Melbourne Institute of Applied Economic and Social Research - Research Publications
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ItemEssential work and emergency childcare: identifying gender differences in COVID-19 effects on labour demand and supply(Oxford University Press (OUP), 2023-03-15)We examine whether the COVID-19 crisis affects women and men differently in terms of employment, working hours, and hourly wages, and whether the effects are demand or supply driven. COVID-19 impacts are studied using administrative data on all Dutch employees up to December 2020, focussing on the national lockdowns and emergency childcare for essential workers in the Netherlands. First, the impact of COVID-19 is much larger for non-essential workers than for essential workers. Although female non-essential workers are more affected than male non-essential workers, on average, women and men are equally affected, because more women than men are essential workers. Second, the impact for partnered essential workers with young children, both men and women, is not larger than for others. Third, single-parent essential workers respond with relatively large reductions in labour supply, suggesting emergency childcare was insufficient for them. Overall, labour demand effects appear larger than labour supply effects.
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ItemCuts to local government spending, multimorbidity and health-related quality of life: A longitudinal ecological study in England(ELSEVIER, 2022-08)BACKGROUND: Population health has stagnated or is declining in many high-income countries. We analysed whether nationally administered austerity cuts in England were associated with prevalence of multimorbidity (individuals with two or more long-term conditions) and health-related quality of life. METHODS: We conducted an observational, longitudinal study on 147 local authorities in England. We examined associations of changes in spending over time (2009/10-2017/18), in total and by budget line, with (i) prevalence of multimorbidity, 2+ conditions (2011/12-2017/18), and (ii) health-related quality of life (EQ-5D-5L) score (2012/13-2016/17). We estimated linear, log-log regression models, incorporating local authority fixed-effects, time-varying demographic and socio-economic confounders, and time trends. FINDINGS: All local authorities experienced real spending cuts, varying from 42% (Barking and Dagenham) to 0·3% (Sefton). A 1% cut in per capita total service expenditure was associated with a 0·10% (95% CI 0·03 to 0·16) increase in prevalence of multimorbidity. We found no association (0·003%; 95% CI -0·01 to 0·01) with health-related quality of life. By budget line, after controlling for other spending, a 1% cut in public health expenditure was associated with a 0·15% (95% CI 0·11 to 0·20) increase in prevalence of multimorbidity, and a 1% cut in adult social care expenditure was associated with a 0·01% (95% CI 0·002 to 0·02) decrease in average health-related quality of life. INTERPRETATION: Fiscal austerity is associated with worse multimorbidity and health-related quality of life. Policymakers should consider the potential health consequences of local government expenditure cuts and knock-on effects for health systems. FUNDING: Medical Research Council.
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ItemInformal caregiving, time use and experienced wellbeing(WILEY, 2022-10-27)Informal carers report lower evaluative wellbeing than non-carers. In contrast to this literature and our own analysis of evaluative wellbeing, we find carers have a small but higher level of experienced wellbeing than non-carers do. To investigate why, we use decomposition analysis which separates explanatory factors into how time is used and how those uses of time are experienced. We analyze activities and associated experienced wellbeing measured in ten-minute intervals over two days by 4817 adults from the 2014/15 UK Time Use Survey. We use entropy balancing to compare carers with a re-weighted counterfactual non-carer group and then apply Oaxaca-Blinder decomposition. The experienced wellbeing gap of 0.066 is the net result of several substantial competing effects of time use. Carers experienced wellbeing would be higher by 0.188 if they had the same patterns and returns to time use as non-carers which is driven by sleep, time stress and alternative characteristics of time use. However, leisure and non-market activities serve to dampen this increase in experienced wellbeing. Initiatives to improve and assess carer wellbeing should pay close attention to how carers spend their time.
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ItemEffects of chain ownership and private equity financing on quality in the English care home sector: retrospective observational study(OXFORD UNIV PRESS, 2022-12-05)BACKGROUND: the structure of care homes markets in England is changing with the emergence of for-profit homes organised in chains and financed by private equity. Previous literature shows for-profit homes were rated lower quality than not-for-profit homes when inspected by the national regulator, but has not considered new forms of financing. OBJECTIVES: to examine whether financing and organisation of care homes is associated with regulator assessments of quality. METHODS: retrospective observational study of the Care Quality Commission's ratings of 10,803 care homes providing services to older people as of January 2020. We used generalised ordered logistic models to assess whether ratings differed between not-for-profit and for-profit homes categorised into three groups: (i) chained ownership, financed by private equity; (ii) chained ownership, not financed by private equity and (iii) independent ownership. We compared Overall and domain (caring, effective, responsive, safe, well-led) ratings adjusted for care home size, age and location. RESULTS: all three for-profit ownership types had lower average overall ratings than not-for-profit homes, especially independent (6.8% points (p.p.) more likely rated as 'Requires Improvement/Inadequate', 95% CI: 4.7-8.9) and private equity chains (6.6 p.p. more likely rated as 'Requires Improvement/Inadequate', 95% CI: 2.9-10.2). Independent homes scored better than private equity chains in the safe, effective and responsive domains but worst in the well-led domain. DISCUSSION: private equity financing and independent for-profit ownership are associated with lower quality. The consequences of the changing care homes market structure for quality of services should be monitored.
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ItemAssociations between inflexible job conditions, health and healthcare utilisation in England: retrospective cross-sectional study(BMJ PUBLISHING GROUP, 2022-12-01)OBJECTIVES: To estimate the strength of association between having an inflexible job and health-related quality of life and healthcare utilisation; and to explore heterogeneity in the effects by gender, age and area-level deprivation. DESIGN: Retrospective cross-sectional study. SETTING: Seven waves of the English General Practice Patient Survey between 2012 and 2017. PARTICIPANTS: 1 232 884 people aged 16-64 years and in full-time employment. We measured job inflexibility by inability to take time away from work during usual working hours to seek medical care. PRIMARY AND SECONDARY OUTCOME MEASURES: Health-related quality of life (EQ-5D-5L); number of months since the respondent last saw a general practitioner (GP) or nurse; use of out-of-hours general practice in the past 6 months. We used regression analyses to estimate the strength of association between outcomes and having an inflexible job, adjusting for person and area-level characteristics. RESULTS: One-third of respondents reported job inflexibility. The probability of job inflexibility was higher at younger ages and in more deprived areas. Job inflexibility was associated with lower EQ-5D-5L utility scores of 0.017 (95% CI 0.016 to 0.018) for women and 0.016 (95% CI 0.015 to 0.017) for men. Women were more affected than men in the mental health domain. The reduction in health-related quality of life associated with having an inflexible job was greater for employees who were older or lived in more deprived areas. Having an inflexible job was associated with a longer time since the last visit to their GP of 0.234 (95% CI 0.201 to 0.268) months for women and 0.199 (95% CI 0.152 to 0.183) months for men. CONCLUSIONS: Inequalities in the prevalence of inflexible jobs contribute to inequalities in health. One mechanism may be through reduced access to healthcare. Policymakers and employers should ensure that all employees have sufficient job flexibility to protect their health.
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ItemNo Preview AvailableNews media representations of people receiving income support and the production of stigma power: An empirical analysis of reporting on two Australian welfare payments(SAGE PUBLICATIONS LTD, 2022-11)People receiving working-age income support payments are often stigmatised as morally and/or behaviourally deficient. We consider the role of the media, as a potential source of structural stigma, in perpetuating negative characterisations of people in receipt of either the Disability Support Pension (DSP) or unemployment benefits (Newstart) during a major period of welfare reform in Australia. Newspaper articles (N = 8290) that appeared in Australia’s five largest newspapers between 2001 and 2016, and referenced either payment were analysed. We found an increased use of fraud language associated with the DSP, which coincides with increased political and policy focus on this payment. We conclude that in a period of increasing political concern with welfare reform, media coverage of welfare recipients is a form of stigma power, acting discursively as symbolic violence.
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ItemNo Preview AvailableNursing Home Competition, Prices, and Quality: A Scoping Review and Policy Lessons(OXFORD UNIV PRESS INC, 2022-08-12)BACKGROUND AND OBJECTIVES: In recent years, countries have increasingly relied on markets to improve efficiency, contain costs, and maintain quality in aged care. Under the right conditions, competition can spur providers to compete by offering better prices and higher quality of services. However, in aged care, market failures can be extensive. Information about prices and quality may not be readily available and search costs can be high. This study undertakes a scoping review on competition in the nursing home sector, with an emphasis on empirical evidence in relation to how competition affects prices and quality of care. RESEARCH DESIGN AND METHODS: Online databases were used to identify studies published in the English language between 1988 and 2020. A total of 50 studies covering 9 countries are reviewed. RESULTS: The review finds conflicting evidence on the relationship between competition and quality. Some studies find greater competition leading to higher quality, others find the opposite. Institutional features such as the presence of binding supply restrictions on nursing homes and public reporting of quality information are important considerations. Most studies find greater competition tends to result in lower prices, although the effect is small. DISCUSSION AND IMPLICATIONS: The literature offers several key policy lessons, including the relationship between supply restrictions and quality, which has implications on whether increasing subsidies can result in higher quality and the importance of price transparency and public reporting of quality.
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ItemNo Preview AvailableVulnerability and recovery: Long-term mental and physical health trajectories following climate-related disasters(PERGAMON-ELSEVIER SCIENCE LTD, 2023-01-31)Extreme weather and climate-related disaster events are associated with a range of adverse health outcomes. People are not equally vulnerable to the adversity, experiencing varied patterns of long-term health trajectories in recovery depending on their vulnerabilities, capacities, and resiliencies. This study aims to identify latent mental and physical health trajectories and their associations with person- and place-based pre-disaster predictors. Using an Australian, population-based, longitudinal dataset spanning 2009-19, group-based multi-trajectory modelling was applied to identify the distinct mental, social, emotional, and physical health trajectories of people who had experienced damage to their home following a climate-related disaster event. Multinomial logistic regression was used to assess a series of social vulnerability predictors (demographic, socioeconomic, housing, health, neighbourhood, and geographical) of health patterns. We identified three distinct health trajectories. Most individuals experienced small or minimal health impacts at the time of the disaster year followed by a fast recovery. However, one-fifth of the exposed population were severely affected during and post disaster. This cohort had the worst mental and physical health prior to the disaster and experienced the largest decreases in mental and physical health and the lowest recoveries. Pre-existing mental and physical conditions were the most substantial risk factors, increasing the probability of experiencing high impact and slow recovery by 61% for mental health and 51% for physical health. In addition, vulnerability in the form of housing affordability stress, lower household income, and lack of community attachment, participation and safety were also significant independent risk factors for ongoing post-disaster health problems. Critically, people's mental and physical health recovery is dependent on pre-disaster vulnerabilities in health, resource access, and capacities. These findings could assist policymakers and health practitioners to more effectively target people most at risk and design prevention and response strategies to prevent the exacerbation of poor health and wellbeing.
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ItemNo Preview AvailableIntergenerational disadvantage: Learning about equal opportunity from social assistance receipt(Elsevier BV, 2022-12)We use variation in the intergenerational persistence across social assistance benefits over 18 years to study the drivers of intergenerational disadvantage. Young people are more likely to receive social assistance if their parents received disability, caring, or single parent benefits, and less likely if they received unemployment benefits. Disparity in intergenerational persistence across benefit types suggests that parental bad luck has broader consequences for youth disadvantage than do their personal choices. Using the intensive margin and timing of parental social assistance to account for unobserved heterogeneity indicates that intergenerational disadvantage is more likely driven by poverty traps than welfare cultures.
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ItemNo Preview AvailableIncome and saving responses to tax incentives for private retirement savings(ELSEVIER SCIENCE SA, 2022-01-20)