Melbourne Institute of Applied Economic and Social Research - Research Publications
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ItemAssociation between telehealth use and general practitioner characteristics during COVID-19: findings from a nationally representative survey of Australian doctors(BMJ PUBLISHING GROUP, 2021)OBJECTIVE: To investigate factors associated with the use of telehealth by general practitioners (GPs) during COVID-19. DESIGN: A nationally representative longitudinal survey study of Australian doctors analysed using regression analysis. SETTING: General practice in Australia during the COVID-19 pandemic. PARTICIPANTS: 448 GPs who completed both the 11th wave (2018-2019) of the Medicine in Australia: Balancing Employment and Life (MABEL) Survey and the MABEL COVID-19 Special Online Survey (May 2020). OUTCOME MEASURES: Proportion of all consultations delivered via telephone (audio) or video (audiovisual); proportion of telehealth consultations delivered via video. RESULTS: 46.1% of GP services were provided using telehealth in early May 2020, with 6.4% of all telehealth consultations delivered via video. Higher proportions of telehealth consultations were observed in GPs in larger practices compared with solo GPs: between +0.21 (95% CI +0.07 to +0.35) and +0.28 (95% CI +0.13 to +0.44). Greater proportions of telehealth consultations were delivered through video for GPs with appropriate infrastructure and for GPs with more complex patients: +0.10 (95% CI +0.04 to +0.16) and +0.04 (95% CI +0.00 to +0.08), respectively. Lower proportions of telehealth consultations were delivered via video for GPs over 55 years old compared with GPs under 35 years old: between -0.08 (95% CI -0.02 to -0.15) and -0.15 (95% CI -0.07 to -0.22), and for GPs in postcodes with a higher proportion of patients over 65 years old: -0.005 (95% CI -0.001 to -0.008) for each percentage point increase in the population over 65 years old. CONCLUSIONS: GP characteristics are strongly associated with patterns of telehealth use in clinical work. Infrastructure support and relative pricing of different consultation modes may be useful policy instruments to encourage GPs to deliver care by the most appropriate method.
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ItemUnprofessional behaviour in Australian hospitals.(Australasian Medical Publishing Company, 2021-01-01)Inappropriate behaviour harms health workers and patients, and evidence-based solutions are needed.
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ItemIs the evidence on the effectiveness of pay for performance schemes in healthcare changing? Evidence from a meta-regression analysis(BMC, 2021-02-24)Background: This study investigated if the evidence on the success of the Pay for Performance (P4P) schemes in healthcare is changing as the schemes continue to evolve by updating a previous systematic review. Methods: A meta-regression analysis using 116 studies evaluating P4P schemes published between January 2010 to February 2018. The effects of the research design, incentive schemes, use of incentives, and the size of the payment to revenue ratio on the proportion of statically significant effects in each study were examined. Results: There was evidence of an increase in the range of countries adopting P4P schemes and weak evidence that the proportion of studies with statistically significant effects have increased. Factors hypothesized to influence the success of schemes have not changed. Studies evaluating P4P schemes which made payments for improvement over time, were associated with a lower proportion of statistically significant effects. There was weak evidence of a positive association between the incentives’ size and the proportion of statistically significant effects. Conclusion: The evidence on the effectiveness of P4P schemes is evolving slowly, with little evidence that lessons are being learned concerning the design and evaluation of P4P schemes.
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ItemLoss aversion, reference dependence and diminishing sensitivity in choice experiments(Elsevier, 2020-12-01)This paper tests for the existence of loss aversion, reference dependence and diminishing sensitivity in a discrete choice experiment (DCE). A status quo alternative is introduced in a DCE of nurses' job choices and modeled as an individual-specific third alternative representing the respondent's current job. This provides a feasible method for including a status quo, which changes the reference point for each respondent. The increased salience of the status quo changes the size of any losses or gains when comparing Job A or Job B with their current situation, and since losses are valued more than gains, affects the marginal utility of each attribute. Models that differentially incorporate loss aversion, reference dependence and changes in sensitivity yield varying estimates of marginal rates of substitution, suggesting that consideration of these effects is important, particularly when policy implications are sought.
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ItemThe impact of price transparency on consumers and providers: A scoping review(Elsevier, 2020-08-01)Escalating levels of healthcare spending and price variation in the healthcare market have driven government and insurer interest in price transparency tools that are intended to help consumers shop for services and reduce overall healthcare spending. However, it is unclear whether the objectives of price transparency are being achieved. We conducted a scoping review to synthesize the impact of price transparency on consumer, provider, and purchaser behaviours and outcomes. Price transparency tools had weak impact overall on consumers due to low uptake, and mixed effects on providers. Price-aware patients chose less costly services that led to out-of-pocket cost savings and savings for health insurers; however, these savings did not translate into reductions in aggregate healthcare spending. Disclosure of list prices had no effect, however disclosure of negotiated prices prompted supply-side competition which led to decreases in prices for shoppable services.
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ItemDoes digital health technology improve physicians' job satisfaction and work-life balance? A cross-sectional national survey and regression analysis using an instrumental variable(BMJ Journals, 2020-01-01)Objectives To examine the association between physicians’ use of digital health technology and their job satisfaction and work–life balance. Design A cross-sectional nationally representative survey of physicians and probit regression models were used to examine the association between using digital health technology and the probability of reporting high job satisfaction and a good work–life balance. Models included a rich set of covariates, including physicians’ personality traits, and instrumental variable analysis was used to control for bias from unobservable confounders and reverse causality. Setting Clinical practice settings in Australia, including physicians working in primary care, hospitals, outpatient settings, and physicians working in the public and private sectors. Participants Respondents to wave 11 (2018–2019) of the Medicine in Australia: Balancing Employment and Life (MABEL) longitudinal survey of doctors. The analysis sample included a broadly nationally representative sample of 7043 physicians, including general practitioners, specialists and physicians in training. Primary and secondary outcome measures The proportion of respondents who used any digital health technology; proportion answered ‘moderately satisfied’ or ‘very satisfied’ to the statement on job satisfaction: ‘Taking everything into account, how do you feel about your work’; proportion agreeing or strongly agreeing to the statement on work–life balance: ‘The balance between my personal and professional commitments is about right.’ Results Physicians with positive beliefs about the effectiveness of using digital health technology were 3.8 percentage points (95% CI 2.7 to 5.0) more likely to use digital health technology compared with those who did not. Physicians with colleagues who already used digital health technology were also 4.1 percentage points (95% CI 2.6 to 5.6) more likely to use digital health technology. The availability of IT support and lack of privacy concerns increased the probability of using digital health technology by 1.6 percentage points (95% CI 1.0 to 2.3) and 0.5 percentage points (95% CI 0.1 to 1.0). Physicians who used digital health technology were 14.2 percentage points (95% CI −1.3 to 29.7) and 20.3 percentage points (95% CI 2.4 to 38.1) more likely to report respectively higher job satisfaction and good work–life balance, compared with the physicians who did not use it. Conclusions Findings suggested digital health technology served more as a work resource than work demand for physicians who used it.
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ItemThe impact of COVID-19 on GPs and non-GP specialists in private practice(Melbourne Institute of Applied Economic and Social Research, 2020)The healthcare system in Australia has not been overwhelmed by the COVID-19 pandemic as initially expected. Nevertheless, there have been significant changes in the use of healthcare from the suspension of non-urgent elective surgery, social distancing restrictions that have discouraged people from leaving home, public fear of contracting or spreading the virus in health facilities, and increased household financial pressure that reduces the affordability of out-ofpocket payments. The aim of this report is to examine the impact of the COVID-19 pandemic on General Practitioners (GPs) and non-GP specialists working in private practice. It examines the short-term effects on doctors’ working patterns and mental health, how doctors have responded and how they have been supported during the pandemic. New evidence is presented from the Medicine in Australia: Balancing Employment and Life (MABEL) COVID-19 Short Online Survey (SOS) – MABEL COVID-19 SOS – which was completed by a representative sample of 2,235 GPs and non-GP specialists between 14 and 24 May 2020, with comparison to the MABEL Wave 11 survey conducted in 2018-19.
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ItemNursing Home Competition, Prices and Quality: A Review and Some Lessons for Australia(Melbourne Institute of Applied Economic and Social Research, 2020-06-01)In recent years, with the aim of containing cost pressure and improving efficiency, many countries have begun to introduce market mechanisms into the aged care sector. Under the right conditions, competition can spur providers to compete by cutting costs, offering better prices and higher quality of services. However, in aged care, market failures can be severe. Information about prices and quality may not be readily available and search costs can be high. This study undertakes a scoping review of the literature on competition in the nursing home sector, with an emphasis on research examining how competition affects prices and quality of care. Online databases were used to identify studies in English language published between 1988–2020. A total of 44 publications covering nine countries are included in this review. On the relationship between competition and quality, the literature offers conflicting evidence. Some studies find greater competition leading to higher quality, while others find the opposite effect. Institutional features such as the presence of binding supply restrictions on nursing homes and public release of information on quality appear to be important considerations. On the price effect of competition, most studies find that greater competition tends to result in lower prices, although the effect is small. The literature offers several lessons for Australia, including whether increasing subsidies can result in higher quality and the role of public reporting of quality ratings in fostering competition.
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ItemPrivate or Public? The declining growth in the use of private healthcare in Australia(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.
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ItemWho is avoiding necessary health care during the COVID-19 pandemic?(Melbourne Institute of Applied Economic and Social Research, 2020-06-01)Australians experiencing high levels of financial stress and mental distress are not seeking needed health care. This study looks into what policies could help encourage greater use of necessary health care to improve wellbeing and avoid more expensive care later on.