Melbourne Institute of Applied Economic and Social Research - Research Publications

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    The role of financial factors in the mobility and location choices of General Practitioners in Australia
    McIsaac, M ; Scott, A ; Kalb, G (BioMed Central, 2019-05-24)
    Background The geographic distribution of health workers is a pervasive policy concern. Many governments are responding by introducing financial incentives to attract health care workers to locate in areas that are underserved. However, clear evidence of the effectiveness of such financial incentives is lacking. Methods This paper examines General Practitioners’ (GPs) relocation choices in Australia and proposes a dynamic location choice model accounting for both source and destination factors associated with a choice to relocate, thereby accounting for push and pull factors associated with job separation. The model is used to simulate financial incentive policies and assess potential for such policies to redistribute GPs. This paper examines the role of financial factors in relocating established GPs into neighbourhoods with relatively low socioeconomic status. The paper uses a discrete choice model and panel data on GPs’ actual changes in location from one year to the next. Results This paper finds that established GPs are not very mobile, even when a financial incentive is offered. Policy simulation predicts that 93.2% of GPs would remain at their current practice and that an additional 0.8% would be retained or would relocate in a low-socioeconomic status (SES) neighbourhood in response to a hypothetical financial incentive of a 10% increase in the earnings of all metropolitan GPs practising in low-SES neighbourhoods. Conclusion With current evidence on the effectiveness of redistribution programmes limited to newly entering GPs, the policy simulations in this paper provide an insight into the potential effectiveness of financial incentives as a redistribution policy targeting the entire GP population. Overall, the results suggest that financial considerations are part of many factors influencing the location choice of GPs. For instance, GP practice ownership played almost as important a role in mobility as earnings.
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    Public, private or both? Analyzing factors influencing the labour supply of medical specialists
    Cheng, TC ; Kalb, G ; Scott, A (WILEY, 2018-05-01)
    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.
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    What factors affect physicians' labour supply: Comparing structural discrete choice and reduced-form approaches
    Kalb, G ; Kuehnle, D ; Scott, A ; Cheng, TC ; Jeon, S-H (WILEY, 2018-02-01)
    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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    Nurses' labour supply elasticities: The importance of accounting for extensive margins
    Hanel, B ; Kalb, G ; Scott, A (ELSEVIER SCIENCE BV, 2014-01-01)
    We estimate a multi-sector model of nursing qualification holders' labour supply in different occupations. A structural approach allows us to model the labour force participation decision, the occupational and shift-type choice, and the decision about hours worked as a joint outcome following from maximising a utility function. Disutility from work is allowed to vary by occupation and also by shift type in the utility function. Our results suggest that average wage elasticities might be higher than previous research has found. This is mainly due to the effect of wages on the decision to enter or exit the profession, which was not included in the previous literature, rather than from its effect on increased working hours for those who already work in the profession.
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    Do Financial Incentives Influence GPs' Decisions to Do After-hours Work? A Discrete Choice Labour Supply Model
    Broadway, B ; Kalb, G ; Li, J ; Scott, A (WILEY, 2017-12-01)
    This paper analyses doctors' supply of after-hours care (AHC), and how it is affected by personal and family circumstances as well as the earnings structure. We use detailed survey data from a large sample of Australian General Practitioners (GPs) to estimate a structural, discrete choice model of labour supply and AHC. This allows us to jointly model GPs' decisions on the number of daytime-weekday working hours and the probability of providing AHC. We simulate GPs' labour supply responses to an increase in hourly earnings, both in a daytime-weekday setting and for AHC. GPs increase their daytime-weekday working hours if their hourly earnings in this setting increase, but only to a very small extent. GPs are somewhat more likely to provide AHC if their hourly earnings in that setting increase, but again, the effect is very small and only evident in some subgroups. Moreover, higher earnings in weekday-daytime practice reduce the probability of providing AHC, particularly for men. Increasing GPs' earnings appears to be at best relatively ineffective in encouraging increased provision of AHC and may even prove harmful if incentives are not well targeted.
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    Rural Amenity and Medical Workforce Shortage: Is there a Relationship?
    McGrail, MR ; Humphreys, JS ; Joyce, C ; Scott, A ; Kalb, G (WILEY, 2011-05-01)
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    Medicine in Australia: Balancing Employment and Life (MABEL)
    Yan, W ; Cheng, TC ; Scott, A ; Joyce, CM ; Humphreys, J ; Kalb, G ; Leahy, A (WILEY-BLACKWELL, 2011-03-01)
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    How do rural GPs' workloads and work activities differ with community size compared with metropolitan practice?
    McGrail, MR ; Humphreys, JS ; Joyce, CM ; Scott, A ; Kalb, G (CSIRO PUBLISHING, 2012-01-01)
    Rural communities continue to experience shortages of doctors, placing increased work demands on the existing rural medical workforce. This paper investigates patterns of geographical variation in the workload and work activities of GPs by community size. Our data comes from wave 1 of the Medicine in Australia: Balancing Employment and Life longitudinal study, a national study of Australian doctors. Self-reported hours worked per usual week across eight workplace settings and on-call/ after-hours workload per usual week were analysed against seven community size categories. Our results showed that a GP's total hours worked per week consistently increases as community size decreases, ranging from 38.6 up to 45.6h in small communities, with most differences attributable to work activities of rural GPs in public hospitals. Higher on-call workload is also significantly associated with smaller rural communities, with the likelihood of GPs attending more than one callout per week ranging from 9% for metropolitan GPs up to 48-58% in small rural communities. Our study is the first to separate hours worked into different work activities whilst adjusting for community size and demographics, providing significantly greater insight to the increased hours worked, more diverse activities and significant after-hours demands experienced by current rural GPs.
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    The supply of general practitioners across local areas: accounting for spatial heterogeneity
    McIsaac, M ; Scott, A ; Kalb, G (BIOMED CENTRAL LTD, 2015-10-03)
    BACKGROUND: The geographic distribution of general practitioners (GPs) remains persistently unequal in many countries despite notable increases in overall supply. This paper explores how the factors associated with the supply of general practitioners (GPs) are aligned with the arbitrary geographic boundaries imposed by the use of spatially referenced GP supply data. METHODS: Data on GP supply in postcodes within Australia are matched to data on the population characteristics and levels of amenities in postcodes. Tobit regression models are used that examine the associations between GP supply and postcode characteristics, whilst accounting for spatial heterogeneity. RESULTS: The results demonstrate that GPs do not consider space in a one-dimensional sense. Location choice is related to both neighbourhood-specific factors, such as hospitals, and broader area factors, such as area income and proximity to private schools. Although the proportion of females and elderly were related to GPs supply, mortality rate was not. CONCLUSIONS: This paper represents the first attempt to map the factors influencing GP supply to the appropriate geographic level at which GPs may be considering that factor. We suggest that both neighbourhood and broader regional characteristics can influence GPs' locational choices. This finding is highly relevant to the design and evaluation of relocation incentive programmes.
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    Who should receive recruitment and retention incentives? Improved targeting of rural doctors using medical workforce data
    Humphreys, JS ; McGrail, MR ; Joyce, CM ; Scott, A ; Kalb, G (WILEY, 2012-02-01)
    OBJECTIVE: The objective of this study was to define an improved classification for allocating incentives to support the recruitment and retention of doctors in rural Australia. DESIGN AND SETTING: Geo-coded data (n = 3636 general practitioners (GPs)) from the national Medicine in Australia: Balancing Employment and Life study were used to examine statistical variation in four professional indicators (total hours worked, public hospital work, on call after-hours and difficulty taking time off) and two non-professional indicators (partner employment and schooling opportunities) which are all known to be related to difficulties with recruitment and retention. MAIN OUTCOME MEASURES: The main outcome measure used for the study was an association of six sentinel indicators for GPs with practice location and population size of community. RESULTS: Four distinct homogeneous population size groups were identified (0-5000, 5001-15,000, 15,001-50,000 and >50,000). Although geographical remoteness (measured using the Australian Standard Geographical Classification-Remoteness Areas (ASGC-RA)) was statistically associated with all six indicators (P < 0.001), population size provided a more sensitive measure in directing where recruitment and retention incentives should be provided. A new six-level rurality classification is proposed, based on a combination of four population size groups and the five ASGC-RA levels. A significant increase in statistical association is measured in four of six indicators (and a slight increase in one indicator) using the new six-level classification versus the existing ASGC-RA classification. CONCLUSIONS: This new six-level geographical classification provides a better basis for equitable resource allocation of recruitment and retention incentives to doctors based on the attractiveness of non-metropolitan communities, both professionally and non-professionally, as places to work and live.