Melbourne Institute of Applied Economic and Social Research - Research Publications

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"It's not a one operation fits all": A qualitative study exploring fee setting and participation in price transparency initiatives amongst medical specialists in the Australian private healthcare sector

Sabanovic, H ; La Brooy, C ; Mendez, SJ ; Yong, J ; Scott, A ; Elshaug, AG ; Prang, K-H (PERGAMON-ELSEVIER SCIENCE LTD, 2023-12)

The Australian government, through Medicare, defines the type of medical specialist services it covers and subsidizes, but it does not regulate prices. Specialists in private practice can charge more than the fee listed by Medicare depending on what they feel 'the market will bear'. This can sometimes result in high and unexpected out-of-pocket (OOP) payments for patients. To reduce pricing uncertainty and 'bill shock' faced by consumers, the government introduced a price transparency website in December 2019. It is not clear how effective such a website will be and whether specialists and patients will use it. The aim of this qualitative study was to explore factors influencing how specialists set their fees, and their views on and participation in price transparency initiatives. We conducted 27 semi-structured interviews with surgical specialists. We analysed the data using thematic analysis and responses were mapped to the Theoretical Domains Framework and the Capability, Opportunity, Motivation and Behavior model. We identified several patient, specialist and system-level factors influencing fee setting. Patient-level factors included patient characteristics, circumstance, complexity, and assumptions regarding perceived value of care. Specialist-level factors included perceived experience and skills, ethical considerations, and gendered-behavior. System-level factors included the Australian Medical Association recommended price list, practice costs, and supply and demand factors including perceived competition and practice location. Specialists were opposed to price transparency websites and lacked motivation to participate because of the complexity of fee setting, concerns over unintended consequences, and feelings of frustration they were being singled out. If price transparency websites are to be pursued, specialists' lack of motivation to participate needs to be addressed.
Private or Public? The declining growth in the use of private healthcare in Australia

Bai, T ; Mendez, S ; Scott, A ; Yong, J (Melbourne Institute of Applied Economic and Social Research, 2020-10-01)

The past five years has seen a steady decline in private health insurance (PHI) membership in Australia. With rising premium prices and out-of-pocket costs, private healthcare has become increasingly unaffordable in an era of low wage growth. Given the private health sector relies heavily on PHI funding, this Research Insight explores how the decline in private health membership has affected the private hospital sector in Australia.
Behind closed doors: the surge in mental distress of parents

Broadway, B ; Mendez, S ; Moschion, J (Melbourne Institute of Applied Economic and Social Research, 2020-08-01)

The economic downturn caused by the COVID-19 pandemic and its subsequent restrictions has had an alarming effect on Australians' mental health. Particularly worrying is the increase in high mental distress among parents, especially among non-employed fathers and parents of primary school aged children. Financial stress and work-family conflict tend to be the two major sources of mental distress for parents. Using data from the Melbourne Institute's Taking the Pulse of the Nation survey and the Household, Income and Labour Dynamics in Australia (HILDA) Survey, this Research Insight examines the surge in mental distress in parents compared to pre-COVID. The study identifies who has been most impacted, looking at how it impacts mothers and fathers, and how employment status and the age of the child can influence mental distress.
Help! High Levels of Parents’ Mental Distress

Broadway, B ; Moschion, J ; Mendez, S (Melbourne Institute, The University of Melbourne, 2020-12-01)

Of the close to 5 million parents with children under 18 in Australia, 24 percent have reported high rates of mental distress since the start of the pandemic. This has persisted well beyond the end of local lockdowns.
Factors affecting general practitioners' decisions to adopt new prescription drugs - Cohort analyses using Australian longitudinal physician survey data

Zhang, Y ; Méndez, SJ ; Scott, A (BioMed Central, 2019-02-07)

Background: We investigate factors affecting Australian general practitioners' decisions to adopt novel oral anticoagulants (NOACs) for the prevention of stroke/systemic embolism among patients with atrial fibrillation. Australia has a national homogeneous review and coverage system, which enables us to distinguish physician level factors while maintaining system level factors and patient coverage information constant. Methods: We conduct a cohort analyses by using longitudinal physician survey data from the Medicine in Australia: Balancing Employment and Life panel survey of Australian physicians (MABEL). MABEL data contain rich physician-level information such as age, gender, education, risk preferences, personality, physicians' communications with other medical professionals, and other practice characteristics. Importantly, the survey data were linked, with physician's consent, to actual utilization data from the Australian Pharmaceutical Benefits Scheme and the Medicare Benefits Schedule between January 1, 2012 and December 31, 2015. We measure speed (days until first time prescribing) of adopting NOACs. We estimate a Cox proportional hazard model to estimate factors affecting the adoption speed. Results: Several factors predict earlier adoption of NOACs: being male, more likely to take clinical risk, higher prescribing volume, being a principal or partner in the practice instead of an employee, spending less time in a typical consultation, and practicing in more affluent areas or areas with a higher proportion of older patients. GPs in Queensland are more likely to adopt NOACs and more likely to be extensive early adopters compared to other GPs. Other characteristics including physician personality, family circumstances, their involvement with public hospitals and teaching activities, and the distance between physician practice location to other clinics in the area are not statistically associated with earlier adoption. Conclusions: Our paper is one of the first to study the relationship between GPs' risk preferences, personality and their decisions to adopt new prescription drugs. Because NOACs are commonly prescribed and considered more cost-effective than their older counterpart, understanding factors affecting physicians' decisions to adopt NOACs has direct policy implications. Our results also highlight that even with universal coverage for prescription drugs, access to new drugs is different among patients, partially because who their doctors are and where they practice.
Parallel trade of pharmaceuticals: The Danish market for statins

Mendez, SJ (WILEY, 2018-02)

This paper investigates and quantifies the impact of parallel trade in markets for pharmaceuticals. The paper develops a structural model of demand and supply using data on price, sales, and the characteristics of statins in Denmark and simulates outcomes under a complete ban of parallel imports, keeping other regulatory schemes unchanged. There are two sets of key results. The first set focuses on price effects. On average, prices increase more in markets where the molecule has lost patent protection; wholesale prices for both generic and original products increase after competition from parallel importers is removed, but the final price paid by consumers (after deducting reimbursement) increases more for original products than for generics because most changes in wholesale prices are absorbed by the prevailing reimbursement rules. The second set of results reports the effects on market participants. My model takes into consideration consumers' preferences, allowing them to substitute between products. Prohibiting parallel imports induces consumers to substitute towards original products for which they have stronger preferences. In sum, banning parallel imports leads to (a) an increase in variable profits for original producers and a decrease for generic firms, (b) an increase in governmental health-care expenditures, and (c) a decrease in the welfare of Danish patients and firms.
Gendered choices of STEM subjects for matriculation are not driven by prior differences in mathematical achievement

Justman, M ; Mendez, SJ (PERGAMON-ELSEVIER SCIENCE LTD, 2018-06-01)

Women's under-representation in high-paying jobs in STEM fields (science, technology, engineering and mathematics) mirrors their earlier choices of matriculation electives: male students favour physics, information technology and advanced mathematics; female students favour life sciences. ‘Pipeline’ theories attribute these patterns to a male advantage in mathematics, but our longitudinal analysis, using administrative data on a full cohort of students in Victoria, Australia, shows that these patterns remain intact after conditioning on prior achievement. Female students require stronger prior signals of mathematical ability to choose male-dominated subjects, and when choosing these subjects earn higher average scores than males, suggesting a possible loss of efficiency. Previous research has shown that socio-economic disadvantage adversely affects boys more than girls, and indeed we find less of a male advantage in physics and advanced mathematics among socially disadvantaged students. We find that students with a language background other than English choose STEM fields with greater frequency than other students, reflecting their comparative advantage, while exhibiting more markedly gendered subject choices, indicating a role for cultural factors. Finally, we find significantly less gender streaming in STEM subjects among female students in all-girl schools than in co-educational schools, but no such difference for male students.