Melbourne Institute of Applied Economic and Social Research - Research Publications

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A Managed Clinical Network for Cardiac Services: set-up, operation and impact on patient care.

Hamilton, ESTC ; Sullivan, M ; Donnan, T ; Taylor, ; Ikenwilo, ; SCOTT, A ; Baker, ; Wyke, ( 2005)
Professional satisfaction in general practice: does it vary by size of community?

McGrail, MR ; Humphreys, JS ; Scott, A ; Joyce, CM ; Kalb, G (WILEY, 2010-07-19)

OBJECTIVE: To investigate whether the level of professional satisfaction of Australian general practitioners varies according to community size and location. DESIGN, SETTING AND PARTICIPANTS: Cross-sectional, population-level national survey using results for a cohort of 3906 GPs (36% were "rural" participants) from the first wave of a longitudinal study of the Australian medical workforce, conducted between June and November 2008. Geographical differences in levels of professional satisfaction were examined using five community size categories: metropolitan, > or = 1 million residents; regional centre, 50,000-999,999; medium-large rural, 10,000-49,999; small rural, 2500-9999; and very small rural, < 2500. MAIN OUTCOME MEASURES: Level of professional satisfaction expressed by GPs working in different sized communities with respect to various job aspects. RESULTS: Professional satisfaction of GPs did not differ by community size for most aspects of the job. Overall satisfaction was high, at about 85% across all community sizes. Satisfaction with remuneration was slightly higher in smaller rural towns, even though the hours worked there were less predictable. Professional satisfaction with freedom of choosing work method, variety of work, working conditions, opportunities to use abilities, amount of responsibility, and colleagues was very high across all community sizes, while difficulties with arranging locums and the stress of running the practice were commonly reported by GPs in all community sizes. CONCLUSIONS: GPs working in different sized communities in Australia express similar levels of satisfaction with most professional aspects of their work.
The "Medicine in Australia: Balancing Employment and Life (MABEL)" longitudinal survey - Protocol and baseline data for a prospective cohort study of Australian doctors' workforce participation

Joyce, CM ; Scott, A ; Jeon, S-H ; Humphreys, J ; Kalb, G ; Witt, J ; Leahy, A (BIOMED CENTRAL LTD, 2010-02-25)

BACKGROUND: While there is considerable research on medical workforce supply trends, there is little research examining the determinants of labour supply decisions for the medical workforce. The "Medicine in Australia: Balancing Employment and Life (MABEL)" study investigates workforce participation patterns and their determinants using a longitudinal survey of Australian doctors. It aims to generate evidence to support developing effective policy responses to workforce issues such as shortages and maldistribution. This paper describes the study protocol and baseline cohort, including an analysis of response rates and response bias. METHODS/DESIGN: MABEL is a prospective cohort study. All Australian doctors undertaking clinical work in 2008 (n = 54,750) were invited to participate, and annual waves of data collections will be undertaken until at least 2011. Data are collected by paper or optional online version of a questionnaire, with content tailored to four sub-groups of clinicians: general practitioners, specialists, specialists in training, and hospital non-specialists. In the baseline wave, data were collected on: job satisfaction, attitudes to work and intentions to quit or change hours worked; a discrete choice experiment examining preferences and trade-offs for different types of jobs; work setting; workload; finances; geographic location; demographics; and family circumstances. DISCUSSION: The baseline cohort includes 10,498 Australian doctors, representing an overall response rate of 19.36%. This includes 3,906 general practitioners, 4,596 specialists, 1,072 specialists in training, and 924 hospital non-specialists. Respondents were more likely to be younger, female, and to come from non-metropolitan areas, the latter partly reflecting the effect of a financial incentive on response for doctors in remote and rural areas. Specialists and specialists in training were more likely to respond, whilst hospital non-specialists were less likely to respond. The distribution of hours worked was similar between respondents and data from national medical labour force statistics. The MABEL survey provides a large, representative cohort of Australian doctors. It enables investigation of the determinants of doctors' decisions about how much, where and in what circumstances they practice, and of changes in these over time. MABEL is intended to provide an important resource for policy makers and other stakeholders in the Australian medical workforce.
Devolved government and public sector pay reform: Considerations of equity and efficiency

Elliott, RF ; Bell, D ; Scott, A ; Ma, A ; Roberts, E (ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2005-06)
DO REGIONAL PRIMARY-CARE ORGANISATIONS INFLUENCE PRIMARY-CARE PERFORMANCE? A DYNAMIC PANEL ESTIMATION

Scott, A ; Coote, W (WILEY, 2010-06)

The role of regional primary-care organizations (PCOs) in health-care systems is not well understood. This is the first study to attempt to isolate the effect of regional PCOs on primary-care performance. We examine Divisions of General Practice in Australia, which were established in 1992. A unique Division-level panel data set is used to examine the effect of Divisions, and their activities, on various aspects of primary-care performance. Dynamic panel estimation is used to account for state dependence and the endogeneity of Divisions' activities. The results show that Divisions were more likely to have influenced general practice infrastructure than clinical performance in diabetes, asthma and cervical screening. The effect of specific Division activities, such as providing support for practice nurses and IT support, was not directly related to changes in the level of general practice performance. Specific support in the areas of diabetes and asthma was associated with general practice performance, but this was due to reverse causality and the effect of unobservable factors, rather than the direct effect of Divisions.
DESIGNING CHOICE EXPERIMENTS WITH MANY ATTRIBUTES. AN APPLICATION TO SETTING PRIORITIES FOR ORTHOPAEDIC WAITING LISTS

Witt, J ; Scott, A ; Osborne, RH (WILEY, 2009-06)

The aim of this paper is to undertake a discrete choice experiment using a 'blocked attribute' design. To date in the health economics literature, most discrete choice experiments have used only a relatively small number of attributes due to concerns about task complexity, non-compensatory decision rules, simplicity of experimental designs, and the costs of surveys. This may lead to omitted variable bias and reduced explanatory power when attributes have been pre-selected from a longer list. There may be situations where it is desirable to include a longer list of attributes, such as attaching weights to quality-of-life instruments to obtain single index scores. We examine this issue in the context of attaching weights to a disease-specific quality-of-life instrument used to prioritise patients on orthopaedic waiting lists in Victorian hospitals. Eleven attributes are allocated across three separate experimental designs and the data pooled for analysis. Pooling is justified given the specific context of the study, including attempts to minimise the effect of unobserved heterogeneity across the three models when designing the study and collecting data. Blocked attribute designs may offer flexibility to researchers when it is not possible or desirable to reduce the number of attributes.
THE EFFECTS OF AN INCENTIVE PROGRAM ON QUALITY OF CARE IN DIABETES MANAGEMENT

Scott, A ; Schurer, S ; Jensen, PH ; Sivey, P (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.
Job satisfaction and quitting intentions: A structural model of British general practitioners

Scott, A ; Gravelle, H ; Simoens, S ; Bojke, C ; Sibbald, B (WILEY, 2006-09)
The effects of pay and job satisfaction on the labour supply of hospital consultants

Ikenwilo, D ; Scott, A (WILEY-BLACKWELL, 2007-12)

There is little evidence about the responsiveness of doctors' labour supply to changes in pay. Given substantial increases in NHS expenditure, new national contracts for hospital doctors and general practitioners that involve increases in pay, and the gradual imposition of a ceiling on hours worked through the European Working Time Directive, knowledge of the size of labour supply elasticities is crucial in examining the effects of these major changes. This paper estimates a modified labour supply model for hospital consultants, using data from a survey of consultants in Scotland. Rigidities in wage setting within the NHS mean that the usual specification of the labour supply model is extended by the inclusion of job quality (job satisfaction) in the equation explaining the optimal number of hours worked. Generalised Method of Moments estimation is used to account for the endogeneity of both earnings and job quality. Our results confirm the importance of pay and non-pay factors on the supply of labour by consultants. The results are sensitive to the exclusion of job quality and show a slight underestimation of the uncompensated earnings elasticity (of 0.09) without controlling for the effect of job quality, and 0.12 when we controlled for job quality. Pay increases in the new contract for consultants will only result in small increases in hours worked. Small and non-significant elasticity estimates at higher quantiles in the distribution of hours suggest that any increases in hours worked are more likely for consultants who work part time. Those currently working above the median number of hours are much less responsive to changes in earnings.
Geographically differentiated pay in the labour market for nurses

Elliott, RF ; Ma, AHY ; Scott, A ; Bell, D ; Roberts, E (ELSEVIER, 2007-01)

This novel application of spatial wage theory to health service labour markets analyses the competitiveness of nurse's pay and how this differs between local labour markets in Britain. A switching regression model is estimated to derive standardised spatial wage differentials (SSWDs) for nurses and their comparators. An SSWD gap is constructed and its relationship to vacancies estimated. A reduction in the gap in a local area is shown to result in an increase in the long-term vacancy rate for National Health Service (NHS) nurses. The competitiveness of nursing pay is shown to have a strong effect on the ability of the NHS to attract and retain nurses.