Melbourne Institute of Applied Economic and Social Research - Research Publications

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Determinants and Outcomes of Invasive Coronary Angiography in Unselected Patients Presenting With Chest Pain to Emergency Departments in Western Australian Teaching Hospitals

Sanfilippo, FM ; Murray, K ; Hillis, GS ; Rankin, JM ; Latchem, D ; Schultz, CJ ; Yong, J ; Li, IW ; Ihdayhid, A ; Briffa, TG (Elsevier BV, 2023-12-01)
"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.
Socioeconomic status and access to care in a universal health care system: The case of acute myocardial infarction in Australia

Sundararajan, V ; Yang, O ; Yong, J (ELSEVIER, 2023-11)
Nursing Home Competition, Prices, and Quality: A Scoping Review and Policy Lessons

Yang, O ; Yong, J ; Scott, A ; Heyn, PC (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.
Effects of competition on hospital quality: an examination using hospital administrative data

Palangkaraya, A ; Yong, J (SPRINGER, 2013-06)

This paper investigates the effects of competition on hospital quality using hospital administration data from the State of Victoria, Australia. Hospital quality is measured by 30-day mortality rates and 30-day unplanned readmission rates. Competition is measured by Herfindahl-Hirschman index and the numbers of competing public and private hospitals. The paper finds that hospitals facing higher competition have lower unplanned admission rates. However, competition is related negatively to hospital quality when measured by mortality, albeit the effects are weak and barely statistically significant. The paper also finds that the positive effect of competition on quality as measured by unplanned readmission differs greatly depending on whether the hospital is publicly or privately owned.
Invasive Coronary Angiography after Chest Pain Presentations to Emergency Departments

Sanfilippo, FM ; Hillis, GS ; Rankin, JM ; Latchem, D ; Schultz, CJ ; Yong, J ; Li, IW ; Briffa, TG (MDPI AG, 2020-12-18)

We investigated patients presenting to emergency departments (EDs) with chest pain to identify factors that influence the use of invasive coronary angiography (ICA). Using linked ED, hospitalisations, death and cardiac biomarker data, we identified people aged 20 years and over who presented with chest pain to tertiary public hospital EDs in Western Australia from 1 January 2016 to 31 March 2017 (ED chest pain cohort). We report patient characteristics, ED discharge diagnosis, pathways to ICA, ICA within 90 days, troponin test results, and gender differences. Associations were examined with the Pearson Chi-squared test and multivariate logistic regression. There were 16,974 people in the ED chest pain cohort, with a mean age of 55.6 years and 50.7% males, accounting for 20,131 ED presentations. Acute coronary syndrome was the ED discharge diagnosis in 10.4% of presentations. ED pathways were: discharged home (57.5%); hospitalisation (41.7%); interhospital transfer (0.4%); and died in ED (0.03%)/inpatients (0.3%). There were 1546 (9.1%) ICAs performed within 90 days of the first ED chest pain visit, of which 59 visits (3.8%) had no troponin tests and 565 visits (36.6%) had normal troponin. ICAs were performed in more men than women (12.3% vs. 6.1%, p < 0.0001; adjusted OR 1.89, 95% CI 1.65, 2.18), and mostly within 7 days. Equal numbers of males and females present with chest pain to tertiary hospital EDs, but men are twice as likely to get ICA. Over one-third of ICAs occur in those with normal troponin levels, indicating that further investigation is required to determine risk profile, outcomes and cost effectiveness.
Nursing Home Competition, Prices and Quality: A Review and Some Lessons for Australia

Yang, O ; Yong, J ; Scott, A (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.
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.
Should hospital funding be linked to socioeconomic status?

Yong, J ; Yang, O (Melbourne Institute of Applied Economic and Social Research, 2020-07-01)

How does socioeconomic status impacts one's health and their access to healthcare? Using records from the Victorian Department of Health and Human Services, this Research Insight classifies patients into four socioeconomic groups according to their use of health and human services. The study also measures hospital use and whether socioeconomic status with in-hospital adverse incidents. The author, Associate Professor Jongsay Yong suggests that hospital funding policy should account for patients' socioeconomic differences.
Cream skimming: Theory and evidence from hospital transfers and capacity utilization

Yang, O ; Chan, MK ; Cheng, TC ; Yong, J (Elsevier, 2020-05-01)

The paper examines cream skimming behaviour by studying hospital transfers in a mixed public-private hospital system. A key innovation is the use of capacity utilization to identify cream skimming. We develop a dynamic model with uncertain patient arrivals and hospital capacity constraints to clarify the conditions under which a profit maximizing hospital will engage in patient selection by transferring ‘hard’ patients—those with severe/complex conditions—to free up capacity to accommodate ‘easy’ patients with few severe/complex conditions. Given finite capacity, public hospitals are strictly less likely to transfer patients than profit-motivated private hospitals at the same level of capacity. We test implications of the model using hospital administrative data from Victoria, Australia, and find empirical support for the cream skimming predictions of the model.