Melbourne Institute of Applied Economic and Social Research - Research Publications
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ItemWhat impact did the creation of Local Health Care Co-operatives have on indicators of practice resources and activity?(BMC, 2008-05-16)BACKGROUND: The creation of Local Health Care Cooperatives (LHCCs) in Scotland in 1999 was typical of attempts to encourage voluntary integration and co-operation between health care providers. One of the three stated objectives of their introduction was to tackle inequalities and improve access to care. METHODS: We used administrative data on all general practices in 1999 and 2003 to examine whether LHCCs had any measurable impact on six indicators of practice resources and activity. We compare three groups (participant, non-participant, and ineligible practices) through regression analysis of changes over time in group means and within-group inequality (measured using Gini coefficients). In addition, for participants we measure changes in the variation between and within LHCCs. RESULTS: Despite having similar registered populations to participants, non-participants had lower levels of resources at the start of the period and this differential widened over time. The changes over time in the activity indicators were similar across the three groups. There was little evidence that inequality between LHCC practices narrowed more than in the other two groups. Practices within LHCCs appear to be become more homogenous while variation increased between LHCCs. CONCLUSION: The mixed messages from our examination of resources and activity indicators demonstrates that there are likely to be important lessons to be learned from the brief experiment with LHCCs. Clear objectives that are evaluated using a battery of simple performance indicators may help to ensure demonstrable change in future initiatives to foster integration and co-operation.
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ItemDifferences in the quality of primary medical care for CVD and diabetes across the NHS: evidence from the quality and outcomes framework(BMC, 2007-05-29)BACKGROUND: Health policy in the UK has rapidly diverged since devolution in 1999. However, there is relatively little comparative data available to examine the impact of this natural experiment in the four UK countries. The Quality and Outcomes Framework of the 2004 General Medical Services Contract provides a new and potentially rich source of comparable clinical quality data through which we compare quality of primary medical care for coronary heart disease (CHD), stroke, hypertension and diabetes across the four UK countries. METHODS: A cross-sectional analysis was undertaken involving 10,064 general practices in England, Scotland, Wales and Northern Ireland. The main outcome measures were prevalence rates for CHD, stroke, hypertension and diabetes. Achievement on 14 simple process, 3 complex process, 9 intermediate outcome and 5 treatment indicators for the four clinical areas. RESULTS: Prevalence varies by up to 28% between the four UK countries, which is not reflected in resource distribution between countries, and penalises practices in the high prevalence countries (Wales and Scotland). Differences in simple process measures across countries are small. Larger differences are found for complex process, intermediate outcome and treatment measures, most notably for Wales, which has consistently lower quality of care. Scotland has generally higher quality than England and Northern Ireland is most consistently the highest quality. CONCLUSION: Previously identified weaknesses in Wales related to waiting times appear to reflect a more general quality problem within NHS Wales. Identifying explanations for the observed differences is limited by the lack of comparable data on practice resources and organisation. Maximising the value of cross-jurisdictional comparisons of the ongoing natural experiment of health policy divergence within the UK requires more detailed examination of resource and organisational differences.
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ItemHealth status and labour force participation: evidence from Australia(JOHN WILEY & SONS LTD, 2006-03-01)This paper examines the effect of health on labour force participation using the Household, Income and Labour Dynamics in Australia (HILDA) Survey. The potential endogeneity of health, especially self-assessed health, in the labour force participation equation is addressed by estimating the health equation and the labour force participation equation simultaneously. Taking into account the correlation between the error terms in the two equations, the estimation is conducted separately for males aged 15-49, males aged 50-64, females aged 15-49 and females aged 50-60. The results indicate that better health increases the probability of labour force participation for all four groups. However, the effect is larger for the older groups and for women. As for the feedback effect, it is found that labour force participation has a significant positive impact on older females' health, and a significant negative effect on younger males' health. For younger females and older males, the impact of labour force participation on health is not significant. The null-hypothesis of exogeneity of health to labour force participation is rejected for all groups.
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ItemAcademic performance, childhood economic resources, and the choice to leave school at age 16(Pergamon Press Ltd., 2007-06-01)A general international observation is that adolescents from disadvantaged families are more likely to leave school at age 16. In this paper we extend the literature on school-leaving decisions by using a new and extensive panel data set from New Zealand; and by examining the effect of family income, and personal and environmental characteristics since childhood on both academic performance and subsequent schooling choices. Results obtained from single equations and joint estimation, allowing for possible endogeneity of academic performance, reveal the importance of the role of academic performance in models of demand for education. Several factors that are at work for a long time, such as household income at different points in time, influence the school-leaving decision through academic performance. These results point to the role that stimulating academic performance can play in breaking cycles of disadvantage. © 2006 Elsevier Ltd. All rights reserved.
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ItemThe Effect of Financial Incentives on Labour Supply: Evidence for Lone Parents from Microsimulation and Quasi-Experimental Evaluation(Institute for Fiscal Studies, 2008-06)The aim of this paper is to analyse the work incentive effects of a change in the Australian tax and transfer system on lone parents in July 2000. To evaluate the effect of the total change only, microsimulation can be used; but for a subgroup of lone parents, a few components of this policy change can be analysed through two alternative approaches - microsimulation and quasi-experimental evaluation. Both approaches examine the effects on the probability of employment and on average working hours. The results from microsimulation show that the combined changes introduced in July 2000 - involving reduced withdrawal rates, changed family payments and lower income tax rates - have increased labour supply for lone parents to a moderate extent. The estimated effect on average working hours when using microsimulation is very close to the effect estimated in a quasi-experimental approach using matching techniques to control for alternative influences.
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ItemThe Social Multiplier and Labor Market Participation of Mothers(American Economic Association, 2009)In France, as in the US, a mother's labor market participation is influenced by the sex composition of her two eldest siblings. This paper shows that it is also affected by the sex composition of the eldest siblings of the other mothers living in the same close neighborhood. Using the sex composition of neighbors' eldest siblings as an instrumental variable, we identify a significant elasticity of own labor market participation to neighbors' participation. We present supportive evidence by comparing the estimates under two regimes for family benefits (pre-and post-1994 reform) and using quarter of birth as an alternative instrument.
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ItemOffre de travail des mères en France: L'effet causal du passage de deux à trois enfants(Institut National de la Statistique et des Etudes Economiques (INSEE), 2009)
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ItemWork and family directions in the USA and australia: A policy research agenda(SAGE PUBLICATIONS INC, 2007-02-01)This article provides a comparative glimpse of work/family issues in Australia and the USA. It begins with a summary of an emerging vision of ideal policies and practices for work and family. The article then provides historical background for the recent emergence of a ‘care gap’ in both countries, focusing on key commonalities and differences. The current status of the gap and the related ‘default solution’ to the gap are then outlined. Key commonalities here include an increasing diversity of family forms, a rise in delayed and denied childbearing, and substantial gender inequality. Significant current divergence across the societies includes relatively more family-responsive governmental policies in Australia, more attractive part-time opportunities for mothers in Australia, a relatively more equal division of labor in the home in the USA, a greater prevalence of corporate-sponsored work/family policies in the USA, and greater coverage of Australian employees by work/family policies negotiated through enterprise agreements. A tentative research agenda is provided in conclusion, focusing on part-time employment options, work incentives and childcare for single parents, the causes of delayed and denied childbearing, and enterprise bargaining and corporate policies.
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