Melbourne Institute of Applied Economic and Social Research - Research Publications

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    The impact of employment on mental healthcare use among people with disability: distinguishing between part- and full-time employment
    Saxby, K ; Dickinson, H ; Petrie, D ; Kavanagh, A ; Aitken, Z (SCANDINAVIAN JOURNAL WORK ENVIRONMENT & HEALTH, 2023)
    OBJECTIVE: Employment can improve mental health among people with disability (PWD), however, little is known about how different levels of workforce participation influence mental healthcare use. The aim of this study was to estimate the extent to which different levels of working hours are associated with changes in mental healthcare use among PWD. METHODS: Data on working hours and healthcare use among working age PWD who were receiving government benefits (N=260 825) was obtained from Australian Census-linked administrative records between 2011 and 2019. Individual fixed effects panel models were used to estimate the impact of increased working hours on mental healthcare (services and prescriptions). Heterogeneity analyses by job security and key sociodemographic characteristics were conducted. RESULTS: Compared to not working, we found that working 1-14, 15-29, and ≥30 hours per week was respectively associated with a 3.3%, 18.0%, and 9.9% reduction in the use of mental healthcare prescriptions as well as a 6.8%, 18.4%, and 22.3% reduction in the use of mental healthcare services by PWD. The effects were larger for PWD in more secure work and those living in rural and disadvantaged areas. CONCLUSIONS: Working more hours was associated with reduced mental healthcare use among PWD. Policy interventions should consider the broader benefits of enabling part-time and secure work placements for PWD, particularly for those living in rural and disadvantaged regions.
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    Baby Bump or Baby Slump? COVID-19, Lockdowns, and their Effects on Births in Australia
    Mooi-Reci, I ; Wooden, M ; Zilio, F (ELSEVIER SCI LTD, 2024-03)
    This study examines changes in birth rates in Australia during the COVID-19 pandemic and the extent to which such changes were influenced by lockdowns. We use natality data at State and small regional area levels spanning the period from 2011 to 2022. In our empirical approach, we first take advantage of a unique quasi-experimental setting that arose in Victoria, Australia's second most populous State, during the first year of the pandemic. Victoria imposed a 111-day stay-at-home lockdown while other States and Territories enforced milder restrictions on social and economic activities. We then exploit lockdowns that lasted more than three months in Victoria and New South Wales in the second year of the pandemic. Within these quasi-experimental settings, our empirical approach was to first use monthly data at the State-level and estimate birth rate deviations from secular trends for the months affected by COVID-19 policies. We also estimate separate models to examine variations in births across regional areas with different compositions of Indigenous population, unemployment, low-income, and non-English speaking residents. Our findings reveal a nationwide fertility increase in 2021, but Victoria exhibited slower growth, especially in areas with higher unemployment, lower income, and more non-English speaking residents. In 2022, we find evidence of a gradual return of birth rates to pre-pandemic trends, though this is mainly concentrated in the major cities. While the second-year lockdowns had limited impacts, language-diverse areas still mostly experienced lower rates of growth in birth rates.
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    Financial incentives and private health insurance demand on the extensive and intensive margins.
    Kettlewell, N ; Zhang, Y (Elsevier BV, 2024-03)
    In countries with dual public and private healthcare systems, individuals are often incentivized to purchase private health insurance through subsidies and penalty. We use administrative data from Australia to study how high-income earners respond on both the intensive and extensive margins to the simultaneous withdrawal of a premium subsidy, and the increase of a tax penalty. We estimate regression discontinuity models by exploiting discontinuous changes in the penalty and subsidy rates. Our setting is particularly interesting because means testing creates different incentives at the extensive and intensive margins. Specifically, we could expect to see higher take-up of insurance coupled with downgrading to less expensive plans. We find evidence that the penalty - despite being large in value - only has a modest effect on take-up. Our results show little evidence of downgrading, which is consistent with a low price elasticity for the high-income earners we study.
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    Age penalties and take-up of private health insurance
    Zhang, Y ; Kettlewell, N (Melbourne Institute, 2021-12-01)
    Penalty mandates are used in many countries to encourage people to purchase health insurance. But are they effective? We use a large administrative dataset for a 10% random sample of all Australian tax-filers to study how people respond to a step-wise age-based mandate, and whether this has changed over time. The mandate creates discontinuities in the incentive to insure by age, which we exploit to estimate causal effects. People who do not insure before the penalty dates face higher premiums in the future, which should encourage them to bring forward purchases. We find that people respond as expected to the initial age-penalty, but not to subsequent penalties. The 2% premium loading results in a 1-4% increase in take-up, with effects increasing after an annual government letter campaign that reminds people approaching the penalty deadline about the policy. We discuss the impact of the mandate on the overall efficiency of the market, and implications of potential reforms.
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    Economic conditions and health: Local effects, national effect and local area heterogeneity
    Janke, K ; Lee, K ; Propper, C ; Shields, K ; Shields, MA (Elsevier BV, 2023-10-01)
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    Surveillance and Self-Control
    Cobb-Clark, DA ; Dahmann, SC ; Kamhöfer, DA ; Schildberg-Hörisch, H (Oxford University Press (OUP), 2023)
    This paper studies important determinants of adult self-control using population-representative data and exploiting Germany’s division as quasi-experimental variation. We find that former East Germans have substantially more self-control than West Germans and provide evidence for government surveillance as a possible underlying mechanism. We thereby demonstrate that institutional factors can shape people’s self-control. Moreover, we find that self-control increases linearly with age. In contrast to previous findings for children, there is no gender gap in adult self-control and family background does not predict self-control.
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    More than half of Australians are only just making ends meet
    Gamarra Rondinel, A ( 2023-12-18)
    Many Australians are struggling to pay for everyday essentials, but some of us are feeling the pinch more than others.
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    Generational differences in mental health trends in the twenty-first century
    Botha, F ; Morris, RW ; Butterworth, P ; Glozier, N (National Academy of Sciences, 2023-12-05)
    Given the observed deterioration in mental health among Australians over the past decade, this study investigates to what extent this differs in people born in different decades-i.e., possible birth cohort differences in the mental health of Australians. Using 20 y of data from a large, nationally representative panel survey (N = 27,572), we find strong evidence that cohort effects are driving the increase in population-level mental ill-health. Deteriorating mental health is particularly pronounced among people born in the 1990s and seen to a lesser extent among the 1980s cohort. There is little evidence that mental health is worsening with age for people born prior to the 1980s. The findings from this study highlight that it is the poorer mental health of Millennials that is driving the apparent deterioration in population-level mental health. Understanding the context and changes in society that have differentially affected younger people may inform efforts to ameliorate this trend and prevent it continuing for emerging cohorts.
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    Household income and the risk of poverty around the time of childbirth
    Gamarra Rondinel, A ; PRICE, A (Melbourne Institute: Applied Economic & Social Research, 2023)
    The study examines the impact of childbirth on household income and poverty during the crucial first 1,000 days of a child's life, using longitudinal data from the Household, Income, and Labour Dynamics in Australia Survey (2001-2021) and an event study approach. The birth of a first child results in a reduction in household gross income, with one-parent households experiencing, on average, a 27% decrease and two-parent households an 18% decrease. Within five years of the first child's birth, a substantial portion of households (37-40%) either remain in poverty or enter poverty. This is more common for one-parent (63-70%) than two-parent households (34-36%), with childbirth amplifying the likelihood of being in poverty by 0.17 and 0.10 percentage points, respectively. Furthermore, without government family payments, the average poverty rate increases from 26% for one-parent households and 10% for two-parent households before childbirth, to 63% and 20%, respectively, in the years following. With family payments, the average poverty rates after childbirth are 37% and 11%, respectively. This indicates that while government payments assist in mitigating poverty, they do not fully shield families from the risk of falling into poverty after childbirth.
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    A randomised controlled trial of email versus mailed invitation letter in a national longitudinal survey of physicians
    Harrap, B ; Taylor, T ; Russell, G ; Scott, A ; Alahdab, F (PUBLIC LIBRARY SCIENCE, 2023-08-22)
    Despite their low cost, the use of email invitations to distribute surveys to medical practitioners have been associated with lower response rates. This research compares the difference in response rates from using email approach plus online completion rather than a mailed invitation letter plus a choice of online or paper completion. A parallel randomised controlled trial was conducted during the 11th annual wave of the nationally representative Medicine in Australia: Balancing Employment and Life (MABEL) longitudinal survey of doctors. The control group was invited using a mailed paper letter (including a paper survey plus instructions to complete online) and three mailed paper reminders. The intervention group was approached in the same way apart from the second reminder when they were approached by email only. The primary outcome is the response rate and the statistical analysis was blinded. 18,247 doctors were randomly allocated to the control (9,125) or intervention group (9,127), with 9,108 and 9,107 included in the analysis. Using intention to treat analysis, the response rate in the intervention group was 35.92% compared to 37.59% in the control group, a difference of -1.66 percentage points (95% CI: -3.06 to -0.26). The difference was larger for General Practitioners (-2.76 percentage points, 95% CI: -4.65 to -0.87) compared to other specialists (-0.47 percentage points, 95% CI: -2.53 to 1.60). For those who supplied an email address, the average treatment effect on the treated was higher at -2.63 percentage points (95% CI: -4.50 to -0.75) for all physicians, -3.17 percentage points (95% CI: -5.83 to -0.53) for General Practitioners, and -2.1 percentage points (95% CI: -4.75 to 0.56) for other specialists. For qualified physicians, using email to invite participants to complete a survey leads to lower response rates compared to a mailed letter. Lower response rates need to be traded off with the lower costs of using email rather than mailed letters.