Melbourne Institute of Applied Economic and Social Research - Research Publications

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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.
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    For worse? Financial hardships and intra-household resource allocation among Australian couples
    Botha, F ; Ribar, DC (Elsevier, 2023-02-01)
    This article investigates differences in husbands' and wives' experiences of financial hardships. It develops and estimates a structural collective household model of expenditures on individual-specific necessities and hardship reporting where each partner has distinct preferences and the household makes Pareto efficient decisions. Using data from the Household, Income, and Labour Dynamics in Australia Survey with unique questions on individual financial hardships, we examine whether differences in preferences, bargaining power, or other characteristics within households affect the distribution of hardships. Wives in our data report more financial hardships than husbands. Estimates from our structural model indicate that wives have weaker preferences than husbands for expenditures on necessary goods for themselves, but there is no evidence of differences in bargaining power. Estimates further indicate that hardships increase with the number of children and spouses' disability status and decrease with spouses’ ages and subjective financial capabilities.
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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)
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    "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 ; Méndez, SJ ; Yong, J ; Scott, A ; Elshaug, AG ; Prang, K-H (Elsevier BV, 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.