Melbourne Institute of Applied Economic and Social Research - Research Publications
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ItemHours worked by general practitioners and waiting times for primary care(WILEY, 2018-10)The decline in the working hours of general practitioners (GPs) is a key factor influencing access to health care in many countries. We investigate the effect of changes in hours worked by GPs on waiting times in primary care using the Medicine in Australia: Balancing Employment and Life longitudinal survey of Australian doctors. We estimate GP fixed effects models for waiting time and use family circumstances to instrument for GP's hours worked. We find that a 10% reduction in hours worked increases average patient waiting time by 12%. Our findings highlight the importance of GPs' labor supply at the intensive margin in determining the length of time patients must wait to see their doctor.
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ItemAccuracy of patient recall for self-reported doctor visits: Is shorter recall better?(WILEY, 2018-11)In health economics, the use of patient recall of health care utilisation information is common, including in national health surveys. However, the types and magnitude of measurement error that relate to different recall periods are not well understood. This study assessed the accuracy of recalled doctor visits over 2-week, 3-month, and 12-month periods by comparing self-report with routine administrative Australian Medicare data. Approximately 5,000 patients enrolled in an Australian study were pseudo-randomised using birth dates to report visits to a doctor over three separate recall periods. When comparing patient recall with visits recorded in administrative information from Medicare Australia, both bias and variance were minimised for the 12-month recall period. This may reflect telescoping that occurs with shorter recall periods (participants pulling in important events that fall outside the period). Using shorter recall periods scaled to represent longer periods is likely to bias results. There were associations between recall error and patient characteristics. The impact of recall error is demonstrated with a cost-effectiveness analysis using costs of doctor visits and a regression example predicting number of doctor visits. The findings have important implications for surveying health service utilisation for use in economic evaluation, econometric analyses, and routine national health surveys.
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ItemPublic, private or both? Analyzing factors influencing the labour supply of medical specialists(WILEY, 2018-05)Abstract This paper investigates the factors influencing the allocation of time between public and private sectors by medical specialists. A discrete choice structural labour supply model is estimated, where specialists choose from a set of job packages that are characterized by the number of working hours in the public and private sectors. The results show that medical specialists respond to changes in earnings by reallocating working hours to the sector with relatively increased earnings, while leaving total working hours unchanged. The magnitudes of the own‐sector and cross‐sector hours elasticities fall in the range of 0.16–0.51. The labour supply response varies by gender, doctor’s age and medical specialty. Family circumstances such as the presence of young dependent children reduce the hours worked by female specialists but not male specialists. Résumé Public, privé ou les deux? Analyse des facteurs influençant l’offre de travail des médecins spécialistes. Ce mémoire étudie les facteurs influençant l’allocation du temps des médecins spécialistes entre le secteur privé et le secteur public. Un modèle structurel de choix discret d’offre de travail est calibré ans lequel les spécialistes choisissent entre des arrangements caractérisés par le nombre d’heures de travail dans le secteur public et le secteur privé. Les résultats montrent que les spécialistes répondent aux changements dans la nature des gains en réaménageant leurs heures de travail vers le secteur qui offre des gains relativement plus élevés, tout en gardant leurs heures totales de travail inchangées. Les magnitudes des élasticités de l’offre des heures à l’intérieur d’un secteur et entre secteurs se situent dans un intervalle entre 0.16‐0.51. La réponse de l’offre de travail varie selon le genre, l’âge et la spécialité. Le cadre familial, comme la présence de jeunes enfants à charge, tend à réduire les heures travaillées par les femmes mais pas pour les hommes.
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ItemWhat factors affect physicians' labour supply: Comparing structural discrete choice and reduced-form approaches(WILEY, 2018-02)Little is known about the response of physicians to changes in compensation: Do increases in compensation increase or decrease labour supply? In this paper, we estimate wage elasticities for physicians. We apply both a structural discrete choice approach and a reduced-form approach to examine how these different approaches affect wage elasticities at the intensive margin. Using uniquely rich data collected from a large sample of general practitioners (GPs) and specialists in Australia, we estimate 3 alternative utility specifications (quadratic, translog, and box-cox utility functions) in the structural approach, as well as a reduced-form specification, separately for men and women. Australian data is particularly suited for this analysis due to a lack of regulation of physicians' fees leading to variation in earnings. All models predict small negative wage elasticities for male and female GPs and specialists passing several sensitivity checks. For this high-income and long-working-hours population, the translog and box-cox utility functions outperform the quadratic utility function. Simulating the effects of 5% and 10% wage increases at the intensive margin slightly reduces the full-time equivalent supply of male GPs, and to a lesser extent of male specialists and female GPs.
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ItemFinancial Incentives to Encourage Value-Based Health Care(SAGE PUBLICATIONS INC, 2018-02)This article reviews the literature on the use of financial incentives to improve the provision of value-based health care. Eighty studies of 44 schemes from 10 countries were reviewed. The proportion of positive and statistically significant outcomes was close to .5. Stronger study designs were associated with a lower proportion of positive effects. There were no differences between studies conducted in the United States compared with other countries; between schemes that targeted hospitals or primary care; or between schemes combining pay for performance with rewards for reducing costs, relative to pay for performance schemes alone. Paying for performance improvement is less likely to be effective. Allowing payments to be used for specific purposes, such as quality improvement, had a higher likelihood of a positive effect, compared with using funding for physician income. Finally, the size of incentive payments relative to revenue was not associated with the proportion of positive outcomes.