Physician responses to insurance benefit restrictions: The case of ophthalmology.

This study examines the impact of social insurance benefit restrictions on physician behaviour, using ophthalmologists as a case study. We examine whether ophthalmologists use their market power to alter their fees and rebates across services to compensate for potential policy-induced income losses. The results show that ophthalmologists substantially reduced their fees and rebates for services directly targeted by the benefit restriction compared to other medical specialists' fees and rebates.

Preterm Birth and Total Health Care Use and Costs in the First 5 Years of Life: A Population-based Study.

Objectives: To investigate the relationship between preterm birth and hospital/out-of-hospital care and costs over the first 5 years of life.

Study Design: Birth data from a population-based cohort of 631 532 infants born between 2007 and 2013 were linked probabilistically with data on hospitalizations, primary and secondary care, and the use of medications. We analyzed the distribution of health care use and public health care costs for infants who survived at least 5 years, comparing the outcomes of extremely preterm (<28 weeks of gestation), very preterm (28-32 weeks), moderate to late preterm (32-37 weeks), and term infants (at least 37 weeks).

Private provider incentives in health care: The case of caesarean births.

Private doctors and hospitals face incentives to intervene in the process of childbirth because they are employed and paid differently from their public counterparts. While private obstetric care has been associated with higher rates of caesarean birth, it is unclear to what extent this is attributable to unobserved selection effects related to clinical need or patient preferences. Using administrative birth data on over 280,000 births in Australia between 2007 and 2012, we implement an instrumental variables framework to account for the endogeneity of choice of care.

Health care use in response to health shocks: Does socio-economic status matter?

We investigate how utilization of primary care, specialist care, and emergency department (ED) care (and the mix across the three) changes in response to a change in health need. We determine whether any changes in utilization are impacted by socio-economic status. The use of a unique Australian data set that consists of a large survey linked to multiple years of detailed administrative records enables us to better control for individual heterogeneity and allows us to exploit changes in health that are related to the onset of two health shocks: a new diagnosis of diabetes and heart disease.

Birth models of care and intervention rates: The impact of birth centres.

Birth centres offer a midwifery-led model of care which supports a non-medicalised approach to childbirth. They are often reported as having low rates of birth intervention, however the precise impact is obscured because less disadvantaged mothers with less complex pregnancies, and who prefer and often select little intervention, are more likely to choose a birth centre. In this paper, we use a methodology that purges the impact of these selection effects and provides a causal interpretation of the impact of birth centres on intervention outcomes.

Accounting for Scale Heterogeneity in Healthcare-Related Discrete Choice Experiments when Comparing Stated Preferences: A Systematic Review.

Background: Scale heterogeneity, or differences in the error variance of choices, may account for a significant amount of the observed variation in the results of discrete choice experiments (DCEs) when comparing preferences between different groups of respondents.

Objective: The aim of this study was to identify if, and how, scale heterogeneity has been addressed in healthcare DCEs that compare the preferences of different groups.

Methods: A systematic review identified all healthcare DCEs published between 1990 and February 2016.

Discrete Choice Experiments: A Guide to Model Specification, Estimation and Software.

We provide a user guide on the analysis of data (including best-worst and best-best data) generated from discrete-choice experiments (DCEs), comprising a theoretical review of the main choice models followed by practical advice on estimation and post-estimation. We also provide a review of standard software. In providing this guide, we endeavour to not only provide guidance on choice modelling but to do so in a way that provides a 'way in' for researchers to the practicalities of data analysis.

Big Data: Will It Improve Patient-Centered Care?

Within a generation, empirical researchers have experienced unprecedented increases in the availability of data. 'Big data' has arrived with considerable hype and a sense that these are dramatic shifts in the research environment that have wide-reaching implications across many disciplines. There is no doubt that the analysis of new and varied sources of data currently available to researchers in health have the potential to better measure, monitor and describe health outcomes of patients and to uncover interesting patterns in how patients respond to treatments and interact with the health system.

Consideration Sets and Their Role in Modelling Doctor Recommendations About Contraceptives.

Decisions about prescribed contraception are typically the result of a consultation between a woman and her doctor. In order to better understand contraceptive choice within this environment, stated preference methods are utilized to ask doctors about what contraceptive options they would discuss with different types of women. The role of doctors is to confine their discussion to a subset of products that best match their patient.

Hips and hearts: the variation in incentive effects of insurance across hospital procedures.

The separate identification of effects due to incentives, selection and preference heterogeneity in insurance markets is the topic of much debate. In this paper, we investigate the presence and variation in moral hazard across health care procedures. The key motivating hypothesis is the expectation of larger causal effects in the case of more discretionary procedures.

Well-being losses due to care-giving.

This paper estimates the impact of informal caregiving on self-reported well-being. It uses a sample of 23,285 respondents of the first eleven waves of the Household, Income and Labour Dynamics in Australia (HILDA). We apply a relatively new analytical method that enables us to estimate fixed effects ordered logit to analyse subjective well-being.

Preference heterogeneity and selection in private health insurance: the case of Australia.

A basic prediction of theoretical models of insurance is that if consumers have private information about their risk of suffering a loss there will be a positive correlation between risk and the level of insurance coverage. We test this prediction in the context of the market for private health insurance in Australia. Despite a universal public system that provides comprehensive coverage for inpatient and outpatient care, roughly half of the adult population also carries private health insurance, the main benefit of which is more timely access to elective hospital treatment.

Explaining health care expenditure variation: large-sample evidence using linked survey and health administrative data.

Explaining individual, regional, and provider variation in health care spending is of enormous value to policymakers but is often hampered by the lack of individual level detail in universal public health systems because budgeted spending is often not attributable to specific individuals. Even rarer is self-reported survey information that helps explain this variation in large samples. In this paper, we link a cross-sectional survey of 267 188 Australians age 45 and over to a panel dataset of annual healthcare costs calculated from several years of hospital, medical and pharmaceutical records.

The effect of adverse information and positive promotion on women's preferences for prescribed contraceptive products.

Recent rapid growth in the range of contraceptive products has given women more choice, but also adds complexity to the resultant decision of which product to choose. This paper uses a discrete choice experiment (DCE) to investigate the effect of adverse information and positive promotion on women's stated preferences for prescribed contraceptive products. In November 2007, 527 Australian women aged 18-49 years were recruited from an online panel.

Preferences for new and existing contraceptive products.

New contraceptive methods provide greater choice in terms of effectiveness, management of side-effects, convenience and frequency of administration and flexibility, but make the decisions about contraception more complex. There are limited data on the factors that determine women's choices among these alternatives, to inform providers about the factors which are most important to women, or to predict uptake of new products. This paper reports on a choice experiment designed to elicit women's preferences in relation to prescribed contraception and to forecast the impact of the introduction of two new products into the Australian market.

Decisions about Pap tests: what influences women and providers?

Despite the success internationally of cervical screening programs debate continues about optimal program design. This includes increasing participation rates among under-screened women, reducing unnecessary early re-screening, improving accuracy of and confidence in screening tests, and determining the cost-effectiveness of program parameters, such as type of screening test, screening interval and target group. For all these issues, information about consumer and provider preferences and insight into the potential impact of any change to program design on consumer and provider behaviour are essential inputs into evidence-based health policy decision making.

Optimal recall length in survey design.

Self-reported data collected via surveys are a key input into a wide range of research conducted by economists. It is well known that such data are subject to measurement error that arises when respondents are asked to recall past utilisation. Survey designers must determine the length of the recall period and face a trade-off as increasing the recall period provides more information, but increases the likelihood of recall error.

Using discrete choice experiments to investigate subject preferences for preventive asthma medication.

Background And Objective: Long-term adherence to inhaled corticosteroids is poor despite the crucial role of preventer medications in achieving good asthma outcomes. This study was undertaken to explore patient preferences in relation to their current inhaled corticosteroid medication, a hypothetical preventer or no medication.

Methods: A discrete choice experiment was conducted in 57 adults with mild-moderate asthma and airway hyper-responsiveness, who were using inhaled corticosteroid View Article and Find Full Text PDF

What influences participation in genetic carrier testing? Results from a discrete choice experiment.

This study explores factors that influence participation in genetic testing programs and the acceptance of multiple tests. Tay Sachs and cystic fibrosis are both genetically determined recessive disorders with differing severity, treatment availability, and prevalence in different population groups. We used a discrete choice experiment with a general community and an Ashkenazi Jewish sample; data were analysed using multinomial logit with random coefficients.

Why worry about awareness in choice problems? Econometric analysis of screening for cervical cancer.

The decision to undertake a screening test is conditional upon awareness of screening. From an econometric perspective there is a potential selection problem, if no distinction is made between aware and unaware non-screeners. This paper explores this problem through analysis of the determinants of cervical screening in Australia.