Kees Van Gool

• PhD
• Professor at The University of Sydney

Objectives The Victorian Healthy Homes Program investigated the impact of thermal home upgrades on energy and health outcomes in vulnerable, older individuals over winter in Victoria, Australia. Design A staggered parallel-group randomised control trial design of 984 (764 per protocol (PP)) vulnerable households and 1313 (1015 PP) individuals. The...

BACKGROUND: Australia is undergoing general practice funding reform, with recent changes to Medicare and the introduction of MyMedicare voluntary patient registration. OBJECTIVE: Within this context, we provide general practitioners (GPs) with an explainer on health economic concepts relevant to current funding reform debates. This article outline...

Introduction: The Victorian Healthy Homes Program (VHHP) is the first randomised control trial (RCT) in Australia that investigates the impact of thermal home upgrades on energy and health outcomes in vulnerable individuals over winter in Victoria Australia. Methods: A staggered parallel-group RCT design of 984 vulnerable households. The interventi...

To understand what Medicare aimed to achieve, we need to revisit the medico‐politics of the time, and the fear of the spectre of socialised medicine. That determined what could be changed (universal insurance and contributions according to means) and what could not (private medical service provision and fee‐for‐service). We consider what Medicare h...

This study examines the impact of social insurance benefit restrictions on physician behaviour, using ophthalmologists as a case study. We examine whether ophthalmologists use their market power to alter their fees and rebates across services to compensate for potential policy‐induced income losses. The results show that ophthalmologists substantia...

The use and costs of health care rise substantially in the months prior to death, and although the use of palliative care services may be expected to lead to less costly care, the evidence is mixed. We analysed the costs of care over the last year of life and the extent to which these are associated with the use and duration of specialist palliativ...

Background International evidence suggests patients receiving cardiac interventions experience differential outcomes by their insurance status. We investigated outcomes of in-hospital care according to insurance status among patients admitted in public hospitals with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (P...

In a bid to improve quality of care, numerous countries have incorporated rewards and penalties into the funding and pricing of hospital services. This paper outlines recent advances in Australia to incorporate financial penalties for hospital acquired complications (HACs) and avoidable hospital readmissions (AHRs) adjustments into the funding of p...

Objective To elucidate the policy implications of recent trends in the funding of radiotherapy services between 2009-10 and 2021-22.Method We use national aggregate claims data to determine time trends in the fees, benefits and out-of-pocket (OOP) costs of radiotherapy and nuclear therapeutic medicine claims funded through the Medicare Benefits Sch...

Objectives: To examine out-of-pocket costs incurred by patients for radiation oncology services and their variation by geographic location. Design: Analysis of patient-level Medical Benefits Schedule (MBS) claims data linked with data from the Sax Institute 45 and Up Study. Setting, participants: People who received Medicare-subsidised radiati...

Objective Out-of-pocket (OOP) costs could act as a potential barrier to accessing specialist services, particularly among low-income patients. The aim of this study is to examine the link between OOP costs and socioeconomic inequality in specialist services in Australia.Methods This study is based on population-level data from the Medicare Benefits...

This is the main report for the evaluation of the Australian Health Care Homes Trial (HCH trial) which started on 1 October 2017 and ended on 30 June 2021. Additional volumes include the Summary Report and a Methods and data supplement.

Volume 3 (Technical and data supplement) for the evaluation of the Australian Health Care Homes Trial (HCH trial) which started on 1 October 2017 and ended on 30 June 2021. Volume 3 provides details of the evaluation methods and provides additional tables based on the evaluation data. Additional volumes include the Summary Report (Volume 1) and Mai...

The summary report for the evaluation of the Australian Health Care Homes Trial (HCH trial) which started on 1 October 2017 and ended on 30 June 2021. The summary report describes the trial, presents key findings and presents key lessons for primary health care reform in Australia. Additional volumes include the Main Report and a Methods and data s...

Introduction: The evaluation of the Victorian Healthy Homes Program (VHHP) will generate evidence about the efficacy and cost-effectiveness of home upgrades to improve thermal comfort, reduce energy use and produce health and economic benefits to vulnerable households in Victoria, Australia. Methods and analysis: The VHHP evaluation will use a s...

Background Crusted scabies is a debilitating dermatological condition. Although still relatively rare in the urban areas of Australia, rates of crusted scabies in remote Aboriginal communities in the Northern Territory (NT) are reported to be among the highest in the world. Objective To estimate the health system costs associated with diagnosing,...

Importance Low-value services have limited or no benefit to patients. Rates of low-value service in public hospitals may vary by patient insurance status, given that there may be different financial incentives for treatment of privately insured patients. Objective To assess the variation in rates of 5 low-value services performed in Australian pub...

Objective: To establish a methodological approach to compare two high-need, high-cost (HNHC) patient personas internationally. Data sources: Linked individual-level administrative data from the inpatient and outpatient sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) across 11 countries: Austral...

Value-based health care has gained increasing prominence among funders and providers in efforts to improve the outcomes important to patients relative to the resources used to deliver care. In Australia, the value-based healthcare agenda has focused on reducing the use of 'low-value' interventions, redesigning models of care to improve integration...

We investigate how utilization of primary care, specialist care, and emergency department (ED) care (and the mix across the three) changes in response to a change in health need. We determine whether any changes in utilization are impacted by socio‐economic status. The use of a unique Australian data set that consists of a large survey linked to mu...

Objective To identify and explore differences in spending and utilization of key health services at the end of life among hip fracture patients across seven developed countries. Data Sources Individual-level claims data from the inpatient and outpatient health care sectors compiled by the International Collaborative on Costs, Outcomes, and Needs i...

Background and objectives: Understanding resource allocation is important to ensure that limited health resources are spent where they bring the greatest benefit. The aim of this study was to explore how much of Australia's national health expenditure is allocated specifically to general practice services, and more broadly to primary healthcare (P...

Background Low value care (LVC) services have limited or no benefit to patients, and curtailing LVC can curb unnecessary spending and improve the quality of care. Some public hospitals in Australia have financial incentives to perform procedures for patients with private health insurance, yet little is known if there are differences in LVC between...

Objective: To compare within-country variation of health care utilization and spending of patients with chronic heart failure (CHF) and diabetes across countries. Data sources: Patient-level linked data sources compiled by the International Collaborative on Costs, Outcomes, and Needs in Care across nine countries: Australia, Canada, England, Fra...

Objective The objective of this study was to explore cross-country differences in spending and utilization across different domains of care for a multimorbid persona with heart failure and diabetes. Data Sources We used individual-level administrative claims or registry data from inpatient and outpatient health care sectors compiled by the Interna...

Objective: This study explores variations in outcomes of care for two types of patient personas-an older frail person recovering from a hip fracture and a multimorbid older patient with congestive heart failure (CHF) and diabetes. Data sources: We used individual-level patient data from 11 health systems. Study design: We compared inpatient mo...

Objective This study explores differences in spending and utilization of health care services for an older person with frailty before and after a hip fracture. Data Sources We used individual-level patient data from five care settings. Study Design We compared utilization and spending of an older person aged older than 65 years for 365 days befor...

This study examines the association between primary care investment and performance, in 34 OECD countries for 2005-15. Specifically, we explore whether an increasing investment in primary care is associated with improved performance, and whether particular characteristics of organisation and delivery are associated with a better return on primary c...

The Australian universal healthcare system aims to ensure affordable and equitable use of healthcare services based on individual health needs. This paper presents empirical evidence on the extent of horizontal inequity (HI) in healthcare services (unequal utilisation by income for equal need) in Australia during the period of promoting reliance on...

Objectives: Although several studies have examined the gap in healthcare use between indigenous and non-indigenous people, empirical evidence on inequity in healthcare use within indigenous populations is limited. This study aims to fill the gap in the literature by investigating income-related inequity (unequal use for equal need) in healthcare ut...

Equity is one of the key goals of universal healthcare coverage (UHC). Achieving this goal does not just depend on the presence of UHC, but also on its design and organisation. In Australia, out-of-hospital medical services are provided by private physicians in a market where fees are unregulated. This makes an interesting case to study equity. Usi...

ISSUES ADDRESSED Health promotion programs are based on the premise that health and well‐being is impacted by a person’s living circumstances, not just factors within the health arena. Chronic health issues require integrated services from health and social services. Navigator positions are effective in assisting chronic disease patients to access...

Equity in healthcare is an overarching goal of many healthcare systems around the world. Empirical studies of equity in healthcare utilisation primarily rely on the horizontal inequity (HI) approach which measures unequal utilisation of healthcare services by socioeconomic status (SES) for equal medical need. The HI method examines, quantifies, and...

Objective: To examine changes in accommodation payments to residential aged care facilities following the introduction of consumer choice reforms in 2014. These reforms have allowed residents to choose between making lump sum refundable deposits and/or rental-style payments. Methods: Quantitative analysis was undertaken for facility-level quarte...

We examine the unregulated pricing behavior of physicians in response to an exogenous decrease in patient entitlements under a government scheme providing insurance for high out-of-pocket medical costs. We use survey-linked administrative data to estimate the causal effects of the policy change on consultation fees. Adopting a quasi-experimental di...

Background Scabies is a common dermatological condition, affecting more than 130 million people at any time. To evaluate and/or predict the effectiveness and cost-effectiveness of scabies interventions, disease transmission modelling can be used. Objective To review published scabies models and data to inform the design of a comprehensive scabies...

Objective Medication adherence is a significant public health concern. Australian studies of statins show patients facing the highest copayments are the least likely to be adherent. This study examined whether the association identified between adherence and costs for statins also applies to a wider group of medications prescribed for Australian pa...

Understanding whether high healthcare costs for individuals persist over time is critical for the development of policies that aim to reduce the prevalence of high cost patients. And while high healthcare costs will occur in any given year based on the prevalence of certain morbidities and acute conditions, a large random component of the distribut...

Risk adjustment and payment systems rely on an accurate understanding of the drivers of healthcare costs. A related concern is whether certain cases of multimorbidity coincide with notably higher costs of healthcare. With the utilisation of administrative data for over 250,000 Australian residents, we investigate whether there are specific combinat...

Australia is one of nine Organisation for Economic Co‐operation and Development (OECD) countries that utilise deputising services to provide after‐hours primary care. While the provision of this service is supposed to be on behalf of regular general practitioners, businesses have adapted to the financial incentives on offer and are directly adverti...

Background and objectives: Australians can seek general practice care from multiple general practitioners (GPs) in multiple locations. This provides high levels of patient choice but may reduce continuity of care. The aim of this study was to estimate the prevalence of attendance at multiple general practices in Australia, and identify patient cha...

Purpose The Western New South Wales Integrated Care Strategy (ICS) was rolled out from November 2014 across three rural sites. The purpose of this paper is to assess its impact on general practices, and examine the feasibility of implementing an ICS, within a predominantly fee-for-service delivery model. Design/methodology/approach Mixed methods w...

Despite the universal health insurance system in Australia, there is inequity in use of needed healthcare services, and it varies across states. Increasing reliance on private funding and fragmented provision of healthcare services might make the Australian system challenging to deliver equitable healthcare services.

Background: In Australia, as in many other Western countries, patient surveys suggest the costs of medicines lead to deferring or avoiding filling of prescriptions. The Australian Pharmaceutical Benefits Scheme provides approved prescription medicines at subsidised prices with relatively low patient co-payments. The Pharmaceutical Benefits Scheme...

We examine whether patients’ perceptions of general practitioner (GP) care varies by the price paid for consultations. Australian consumer survey data from 2275 individuals were used to analyse the relationship between price and patient experience of GP care. Using both standard models for count data and a latent class model that distinguishes betw...

Economic theory predicts that changing financial rewards will change behaviour. This is valid in terms of service use; higher costs reduce health care use. It should follow that paying more for quality should improve quality; however, the research evidence thus far is equivocal, particularly in terms of better health outcomes. One reason is that "f...

After a period of steady decline, out-of-pocket (OOP) costs for general practitioner (GP) consultations in Australia began increasing in the mid-1990s. Following the rising community concerns about the increasing costs, the Australian Government introduced the Strengthening Medicare reforms in 2004 and 2005, which included a targeted incentive for...

Consultation Liaison (CL) services provide direct access to specialist services for support, treatment advice and assistance with the management of a given condition. Alcohol and other drugs (AOD) CL services aim to improve identification and treatment of patients with AOD morbidity. Our objective was to evaluate the costs and consequences of AOD C...

This study shows that, in an unregulated fee-setting environment, specialist physicians practise price discrimination on the basis of their patients' income status. Our results are consistent with profit maximisation behaviour by specialists. These findings are based on a large population survey that is linked to administrative medical claims recor...

Objective: This observational study aimed to identify clinical variables and health system characteristics associated with incomplete guideline application in drug treatment of patients with chronic heart failure (HF) across 15 countries. Methods: Three data sets were used: European Society of Cardiology Heart Failure Registry, Organisation for Eco...

This study estimates the burden of drug and alcohol morbidity on hospitals in New South Wales (NSW) by observing a multi-site collective sample utilising survey information and data linkage. Specifically we aimed to determine the prevalence of alcohol and other drug (AOD) problems and to estimate patterns of utilisation of hospital services, costs...

To determine the monthly treatment costs for each element of cancer care in patients receiving chemotherapy and to apportion the burden of cost by financing agent (Commonwealth, State government, private health insurer, patient). A cohort of 478 patients (54% breast, 33% colorectal and 13% non-small-cell lung cancer) were recruited from 12 centers...

To review and update the conceptual framework, indicator content and research priorities of the Organisation for Economic Cooperation and Development's (OECD) Health Care Quality Indicators (HCQI) project, after a decade of collaborative work. A structured assessment was carried out using a modified Delphi approach, followed by a consensus meeting,...

Many of the issues with using data from clinical trials and observational studies for economic evaluations are highlighted in the case of chemotherapy side effects. We present the results of an observational cohort study using linked administrative data. The chemotherapy side effects identified in the administrative data are compared with patient s...

The economic crisis that started in 2008 has had a profound impact on the lives of citizens. Millions of people lost their job, saw their life-savings disappear and experienced prolonged financial hardship. The economic crisis has also led a number of OECD governments to introduce austerity measures to reduce public deficits. The health sector, lik...

Cystic fibrosis (CF) is a progressive disease with treatments intensifying as patients get older and severity worsens. To inform policy makers about the cost burden in CF, it is crucial to understand what factors influence the costs and how they affect the costs. Based on 1,060 observations (from 731 patients) obtained from the Australian Data Regi...

Background: To save costs, the Australian Government recently deferred approval of seven new medicines recommended by the Pharmaceutical Benefits Advisory Committee (PBAC) for up to 7 months. Objectives: The aim of this research is to examine the timelines of PBAC applications following approval by the Therapeutic Goods Administration (TGA), all...

Childhood abuse is a serious social and economic problem. In Australia, there are 17,000 substantiated cases of physical and sexual child abuse each year. We model the relationship between childhood abuse and long-term health, health care costs and well being using data from the 2007 National Survey of Mental Health and Wellbeing. We find that adul...

Introduction: Many governments have introduced health technology assessment (HTA) as an important tool to manage the uptake and use of health-related technologies efficiently. Although surgeons play a central role in the uptake and diffusion of new technologies, little is known about their opinion and understanding of the HTA role and process. Me...

Cystic fibrosis (CF) is an inherited disease that requires more intensive treatments as the disease progresses. Recent medical advancements have improved survival but have also increased costs. Our lack of understanding on the relationship between disease severity and lifetime health care costs is a major impediment to the timely economic assessmen...

Background and objective: The increasing cost of chemotherapy is placing greater pressures on limited healthcare budgets. A potentially important, but often overlooked, aspect of chemotherapy is the cost associated with administration. This study aims to develop a better understanding of these costs, and in doing so, develop a model to estimate th...

Carrier screening for cystic fibrosis is not widely available in Australia, partly due to concerns regarding its cost-effectiveness. The benefit of information from pregnancy to pregnancy has not been widely considered in existing cost-effectiveness analyses. A decision tree was constructed estimating costs and outcomes from screening, including bo...

To save costs, the government recently deferred approval of seven new medicines recommended by the Pharmaceutical Benefits Advisory Committee (PBAC) for up to seven months. This decision impacted on the accessibility of affordable and appropriate medicines for patients. Whilst criticism has focussed on this decision and delays at the end of the app...

New medicines and therapeutic combinations are tested and marketed every year. Healthcare decision makers have to make explicit choices about adopting new treatments and deal with the resource consequences of their choices. The aim of this article is to examine the nursing workload of administering alternative chemotherapy protocols as a driver of...

Several studies have shown that a key determinant of successful health technology assessment (HTA) uptake is a clear, fair, and consistent decision-making process for the approval and introduction of health technologies. The aim of this study was to gauge healthcare providers' and managers' perceptions of local level decision making and determine w...

Brighter Futures is the NSW DOCS early intervention program targeting children aged 0 to 8. The program is designed to “support pregnant women and families with young children aged 0-8 years who require long-term support (up to two years) by a range of services. The program gives particular priority to those families with children under three year...

The Medicare Safety Net (MSN) was introduced in March 2004 to provide financial relief for those who incur high out-of-pocket costs from medical services. The policy has the potential to improve equity. This study examines: (i) how the health and income profiles of small areas influence MSN expenditure; and (ii) the distribution of expenditure by m...

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 Cent...

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 Expenditu...

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. A systematic literature search identified 14 studies (out of 29 economic studies on CF) focusing on preconception or prenatal sc...

This study investigated the hypothesis that socioeconomic differences in health status change can largely be explained by the higher prevalence of individual health-risk behaviors among those of lower socioeconomic position. Data were from the Americans' Changing Lives study, a longitudinal survey of 3617 adults representative of the US non-institu...

The aims of this paper are: to review and describe different approaches to HTA used in Australia and in other countries and to identify the features of best practice in HTA, particularly those likely to be most relevant to HTA at a local (ie state/regional) level. There are a number of well-developed models of HTA at the national and local levels....

Like other countries, Australia has had some success in incorporating economic evidence into national healthcare decisions. However, it has been recognised that this coverage does not extend to the local hospital or health region level. An extensive body of research has identified barriers to the use of economic evidence at the local level, leading...

Many jurisdictions have used public funding of health care to reduce or remove price at the point of delivery of services. Whilst this reduces an important barrier to accessing care, it does nothing to discriminate between groups considered to have greater or fewer needs. In this paper, we consider whether active targeted recruitment, in addition t...

Introduction: Since 1991 State and Federal Governments, under the auspices of BreastScreen Australia, have been providing mammography services free at the point of delivery to women aged 40 and over. One of the stated aims of the program is to provide equitable access to all women in the target group. Methods: Data on self-reported utilisation of b...

Objective: To provide decision makers with a tool to inform resource allocation decisions at the local level, using cardiovascular disease prevention as an example. Method: Evidence from the international literature was extrapolated to estimate the health and financial impacts in Central Sydney Area Health Service (CSAHS) of three different prevent...

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 allocati...

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 arti...

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 Expenditu...

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 Saf...

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...

Current funding mechanisms can impede the efficient use and integration of telemedicine services. Telemedicine has developed in Australia against a background of complex funding arrangements and interwoven health-care responsibilities. These impediments are not unique to telemedicine but are accentuated by its ability to cover different locations,...