each device that has been or...
The use of information theory as a basis for the construction of scalar case mix indexes for hospitals is well established but to date no results arising from an application of these indexes to Australian hospitals have been published. This paper provides a simplified explanation of the information theory approach and constructs the indexes for Que...
This paper outlines a scheme for distributing natural disaster relief to individuals derived from the principles of equity in taxation. This scheme is then given a specific algebraic formulation which, given a constraint on the total value of grants to be distributed, can be solved subject to grant-making bodies determining one of two policy parame...
A new hospital payment scheme for patients treated under the Medicare program for the aged has recently been introduced in the United States. Under this scheme, hospitals receive a fixed amount of money per patient treated with the amount depending on the Diagnosis Belated Group classification of the patient. This paper argues that this scheme can...
The commonwealth government's natural disaster relief policy over the period of 1970–1971 to 1977–1978 required each state to undertake a particular “base” expenditure on natural disaster relief before Commonwealth assistance was payable. This article examines the impact of this policy on “horizontal imbalance” between the states, an imbalance whic...
This paper presents an outline of government policy on natural disaster relief in Australia. Two effects of that policy on the distribution of the costs of a particular natural disaster (the 1974 Queensland floods) are then quantified. First, the relative shares of public sector relief borne by the three levels of government in Australia following...
The commonwealth government's natural disaster relief policy over the period of 1970–1971 to 1977–1978 required each state to undertake a particular “base” expenditure on natural disaster relief before Commonwealth assistance was payable. This article examines the impact of this policy on “horizontal imbalance” between the states, an imbalance whic...
The Commonwealth Government has for some time provided assistance to the States for personal distress and hardship and the restoration of their assets following a natural disaster. Prior to 1970-71, all State expenditures in these areas were matched dollar-for-dollar by a grant from the Commonwealth. In 1970-71, the policy was changed so that, no C...
Throughout its settled history Australia has been amassing an experience of flood events that have been serious enough to do severe damage to river basin and coastal communities. While it is a highly commendable objective of the Commonwealth's recently announced Water Policy that losses and destruction caused by floods should be minimised, it is in...
The distributional impact of a disaster depends on societal institutions (insurance, private philanthrop and government) and the ways in which they operate. Considers these matters for a particular disaster in a high income country. Complications with respect to estimating economic losses from a natural disaster are considered, as well as how the s...
Chronic diseases -eg heart disease, cancer, diabetes -affect around 80% of older Australians, are the main causes of disability and premature death, and account for 70% of Australia's health expenditures. Individuals tend to acquire multiple chronic diseases (comorbidities) as they age. Older Australians with three or more such illnesses assess the...
This article is published as Chapter 8 in E-book:
Walker A, Butler J, Colagiuri, S (eds). 2013, Health Policy in Ageing Populations: Economic Modeling of Chronic Disease Policy Options in Australia. E-book is open access, at http://www.eurekaselect.com/118691/volume/1,Bentham Science Publishers.
Chapter 8, “Simulating a Policy Relevant Reform Opt...
