Melbourne Institute of Applied Economic and Social Research - Research Publications
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ItemShould I stay or should I go? Hospital emergency department waiting times and demand(Wiley, 2018-03-01)In the absence of the price mechanism, hospital emergency departments rely on waiting times, alongside prioritisation mechanisms, to restrain demand and clear the market. This paper estimates by how much the number of treatments demanded is reduced by a higher waiting time. I use variation in waiting times for low-urgency patients caused by rare and resource-intensive high-urgency patients to estimate the relationship. I find that when waiting times are higher, more low-urgency patients are deterred from treatment and leave the hospital during the waiting period without being treated. The waiting time elasticity of demand for low-urgency patients is approximately −0.25 and is highest for the lowest-urgency patients.
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ItemPrimary care physicians and infant mortality: Evidence from Brazil(Public Library of Science (PLoS), 2019-05-31)Primary health care has been recognized as a critical strategy for improving population health in developing countries. This paper investigates the effect of primary care physicians on the infant mortality rate in Brazil using a dynamic panel data approach. This method accounts for the endogeneity problem and the persistence of infant mortality over time. The empirical analysis uses an eight-year panel of municipalities between 2005 and 2012. The results indicate that primary care physician supply contributed to the decline of infant mortality in Brazil. An increase of one primary care physician per 10,000 population was associated with 7.08 fewer infant deaths per 10,000 live births. This suggests that, in addition to other determinants, primary care physicians can play an important role in accounting for the reduction of infant mortality rates.
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ItemAnatomy of a demand shock: Quantitative analysis of crowding in hospital emergency departments in Victoria, Australia during the 2009 influenza pandemic(PUBLIC LIBRARY SCIENCE, 2019-09-24)OBJECTIVE: An infectious disease outbreak such as the 2009 influenza pandemic is an unexpected demand shock to hospital emergency departments (EDs). We analysed changes in key performance metrics in (EDs) in Victoria during this pandemic to assess the impact of this demand shock. DESIGN AND SETTING: Descriptive time-series analysis and longitudinal regression analysis of data from the Victorian Emergency Minimum Dataset (VEMD) using data from the 38 EDs that submit data to the state's Department of Health and Human Services. MAIN OUTCOME MEASURES: Daily number of presentations, influenza-like-illness (ILI) presentations, daily mean waiting time (time to first being seen by a doctor), daily number of patients who did-not-wait and daily number of access-blocked patients (admitted patients with length of stay >8 hours) at a system and hospital-level. RESULTS: During the influenza pandemic, mean waiting time increased by up to 25%, access block increased by 32% and did not wait presentations increased by 69% above pre-pandemic levels. The peaks of all three crowding variables corresponded approximately to the peak in admitted ILI presentations. Longitudinal fixed-effects regression analysis estimated positive and statistically significant associations between mean waiting times, did not wait presentations and access block and ILI presentations. CONCLUSIONS: This pandemic event caused excess demand leading to increased waiting times, did-not-wait patients and access block. Increases in admitted patients were more strongly associated with crowding than non-admitted patients during the pandemic period, so policies to divert or mitigate low-complexity non-admitted patients are unlikely to be effective in reducing ED crowding.
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ItemCompetition, prices and quality in the market for physician consultations(Wiley, 2016-04)Prices for consultations with General Practitioners (GP's) in Australia are unregulated, and patients pay the difference between the price set by the GP and a fixed reimbursement from the national tax-funded Medicare insurance scheme. We construct a Vickrey-Salop model of GP price and quality competition and test its predictions using individual GP-level data on prices, the proportion of patients who are charged no out-of-pocket fee, average consultation length, and characteristics of the GP's, their practices and their local areas. We measure the competition to which the GP is exposed by the distance to other GP practices and allow for the endogeneity of GP location decisions with measures of area characteristics and area fixed-effects. Within areas, GP's with more distant competitors charge higher prices and a smaller proportion of their patients make no out-of-pocket payment. GP's with more distant competitors also have shorter consultations, though the effect is small and statistically insignificant.
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ItemJunior doctors' preferences for specialty choice(ELSEVIER, 2012-12)A number of studies suggest that there is an over-supply of specialists and an under-supply of general practitioners in many developed countries. Previous econometric studies of specialty choice from the US suggest that although income plays a role, other non-pecuniary factors may be important. This paper presents a novel application of a choice experiment to identify the effects of expected future earnings and other attributes on specialty choice. We find the implied marginal wage estimated from our discrete choice model is close to the actual wages of senior specialists, but much higher than those of senior GPs. In a policy simulation we find that increasing GPs' earnings by $50,000, or increasing opportunities for procedural or academic work can increase the number of junior doctors choosing general practice by between 8 and 13 percentage points. The simulation implies an earnings elasticity of specialty choice of 0.95.
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ItemTHE EFFECTS OF AN INCENTIVE PROGRAM ON QUALITY OF CARE IN DIABETES MANAGEMENT(WILEY-BLACKWELL, 2009-09)An incentive program for general practitioners to encourage systematic and igh-quality care in chronic disease management was introduced in Australia in 1999. There is little empirical evidence and ambiguous theoretical guidance on which effects to expect. This paper evaluates the impact of the incentive program on quality of care in diabetes, as measured by the probability of ordering an HbA1c test. The empirical analysis is conducted with a unique data set and a bivariate probit model to control for the self-selection process of practices into the program. The study finds that the incentive program increased the probability of an HbA1c test being ordered by 20 percentage points and that participation in the program is facilitated by the support of Divisions of General Practice.