ORCID Profile
0000-0002-1424-9304
Current Organisation
University of Sydney
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Publisher: Emerald
Date: 12-01-2018
DOI: 10.1108/JICA-08-2017-0026
Abstract: The Western New South Wales Integrated Care Strategy (ICS) was rolled out from November 2014 across three rural sites. The purpose of this paper is to assess its impact on general practices, and examine the feasibility of implementing an ICS, within a predominantly fee-for-service delivery model. Mixed methods were used to analyse the implementation of the ICS, including practice-level patient data on changes in service provision. This includes unit-record data on 130 enroled patients across three rural sites, as well as qualitative data collection from providers. There were significant increases in both revenue-generating and non-revenue-generating activities (primarily care coordination activities) associated with implementing the ICS. Each occasion of service involved greater contact time with practice staff other than GPs, as well as greater administration time. There is evidence that ICS activities such as case conferencing and team care planning substitute for traditional GP consultations. Overall, the study found that a significant investment of resources – namely staff time devoted to a range of activities – was required to support the implementation of the ICS. Such an investment was supported both externally and through revenue-generating practice-level activities. The data collection and evaluation project is ongoing, with analysis based on the first wave of data from three sites. At the practice level, a substantial commitment of resources is required to invest in, and sustain, a new model of integrated care (IC). This commitment can currently be supported both through higher revenue generation at the practice level, and externally by health system stakeholders, but changes in financial settings could impact on financial viability. This paper provides evidence on the role of blended payment mechanisms in facilitating the implementation of IC in a rural setting where there are medical workforce constraints.
Publisher: Wiley
Date: 23-02-2017
DOI: 10.1002/HEC.3317
Abstract: This study shows that, in an unregulated fee-setting environment, specialist physicians practise price discrimination on the basis of their patients' income status. Our results are consistent with profit maximisation behaviour by specialists. These findings are based on a large population survey that is linked to administrative medical claims records. We find that, for an initial consultation, specialist physicians charge their high-income patients AU$26 more than their low-income patients. While this gap equates to a 19% lower fees for the poorest patients (bottom 25% of the household income distribution), it is unlikely to remove the substantial financial barriers they face in accessing specialist care. There are large variations across specialties, with neurologists exhibiting the largest fee gap between the high-income and low-income patients. Several possible channels for deducing the patient's income are examined. We find that patient characteristics such as age, health concession card status and private health insurance status are all used by specialists as proxies for income status. These characteristics are particularly important to further practise price discrimination among the low-income patients but are less relevant for the high-income patients. Copyright © 2016 John Wiley & Sons, Ltd.
Publisher: Springer Science and Business Media LLC
Date: 05-06-2007
Abstract: Many jurisdictions have used public funding of health care to reduce or remove price at the point of delivery of services. Whilst this reduces an important barrier to accessing care, it does nothing to discriminate between groups considered to have greater or fewer needs. In this paper, we consider whether active targeted recruitment, in addition to offering a 'free' service, is associated with a reduction in social inequalities in self-reported utilization of the breast screening services in NSW, Australia. Using the 1997 and 1998 NSW Health Surveys we estimated probit models on the probability of having had a screening mammogram in the last two years for all women aged 40–79. The models examined the relative importance of socio-economic and geographic factors in predicting screening behaviour in three different needs groups – where needs were defined on the basis of a woman's age. We find that women in higher socio-economic groups are more likely to have been screened than those in lower groups for all age groups. However, the socio-economic effect is significantly less among women who were in the actively targeted age group. This indicates that recruitment and follow-up was associated with a modest reduction in social inequalities in utilisation although significant income differences remain.
Publisher: Springer Science and Business Media LLC
Date: 12-2012
DOI: 10.2165/11597280-000000000-00000
Abstract: The increasing cost of chemotherapy is placing greater pressures on limited healthcare budgets. A potentially important, but often overlooked, aspect of chemotherapy is the cost associated with administration. This study aims to develop a better understanding of these costs, and in doing so, develop a model to estimate the comparative cost of administering alternative chemotherapy protocols for economic evaluation or local decision making. We identified the potential tasks and choices related to administering intravenous chemotherapy, grouped tasks according to anticipated resource use, and allocated costs to each task using data from an evidence-based collection of cancer protocols or from primary data collection. The resources were costed from a healthcare system perspective using standard data sources within Australia. The model was applied to alternative protocols used in the treatment of three different cancers: locally advanced and metastatic non-small-cell lung cancer, adjuvant colorectal cancer and adjuvant breast cancer. For the three cancer types examined, the cost of completed administration ranged from 1274 Australian dollars ($A) to $A3015 (year 2009 values) for 13 different protocols potentially used for the initial treatment of locally advanced and metastatic non-small-cell lung cancer $A5175-8445 for seven protocols for adjuvant colorectal cancer treatment and $A1494-4074 for seven protocols for adjuvant breast cancer treatment. The results are of practical significance to those undertaking economic evaluations and to decision makers who use this information within the area of chemotherapy. The ex les used suggest that administration costs per visit varied inversely with the number of visits. The results provide information where little has previously been available and may allow decisions about costs and resource allocation to be made with more certainty. Although our model uses costs from the public health system within an Australian state (New South Wales), it can be adapted for use in other jurisdictions.
Publisher: Wiley
Date: 10-11-2021
Abstract: To establish a methodological approach to compare two high‐need, high‐cost (HNHC) patient personas internationally. Linked in idual‐level administrative data from the inpatient and outpatient sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) across 11 countries: Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States. We outline a methodological approach to identify HNHC patient types for international comparisons that reflect complex, priority populations defined by the National Academy of Medicine. We define two patient profiles using accessible patient‐level datasets linked across different domains of care—hospital care, primary care, outpatient specialty care, post‐acute rehabilitative care, long‐term care, home‐health care, and outpatient drugs. The personas include a frail older adult with a hip fracture with subsequent hip replacement and an older person with complex multimorbidity, including heart failure and diabetes. We demonstrate their comparability by examining the characteristics and clinical diagnoses captured across countries. Data collected by ICCONIC partners. Across 11 countries, the identification of HNHC patient personas was feasible to examine variations in healthcare utilization, spending, and patient outcomes. The ability of countries to examine linked, in idual‐level data varied, with the Netherlands, Canada, and Germany able to comprehensively examine care across all seven domains, whereas other countries such as England, Switzerland, and New Zealand were more limited. All countries were able to identify a hip fracture persona and a heart failure persona. Patient characteristics were reassuringly similar across countries. Although there are cross‐country differences in the availability and structure of data sources, countries had the ability to effectively identify comparable HNHC personas for international study. This work serves as the methodological paper for six accompanying papers examining differences in spending, utilization, and outcomes for these personas across countries.
Publisher: Elsevier BV
Date: 08-2018
DOI: 10.1016/J.SOCSCIMED.2018.06.008
Abstract: Understanding whether high healthcare costs for in iduals persist over time is critical for the development of policies that aim to reduce the prevalence of high cost patients. And while high healthcare costs will occur in any given year based on the prevalence of certain morbidities and acute conditions, a large random component of the distribution means that it is rarely the same people driving the bulk of healthcare expenditures. Using administrative data for over 250,000 Australian residents for the years between 2006 and 2011, we analyse the persistence of high annual healthcare costs. We examine the prevalence of high cost persistence in this s le, and then, we use endogenous switching models to identify the morbidity groups that are related with high cost persistence. These models also measure cases of cost lification that are associated with a history of high cost healthcare. This analysis uses data from multiple categories of healthcare, specifically medical services, pharmaceuticals and admitted patient care. While there is a relatively low number of patients with persistent high cost (approximately 3% of the s le), this group accounted for 19% of aggregate expenditure. Pharmaceuticals were the most persistently high cost category of healthcare with 5% of the s le accounting for 32% of aggregate pharmaceutical expenditure. The morbidities associated with notable cost lifications are morbidities that are hard to prevent or involve escalations of adverse health states that are difficult to avert. This casts doubt on whether broad policies can reduce the prevalence of in iduals with persistently high healthcare costs.
Publisher: Wiley
Date: 11-08-2021
Abstract: This study explores variations in outcomes of care for two types of patient personas—an older frail person recovering from a hip fracture and a multimorbid older patient with congestive heart failure (CHF) and diabetes. We used in idual‐level patient data from 11 health systems. We compared inpatient mortality, mortality, and readmission rates at 30, 90, and 365 days. For the hip fracture persona, we also calculated time to surgery. Outcomes were standardized by age and sex. Data was compiled by the International Collaborative on Costs, Outcomes and Needs in Care across 11 countries for the years 2016–2017 (or nearest): Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States. The hip s le across ranged from 1859 patients in Aragon, Spain, to 42,849 in France. Mean age ranged from 81.2 in Switzerland to 84.7 in Australia, and the majority of hip patients across countries were female. The congestive heart failure (CHF) s le ranged from 742 patients in England to 21,803 in the United States. Mean age ranged from 77.2 in the United States to 80.3 in Sweden, and the majority of CHF patients were males. Average in‐hospital mortality across countries was 4.1%. for the hip persona and 6.3% for the CHF persona. At the year mark, the mean mortality across all countries was 25.3% for the hip persona and 32.7% for CHF persona. Across both patient types, England reported the highest mortality at 1 year followed by the United States. Readmission rates for all periods were higher for the CHF persona than the hip persona. At 30 days, the average readmission rate for the hip persona was 13.8% and 27.6% for the CHF persona. Across 11 countries, there are meaningful differences in health system outcomes for two types of patients.
Publisher: Wiley
Date: 19-08-2021
Abstract: To compare within‐country variation of health care utilization and spending of patients with chronic heart failure (CHF) and diabetes across countries. Patient‐level linked data sources compiled by the International Collaborative on Costs, Outcomes, and Needs in Care across nine countries: Australia, Canada, England, France, Germany, New Zealand, Spain, Switzerland, and the United States. Patients were identified in routine hospital data with a primary diagnosis of CHF and a secondary diagnosis of diabetes in 2015/2016. We calculated the care consumption of patients after a hospital admission over a year across the care pathway—ranging from primary care to home health nursing care. To compare the distribution of care consumption in each country, we use Gini coefficients, Lorenz curves, and female–male ratios for eight utilization and spending measures. In all countries, rehabilitation and home nursing care were highly concentrated in the top decile of patients, while the number of drug prescriptions were more uniformly distributed. On average, the Gini coefficient for drug consumption is about 0.30 (95% confidence interval (CI): 0.27–0.36), while it is, 0.50 (0.45–0.56) for primary care visits, and more than 0.75 (0.81–0.92) for rehabilitation use and nurse visits at home (0.78 0.62–0.9). Variations in spending were more pronounced than in utilization. Compared to men, women spend more days at initial hospital admission (+5%, 1.01–1.06), have a higher number of prescriptions (+7%, 1.05–1.09), and substantially more rehabilitation and home care (+20% to 35%, 0.79–1.6, 0.99–1.64), but have fewer visits to specialists (−10% 0.84–0.97). Distribution of health care consumption in different settings varies within countries, but there are also some common treatment patterns across all countries. Clinicians and policy makers need to look into these differences in care utilization by sex and care setting to determine whether they are justified or indicate suboptimal care.
Publisher: Wiley
Date: 07-09-2021
Abstract: To identify and explore differences in spending and utilization of key health services at the end of life among hip fracture patients across seven developed countries. In idual‐level claims data from the inpatient and outpatient health care sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC). We retrospectively analyzed utilization and spending from acute hospital care, emergency department, outpatient primary care and specialty physician visits, and outpatient drugs. Patterns of spending and utilization were compared in the last 30, 90, and 180 days across Australia, Canada, England, Germany, New Zealand, Spain, and the United States. We employed linear regression models to measure age‐ and sex‐specific effects within and across countries. In addition, we analyzed hospital‐centricity, that is, the days spent in hospital and site of death. We identified patients who sustained a hip fracture in 2016 and died within 12 months from date of admission. Resource use, costs, and the proportion of deaths in hospital showed large variability being high in England and Spain, while low in New Zealand. Days in hospital significantly decreased with increasing age in Canada, Germany, Spain, and the United States. Hospital spending near date of death was significantly lower for women in Canada, Germany, and the United States. The age gradient and the sex effect were less pronounced in utilization and spending of emergency care, outpatient care, and drugs. Across seven countries, we find important variations in end‐of‐life care for patients who sustained a hip fracture, with some differences explained by sex and age. Our work sheds important insights that may help ongoing health policy discussions on equity, efficiency, and reimbursement in health care systems.
Publisher: Wiley
Date: 14-08-2021
Abstract: This study explores differences in spending and utilization of health care services for an older person with frailty before and after a hip fracture. We used in idual‐level patient data from five care settings. We compared utilization and spending of an older person aged older than 65 years for 365 days before and after a hip fracture across 11 countries and five domains of care as follows: acute hospital care, primary care, outpatient specialty care, post–acute rehabilitative care, and outpatient drugs. Utilization and spending were age and sex standardized.. The data were compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) across 11 countries as follows: Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States. The s le ranged from 1859 patients in Spain to 42,849 in France. Mean age ranged from 81.2 in Switzerland to 84.7 in Australia. The majority of patients across countries were female. Relative to other countries, the United States had the lowest inpatient length of stay (11.3), but the highest number of days were spent in post–acute care rehab (100.7) and, on average, had more visits to specialist providers (6.8 per year) than primary care providers (4.0 per year). Across almost all sectors, the United States spent more per person than other countries per unit ($13,622 per hospitalization, $233 per primary care visit, $386 per MD specialist visit). Patients also had high expenditures in the year prior to the hip fracture, mostly concentrated in the inpatient setting. Across 11 high‐income countries, there is substantial variation in health care spending and utilization for an older person with frailty, both before and after a hip fracture. The United States is the most expensive country due to high prices and above average utilization of post–acute rehab care.
Publisher: CSIRO Publishing
Date: 2012
DOI: 10.1071/AH11110
Abstract: Background. To save costs, the Australian Government recently deferred approval of seven new medicines recommended by the Pharmaceutical Benefits Advisory Committee (PBAC) for up to 7 months. Objectives. The aim of this research is to examine the timelines of PBAC applications following approval by the Therapeutic Goods Administration (TGA), allowing the recent Cabinet delays to be considered in the context of the overall medicines approval process. Methods. All new chemical entities and products for new indications approved in 2004 by the Australian Drug Evaluation Committee (ADEC) were identified. Outcomes of PBAC meetings from 2004 to 2010 were then searched to identify if and when these products were reviewed by PBAC. Results. ADEC recommended 63 eligible products for registration in 2004. Of the 113 submissions made to PBAC for these products, 66 were successful. Only 43% of the products were submitted to PBAC within 2 years, with an average 17-month delay from TGA approval of a product to consideration by the PBAC. Conclusions. Cabinet decisions to defer listing of new medicines delays access to new treatments. This occurred in addition to other longer delays, earlier in the approval process for medicines, resulting in a significant impact on the overall timeliness of listing. What is known about the topic? There is evidence that the time from registration of new drugs on the TGA to their listing for subsidised availability is increasing. The government’s recent decision to delay the listing of seven new drugs for subsidisation raised concerns about the potential for additional delays to impact the accessibility of new, affordable medicines for patients. What does this paper add? This paper examines delays at various stages in the process of approval for pharmaceutical subsidies on the Pharmaceutical Benefits Scheme (PBS), putting the deferral of new medicine listings in the overall context of the approval process. It identifies the potential role of pharmaceutical companies and product sponsors in delaying access to new, affordable medicines early in the approval process. What are the implications for practitioners? Delays in the subsidisation of medicines, wherever they occur in the process, not only reduce patient access, but may also lead to pressure in other areas of the health care system to finance such medicines. This makes these results of particular interest to clinician managers, health care managers and policy makers.
Publisher: AMPCo
Date: 03-2017
DOI: 10.5694/MJA16.01297
Publisher: SAGE Publications
Date: 10-2002
DOI: 10.1177/1357633X0200800501
Abstract: Current funding mechanisms can impede the efficient use and integration of telemedicine services. Telemedicine has developed in Australia against a background of complex funding arrangements and interwoven health-care responsibilities. These impediments are not unique to telemedicine but are accentuated by its ability to cover different locations, clinical areas and purposes. There is also a link between economic evaluation and funding mechanisms for telemedicine. While economic evaluations provide important information for the efficient allocation of resources, the funding environment in which telemedicine is established is also crucial in ensuring that services are efficient. Given these complexities, should telemedicine be funded? We conclude that this will depend on: the objectives and priorities of the health system the efficiency of telemedicine relative to that of other forms of health-care delivery and the funding environment. In terms of resource allocation processes, the optimum scenario is likely to be where the decision to invest in telemedicine services is made taking local needs into account, but where considerations such as market structure and network compatibility are examined on a broader scale and balanced against the principles of efficiency and equity.
Publisher: Wiley
Date: 20-06-2013
Publisher: SAGE Publications
Date: 2023
DOI: 10.1177/11786329231187891
Abstract: In a bid to improve quality of care, numerous countries have incorporated rewards and penalties into the funding and pricing of hospital services. This paper outlines recent advances in Australia to incorporate financial penalties for hospital acquired complications (HACs) and avoidable hospital readmissions (AHRs) adjustments into the funding of public hospital services. It describes the work in the development of suitable measures to identify episodes, the design of the analytical approach used for risk adjustment and the calculation of the funding implications including d ening effects to account for the level of risk. Using the 2019 to 20 round of data collection, this paper reports on the risk adjustment analysis, incremental costs of HACs and AHRs, and the funding d ening effects, the paper further discusses the implementation strategies undertaken by the Independent Health and Aged Care Pricing Authority (IHACPA) to ensure transparency, stakeholder consultation and engagement. The paper argues that both the technical development and its implementation strategies have been central to making safety and quality an integral and accepted part of Australia’s public hospital funding arrangements.
Publisher: Therapeutic Guidelines Limited
Date: 06-2007
Publisher: Elsevier BV
Date: 03-2013
DOI: 10.1016/J.JVAL.2012.12.003
Abstract: Cystic fibrosis (CF) is an inherited disease that requires more intensive treatments as the disease progresses. Recent medical advancements have improved survival but have also increased costs. Our lack of understanding on the relationship between disease severity and lifetime health care costs is a major impediment to the timely economic assessment of new treatments. Using data from three waves of the Australian Cystic Fibrosis Australia Data Registry, we estimate the annual costs of CF care by age and health state. We define health states on the basis of annual lung-function scores and patient's organ transplant status. We exploit the longitudinal nature of the data to model disease progression, and we use this to estimate lifetime health care costs. The mean annual health care cost for treating CF is US $15,571. Costs for patients with mild, moderate, and severe disease are US $10,151, US $25,647, and US $33,691, respectively. Lifetime health care costs are approximately US $306,332 (3.5% discount rate). The majority of costs are accounted for by hospital inpatients (58%), followed by pharmaceuticals (29%), medical services (10%), complications (2%), and diagnostic tests (1%). Our study is the first of its kind using the Australian Cystic Fibrosis Data Registry, and demonstrates the utility of longitudinal registry data for the purpose of economic analysis. Our results can be used as an input to future economic evaluations by providing analysts with a better understanding of the long-term cost impact when new treatments are developed.
Publisher: The Royal Australian College of General Practitioners
Date: 05-2018
Publisher: CSIRO Publishing
Date: 16-11-2022
DOI: 10.1071/AH21115
Abstract: Value-based health care has gained increasing prominence among funders and providers in efforts to improve the outcomes important to patients relative to the resources used to deliver care. In Australia, the value-based healthcare agenda has focused on reducing the use of ‘low-value’ interventions, redesigning models of care to improve integration between providers and increasing the use of patient-reported measures to drive improvement all have occurred within existing payment structures. In this paper we describe options for value-based payment reform and highlight two challenges critical for success: attributing financial risk fairly and organisational structures. What is known about the topic? ‘Fee for service’ is the dominant payment method in Australia and creates incentives to increase service volume, rewarding inputs rather than improvements in longer-term health outcomes. There is increasing recognition that payment reform is needed to support the shift to value-based health care in Australia. What does this paper add? This paper describes the three main options for value-based payment reform: episode-based bundled payments chronic condition bundled payments and comprehensive capitation payments. Each involves some degree of funds pooling, and the shifting of risk from the funder to provider to stimulate the more efficient use of resources. What are the implications for practitioners? We conclude that local hospital authorities in the states, private health insurers and primary health networks could implement reform as payment holders, but that capacity development in coordination and risk adjustment will be required. Successful implementation of payment reform will also require investment in data collection and information technology to track patients’ care and measure outcomes and costs.
Publisher: Informa UK Limited
Date: 11-12-2015
DOI: 10.1586/14737167.2015.990888
Abstract: Many of the issues with using data from clinical trials and observational studies for economic evaluations are highlighted in the case of chemotherapy side effects. We present the results of an observational cohort study using linked administrative data. The chemotherapy side effects identified in the administrative data are compared with patient self-reports of such events. The results of these comparisons are then used to guide a discussion of the issues surrounding the use of administrative data to identify clinical events for the population of economic models. Although the advantages of easy access and generalizability of the results make administrative data an attractive option for populating economic models, this is not always possible because of the limitations of these data.
Publisher: CSIRO Publishing
Date: 2014
DOI: 10.1071/AH13191
Publisher: Elsevier BV
Date: 07-2012
DOI: 10.1016/J.JCF.2012.02.007
Abstract: Carrier screening for cystic fibrosis is not widely available in Australia, partly due to concerns regarding its cost-effectiveness. The benefit of information from pregnancy to pregnancy has not been widely considered in existing cost-effectiveness analyses. A decision tree was constructed estimating costs and outcomes from screening, including both initial and subsequent pregnancies. Effectiveness was expressed in terms of CF births averted. Costs were collected using a health service perspective. All costs and outcomes were discounted at 5% per annum. Screening reduced the annual incidence of CF births from 34 to 14/100,000 births (an aggregate number of CF births of 100.9 and 41.9 respectively). In initial pregnancies, costs in the screening arm (A$16.6 million/100,000 births) exceed those in the non-screening arm (A$13.4 million/100,000 births). The incremental cost per CF birth in initial pregnancies is therefore approximately A$150,000. However, this was reversed for subsequent pregnancies, in that the pre-collected information reduces the incidence of CF in subsequent pregnancies at low additional costs. When aggregated, the results suggest screening is likely to be cost-saving. The introduction of national carrier screening for cystic fibrosis should be considered, as it is likely to reduce CF incidence at an acceptable (potentially negative) cost.
Publisher: AMPCo
Date: 11-2016
DOI: 10.5694/MJA15.01110
Abstract: Economic theory predicts that changing financial rewards will change behaviour. This is valid in terms of service use higher costs reduce health care use. It should follow that paying more for quality should improve quality however, the research evidence thus far is equivocal, particularly in terms of better health outcomes. One reason is that "financial incentives" encompass a range of payment types and sizes of reward. The design of financial incentives should take into account the desired change and the context of existing payment structures, as well as other strategies for improving quality further, financial incentives should be fair in rewarding effort. Financial incentives may have unintended consequences, including rewarding hospitals for selecting patients with lower risks, erting attention from the overall patient population to specific conditions, gaming, and "crowding out" or displacing intrinsic motivation. Managers and clinicians can only respond to financial incentives if they have the data, tools and skills to effect changes. Australia should not adopt widespread use of financial incentives for improving quality in health care without careful consideration of their design and context, the potential for unintended effects (particularly beyond their immediate targets), and evaluation of outcomes. The relative cost-effectiveness of financial incentives compared with, or in concert with, other strategies should also be considered.
Publisher: Elsevier BV
Date: 06-2021
Publisher: Oncology Nursing Society (ONS)
Date: 26-11-2010
Publisher: Public Library of Science (PLoS)
Date: 08-03-2019
Publisher: Cambridge University Press (CUP)
Date: 31-03-2009
DOI: 10.1017/S0266462309090187
Abstract: Objectives: Several studies have shown that a key determinant of successful health technology assessment (HTA) uptake is a clear, fair, and consistent decision-making process for the approval and introduction of health technologies. The aim of this study was to gauge healthcare providers' and managers' perceptions of local level decision making and determine whether these processes offer a conducive environment for HTA. An Area Health Service (AHS) aimed to use the results of this study to help design a new process of technology assessment and decision making. Methods: An online survey was sent to all health service managers and healthcare providers working in one AHS in Sydney, Australia. Questions related to perceptions of current health technology decisions in participants' own institution/facility and opinions on key criteria for successful decision-making processes. Results: Less than a third of participants agreed with the statements that local decision-making processes were appropriate, easy to understand, evidence-based, fair, or consistently applied. Decisions were reportedly largely influenced by total cost considerations as well as by the central state health departments and the Area executive. Conclusions: Although there are renewed initiatives in HTA in Australia, there is a risk that such investments will not be productive unless policy makers also examine the decision-making contexts within which HTA can successfully be implemented. The results of this survey show that this is especially true at the local level and that any HTA initiative should be accompanied by efforts to improve decision-making processes.
Publisher: CSIRO Publishing
Date: 04-05-2023
DOI: 10.1071/AH22293
Abstract: Objective To elucidate the policy implications of recent trends in the funding of radiotherapy services between 2009–10 and 2021–22. Method We use national aggregate claims data to determine time trends in the fees, benefits and out-of-pocket (OOP) costs of radiotherapy and nuclear therapeutic medicine claims funded through the Medicare Benefits Schedule (MBS) program. All dollar figures are expressed in constant 2021 Australian dollars. Results Radiotherapy and nuclear therapeutic medicine MBS claims increased by 78% whereas MBS funding increased by 137% between 2009–10 and 2021–22. The main driver of Medicare funding growth has been the Extended Medicare Safety Net, which has increased by 404%. Over the 13 year observation period, the percentage of bulk-billed claims peaked in 2017–18 at 76.1% but fell to 69.8% in 2021–22. For non-bulk billed services, average OOP costs per claim increased from $20.40 in 2009–10 to $69.78 in 2021–22. Conclusion Despite increased Medicare funding, patients face increasing financial barriers to access radiation oncology services. Policies with regard to funding radiotherapy services should be reviewed to ensure that services are easily accessible and affordable for all those needing treatment and at a reasonable cost to Government.
Publisher: Wiley
Date: 05-08-2021
Abstract: The objective of this study was to explore cross‐country differences in spending and utilization across different domains of care for a multimorbid persona with heart failure and diabetes. We used in idual‐level administrative claims or registry data from inpatient and outpatient health care sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) across 11 countries: Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States (US). Data collected by ICCONIC partners. We retrospectively analyzed age–sex standardized utilization and spending of an older person (65–90 years) hospitalized with a heart failure exacerbation and a secondary diagnosis of diabetes across five domains of care: hospital care, primary care, outpatient specialty care, post–acute rehabilitative care, and outpatient drugs. S le sizes ranged from n = 1270 in Spain to n = 21,803 in the United States. Mean age (standard deviation [SD]) ranged from 76.2 (5.6) in the Netherlands to 80.3 (6.8) in Sweden. We observed substantial variation in spending and utilization across care settings. On average, England spent $10,956 per person in hospital care while the United States spent $30,877. The United States had a shorter length of stay over the year (18.9 days) compared to France (32.9) and Germany (33.4). The United States spent more days in facility‐based rehabilitative care than other countries. Australia spent $421 per person in primary care, while Spain (Aragon) spent $1557. The United States and Canada had proportionately more visits to specialist providers than primary care providers. Across almost all sectors, the United States spent more than other countries, suggesting higher prices per unit. Across 11 countries, there is substantial variation in health care spending and utilization for a complex multimorbid persona with heart failure and diabetes. Drivers of spending vary across countries, with the United States being the most expensive country due to high prices and higher use of facility‐based rehabilitative care.
Publisher: SAGE Publications
Date: 07-2002
DOI: 10.1258/135581902320176368
Abstract: Without adequate information it is difficult to determine the success or failure of health policies. This paper assesses the adequacy of Australia& s health information for evidence-based policy. Three policy areas are analysed: the impact of changing the public and private health financing mix waiting lists and waiting times and pooling of funds. In each, the issue is analysed to identify the key policy questions, the available data and existing analyses are examined, and gaps in data availability and analysis are assessed. There is variability in the extent and usefulness of current health information. In terms of the impact of changing the financing mix, there is good information on the distribution of finance, but much less available on comparative use or efficiency of public and private hospitals. There is comprehensive information available on waiting lists and waiting times but little analysis of the implications of this for equity of access or the costs and benefits of reducing waiting times. There is insufficient information for the development of the capitation based formulae required for the introduction of the pooling of funds, nor enough information to assess the extent and impact of current cost-shifting which might be addressed by pooling funds. While the concept of evidence-based medicine has been embraced with regard to specific treatment decisions, there has not been a parallel investment in the use of evidence to drive policy decisions.
Publisher: Springer Science and Business Media LLC
Date: 23-10-2023
Publisher: Wiley
Date: 07-08-2020
DOI: 10.1111/AJAG.12707
Abstract: To examine changes in accommodation payments to residential aged care facilities following the introduction of consumer choice reforms in 2014. These reforms have allowed residents to choose between making lump sum refundable deposits and/or rental-style payments. Quantitative analysis was undertaken for facility-level quarterly data of 136 separate facilities, which were operated by six providers over the period under study. While the total pool of payments has grown strongly, consumers have increasingly favoured rental-style payments over lump sum refundable deposits. Consumer choice has changed the landscape of accommodation payment receipts in the provision of residential aged care services. Greater understanding is needed on how consumer preferences impact on the financial risk borne by providers and their ability to invest in future capacity.
Publisher: Wiley
Date: 12-09-2021
DOI: 10.1002/HEC.4427
Abstract: 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 in idual 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. We extend the analysis by also examining changes to patient out‐of‐pocket costs. We find significant differences in the mix between primary and specialist care use according to income and type of health shock but no evidence of using ED as a substitute for other care. Our results indicate that low‐ and high‐income patients navigate very different pathways for their care following the onset of diabetes and to a lesser extent heart disease. These pathways appear to be chosen on the basis of ability to pay, rather than the most effective or efficient bundle of care delivered through a combination of GP and specialist care.
Publisher: Wiley
Date: 21-05-2018
DOI: 10.1002/HEC.3779
Abstract: Australia is one of nine Organisation for Economic Co-operation and Development (OECD) countries that utilise deputising services to provide after-hours primary care. While the provision of this service is supposed to be on behalf of regular general practitioners, businesses have adapted to the financial incentives on offer and are directly advertising their services to consumers emphasising patient convenience and no copayments. The introduction of corporate entities has changed the way that deputising services operate. We use a difference-in-difference approach to estimate the amount of growth in urgent after-hours services that was not warranted by urgent medical need. These estimates are calculated by comparing the growth in urgent attendances that occurred during times of the day that are classified as "after-hours" (e.g., 6 pm-11 pm Monday to Friday) with those that are classified as "unsociable-hours" (e.g., 11 pm-7 am Monday to Friday). For the national level, we estimate that 593,141 unwarranted attendances were induced as urgent after-hours consultations in a single year. This corresponds to a national estimate of the total benefits paid for unwarranted demand of approximately $77 million. While deputising services have filled a short-fall in after-hours services, the overuse of urgent items has meant that that this has been achieved at a considerable cost to the Australian Government.
Publisher: Wiley
Date: 31-05-2009
Publisher: Wiley
Date: 07-07-2016
DOI: 10.1002/HEC.3376
Abstract: After a period of steady decline, out-of-pocket (OOP) costs for general practitioner (GP) consultations in Australia began increasing in the mid-1990s. Following the rising community concerns about the increasing costs, the Australian Government introduced the Strengthening Medicare reforms in 2004 and 2005, which included a targeted incentive for GPs to charge zero OOP costs for consultations provided to children and concession cardholders (older adults and the poor), as well as an increase in the reimbursement for all GP visits. This paper examines the impact of those reforms using longitudinal survey and administrative data from a large national s le of women. The findings suggest that the reforms were effective in reducing OOP costs by an average of $A0.40 per visit. Decreases in OOP costs, however, were not evenly distributed. Those with higher pre-reform OOP costs had the biggest reductions in OOP costs, as did those with concession cards. However, results also reveal increases in OOP costs for most people without a concession card. The analysis suggests that there has been considerable heterogeneity in GP responses to the reforms, which has led to substantial changes in the fees charged by doctors and, as a result, the OOP costs incurred by different population groups. Copyright © 2016 John Wiley & Sons, Ltd.
Publisher: Elsevier BV
Date: 06-2020
Publisher: Springer Science and Business Media LLC
Date: 21-09-2019
DOI: 10.1007/S10198-019-01118-2
Abstract: Equity in healthcare is an overarching goal of many healthcare systems around the world. Empirical studies of equity in healthcare utilisation primarily rely on the horizontal inequity (HI) approach which measures unequal utilisation of healthcare services by socioeconomic status (SES) for equal medical need. The HI method examines, quantifies, and explains inequity which is based on regression analysis, the concentration index, and the decomposition technique. However, this method is not beyond limitations and criticisms, and it has been subject to several methodological challenges in the past decade. This review presents a summary of the recent developments and debates on various methodological issues and their implications on the assessment of HI in healthcare utilisation. We discuss the key disputes centred on measurement scale of healthcare variables as well as the evolution of the decomposition technique. We also highlight the issues about the choice of variables as the indicator of SES in measuring inequity. This follows a discussion on the application of the longitudinal method and use of administrative data to quantify inequity. Future research could exploit the potential for health administrative data linked to social data to generate more comprehensive estimates of inequity across the healthcare continuum. This review would be helpful to guide future applied research to examine inequity in healthcare utilisation.
Publisher: The Royal Australian College of General Practitioners
Date: 09-2021
Publisher: Elsevier BV
Date: 12-2015
DOI: 10.1016/J.JVAL.2015.08.005
Abstract: This observational study aimed to identify clinical variables and health system characteristics associated with incomplete guideline application in drug treatment of patients with chronic heart failure (HF) across 15 countries. Three data sets were used: European Society of Cardiology Heart Failure Registry, Organisation for Economic Co-operation and Development's Health System Characteristics Survey, and Organisation for Economic Co-operation and Development Health Statistics 2013. Patient and country variables were examined by multilevel, multiple logistic regression. The study population consisted of ambulatory patients with chronic HF and reduced ejection fraction. Inappropriateness of prescription of pharmacological treatments was defined as patients not prescribed at least one of the two recommended treatments (angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers and beta-blockers) or treated with both medications but at suboptimal dosage and in absence of documented contraindication/intolerance. Of 4605 patients, 1097 (23.8%) received inappropriate drug prescriptions with a large variation within and across countries, with 18.5% of the total variability accounted for by between-country health structure characteristics. Patient-level characteristics such as having mitral regurgitation (odds ratio 1.4 95% confidence interval 1.1-1.7) was significantly associated with inappropriate prescription of recommended drugs, whereas chronic obstructive pulmonary disease (odds ratio 0.7 95% confidence interval 0.5-0.9) was associated with more appropriate prescriptions. Among the country-level variables, incentives or obligation to comply with guidelines increased the probability of prescription appropriateness. Combining clinical variables with health system characteristics is a promising exercise to explain the appropriateness of recommended drug prescriptions. Such an understanding can help decision makers to design more effective policies to improve adherence to guidelines, improve health care outcomes, and potentially reduce costs.
Publisher: Springer Science and Business Media LLC
Date: 28-06-2017
DOI: 10.1007/S40258-017-0336-8
Abstract: In Australia, as in many other Western countries, patient surveys suggest the costs of medicines lead to deferring or avoiding filling of prescriptions. The Australian Pharmaceutical Benefits Scheme provides approved prescription medicines at subsidised prices with relatively low patient co-payments. The Pharmaceutical Benefits Scheme defines patient co-payment levels per script depending on whether patients are "concessional" (holding prescribed pension or other government concession cards) or "general", and whether they have reached a safety net defined by total out-of-pocket costs for Pharmaceutical Benefits Scheme-approved medicines. The purpose of this study was to explore the impact of costs on adherence to statins in this relatively low-cost environment. Using data from a large-scale survey of older Australians in the state of New South Wales linked to administrative data from the national medical and pharmaceutical insurance schemes, we explore the relationships between adherence to medication regimes for statins and out-of-pocket costs of prescribed pharmaceuticals, income, other health costs, and a wide set of demographic and socio-economic control variables using both descriptive analysis and logistic regressions. Within the general non-safety net group, which has the highest co-payment, those with lowest income have the lowest adherence, suggesting that the general safety threshold may be set at a level that forms a major barrier to statin adherence. This is reinforced by over 75% of those who were not adherent before reaching the safety net threshold becoming adherent after reaching the safety net with its lower co-payments. The main financial determinant of adherence is the concessional/general and safety net category of the patient, which means the main determinant is the level of co-payment.
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/AH18146
Abstract: Objective Medication adherence is a significant public health concern. Australian studies of statins show patients facing the highest copayments are the least likely to be adherent. This study examined whether the association identified between adherence and costs for statins also applies to a wider group of medications prescribed for Australian patients with chronic conditions. Methods Data from 267086 participants in the Sax Institute’s 45 and Up Study linked to data from the Pharmaceutical Benefits Scheme (PBS) provided by the Department of Human Services were used. Patients using angiotensin II receptor blockers, angiotensin-converting enzyme inhibitors, glitazones and bisphosphonates were identified and classified according to concessional status and whether they had access to the PBS ‘safety net’. Data were analysed using mainly descriptive methods to investigate the association of adherence with cost and other selected covariates. Results Across medications, the group facing the highest copayment was least adherent. Speaking a language other than English at home and facing high levels of psychological distress were also associated with lower levels of adherence. Conclusions As for statins, the main financial determinant of adherence is cost in the form of prescribed copayments, suggesting that this may apply across many medications. What is known about the topic? Previous studies have shown patients’ concern about the costs of pharmaceuticals, and more detailed studies of statins show that the lowest adherence relates to patients facing the highest copayments. What does this paper add? This paper provides support for the contention that the results found for statins broadly apply across more medications used by people with chronic conditions. What are the implications for practitioners? Although practitioners cannot affect legislated copayments, they can consider the costs of options for medications for patients with chronic conditions, especially those general patients who have not reached the safety net, and they can be aware that patients from homes where English is not spoken and patients with high levels of psychological distress are also likely to have low adherence without intervention.
Publisher: Elsevier BV
Date: 09-2020
Publisher: American Medical Association (AMA)
Date: 10-12-2021
Publisher: Springer Science and Business Media LLC
Date: 09-08-2015
DOI: 10.1007/S10198-014-0621-5
Abstract: Cystic fibrosis (CF) is a progressive disease with treatments intensifying as patients get older and severity worsens. To inform policy makers about the cost burden in CF, it is crucial to understand what factors influence the costs and how they affect the costs. Based on 1,060 observations (from 731 patients) obtained from the Australian Data Registry, in idual annual health care costs were calculated and a regression analysis was carried out to examine the impact of multiple variables on the costs. A method of retransformation and a hypothetical patient were used for cost analysis. We show that an additional one unit improvement of FEV1pp (i.e., forced expiratory volume in 1 s as a percentage of predicted volume) reduces the costs by 1.4%, or for a hypothetical patient whose FEV1pp is 73 the cost reduction is A$252. The presence of chronic infections increases the costs by 69.9-163.5% (A$12,852-A$30,047 for the hypothetical patient) depending on the type of infection. The type of CF genetic mutation and the patient's age both have significant effects on the costs. In particular, being homozygous for p.F508del increases the costs by 26.8% compared to all the other gene mutations. We conclude that bacterial infections have a very strong influence on the costs, so reducing both the infection rates and the severity of the condition may lead to substantial cost savings. We also suggest that the patient's genetic profile should be considered as an important cost determinant.
Publisher: Wiley
Date: 07-05-2020
DOI: 10.1002/HPJA.348
Abstract: Health promotion programs are based on the premise that health and well‐being is impacted by a person's living circumstances, not just factors within the health arena. Chronic health issues require integrated services from health and social services. Navigator positions are effective in assisting chronic disease patients to access services. This family program in a small rural town in Western New South Wales targeted marginalised families with children under five years of age with a chronic health issue. The navigator developed a cross‐sectoral care plan to provide services to address family issues. The study aimed to identify navigator factors supporting improved family outcomes. Participants included parent/clients (n = 4) and the cross‐sectoral professional team (n = 9) involved in the program. During the interview, participants were asked about their perspective of the program. Interview transcripts were thematically analysed informed by the Chronic Care Model underpinned by Health Promotion Theory. The program improved client family's lives in relation to children's health and other family health and social issues. Trust in the care navigator was the most important factor for parents to join and engage with the program. The care navigator role was essential to maintaining client engagement and supporting cooperation between services to support families. Essential care navigator skills were commitment, ability to persuade and empower parents and other professionals. This descriptive study demonstrated the positive influence of the care navigator and the program on high risk families in a small isolated community. It can be adopted by other communities to improve life for families at risk.
Publisher: Wiley
Date: 13-04-2015
DOI: 10.1111/AJCO.12354
Abstract: To determine the monthly treatment costs for each element of cancer care in patients receiving chemotherapy and to apportion the burden of cost by financing agent (Commonwealth, State government, private health insurer, patient). A cohort of 478 patients (54% breast, 33% colorectal and 13% non-small-cell lung cancer) were recruited from 12 centers representing metropolitan and regional settings in public and private sectors. Primary data were linked to secondary data held in New South Wales state (Admitted Patients and Emergency Department Data) and Commonwealth (Medicare and Pharmaceutical Benefits) databases. The monthly treatment costs of each element of care and the funding agent were calculated from secondary health data. Across all tumor types, the mean monthly treatment cost was $4162 (10%-90% quantiles $1018-$8098 range $2853 [adjuvant colorectal] to $5622 [metastatic lung]), with 54% of this cost borne by Commonwealth government, 26% by private health insurers, 14% by State government and 6% by patients. The mean monthly costs of treating metastatic disease were $1415 greater than those for adjuvant therapy. The mean monthly costs were contributed to by inpatient care ($1657, 40%), chemotherapy prescriptions ($1502, 36%), outpatient care ($452, 11%) and administration of chemotherapy ($364, 9%). All four funders have a shared incentive to reduce absolute monthly treatment costs since their proportional contribution is relatively constant for most tumor types and stages. There are opportunities to reduce cancer care costs by minimizing the risk of inpatient hospital admissions that arise from chemotherapy administration and by recognizing incentives for cost-shifting.
Publisher: Springer Science and Business Media LLC
Date: 03-2002
DOI: 10.1007/S10198-001-0090-5
Abstract: Portfolio theory is central to the analysis of risk in many areas of economics but is seldom used appropriately in health economics. This contribution examines the use of portfolio theory in the context of cost-effectiveness analysis (CEA). A number of modifications are needed to apply portfolio analysis to the economic evaluation of health care interventions. First, the method of reporting the results of a CEA, and consequently some of the underlying assumptions, needs to be modified. Second, portfolio theory needs to be expressed in terms of effects on in iduals aggregated to a population. Finally, one needs to allow for the possibility of synergy between the various health interventions. This paper derives a general formula for a portfolio of health care interventions that allows for synergies between interventions where the population effects are aggregated from in idual effects. A number of special cases are also derived to highlight the nature of the formulation of the modified portfolio theory. We conclude that, while modified portfolio theory adds a theoretical foundation to health care evaluations, it may not be operational until estimates of the correlation between interventions are available, and the question of uncertainty is resolved in health care evaluation. Also, while a synergy may be present at the in idual level, when aggregated over a large population it may not be significant given the standard assumption of constant returns to scale.
Publisher: Informa UK Limited
Date: 19-05-2018
Publisher: Wiley
Date: 21-07-2016
DOI: 10.1111/DAR.12302
Abstract: This study estimates the burden of drug and alcohol morbidity on hospitals in New South Wales (NSW) by observing a multi-site collective s le utilising survey information and data linkage. Specifically we aimed to determine the prevalence of alcohol and other drug (AOD) problems and to estimate patterns of utilisation of hospital services, costs of presentations, and admissions for patients with AOD problems. Patients were recruited from eight NSW public hospitals presenting to the hospital emergency department over a 10 day period. Participants completed a self-administered survey with demographic characteristics and questions about substance use. More than two-thirds (68%) of participants consented to provide access to their NSW Health medical data for a period spanning 2.5 years. One-third (35%) of the total s le were identified as having problematic AOD use with one in five of these patients requiring a high level of intervention. Those patients requiring a high level of intervention present more often and cost more per presentation. If admitted they were more likely to have longer stays and were also more likely to be admitted to a psychiatric ward and have a longer stay in the ward. This study demonstrates a need for AOD interventions in the emergency department setting, both because it represents an opportunity for intervention in a population in which problems with substance use is highly prevalent, and because there is evidence that AOD imposes additional costs on the health system. [Butler K, Reeve R, Arora S, Viney R, Goodall S, van Gool K, Burns L. The hidden costs of drug and alcohol use in hospital emergency departments. Drug Alcohol Rev 2016 :359-366].
Publisher: Oxford University Press (OUP)
Date: 10-03-2015
Abstract: To review and update the conceptual framework, indicator content and research priorities of the Organisation for Economic Cooperation and Development's (OECD) Health Care Quality Indicators (HCQI) project, after a decade of collaborative work. A structured assessment was carried out using a modified Delphi approach, followed by a consensus meeting, to assess the suite of HCQI for international comparisons, agree on revisions to the original framework and set priorities for research and development. International group of countries participating to OECD projects. Members of the OECD HCQI expert group. A reference matrix, based on a revised performance framework, was used to map and assess all seventy HCQI routinely calculated by the OECD expert group. A total of 21 indicators were agreed to be excluded, due to the following concerns: (i) relevance, (ii) international comparability, particularly where heterogeneous coding practices might induce bias, (iii) feasibility, when the number of countries able to report was limited and the added value did not justify sustained effort and (iv) actionability, for indicators that were unlikely to improve on the basis of targeted policy interventions. The revised OECD framework for HCQI represents a new milestone of a long-standing international collaboration among a group of countries committed to building common ground for performance measurement. The expert group believes that the continuation of this work is paramount to provide decision makers with a validated toolbox to directly act on quality improvement strategies.
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.JSAT.2016.05.008
Abstract: Consultation liaison (CL) services provide direct access to specialist services for support, treatment advice and assistance with the management of a given condition. Alcohol and other drugs (AOD) CL services aim to improve identification and treatment of patients with AOD morbidity. Our objective was to evaluate the costs and consequences of AOD CL services in hospitals in New South Wales, Australia. Patients were surveyed at eight hospitals and problematic AOD use was identified using the Alcohol, Smoking and Substance Involvement Screening Test (n=1615). For consenting participants, medical record data were obtained from 18 months pre- to 12 months post-survey. We used interrupted time series analyses to compare utilization and costs for patients with and without AOD problems and changes over time between those who received AOD CL and similar patients. Approximately 35% of patients surveyed had AOD problems (excluding tobacco) with 7% requiring intensive treatment. Only 24% of patients requiring intensive treatment were treated by AOD CL. Those treated had relative improvements over time in the cost of presentations to emergency departments, emergency admission performance and increased uptake of appropriate pharmaceuticals. The estimated net benefit of AOD CL services was at least AUD$100,000 savings per hospital per year. Expanding AOD CL services to address current unmet need may lead to even greater cost savings for hospitals.
Publisher: Elsevier BV
Date: 11-2020
Publisher: CSIRO Publishing
Date: 2008
DOI: 10.1071/AH080520
Abstract: This study describes health care decision makers? perceptions about decision making processes for the introduction, diffusion and prioritisation of new health technologies at the regional and institutional level. The aim of the study was to aid the design of a new process of technology assessment and decision making for the Northern Sydney and Central Coast Area Health Service (NSCCAHS). Twelve in-depth, semi-structured interviews were conducted with senior health service managers, nurse managers and senior medical clinicians in the NSCCAHS. Interviewees described prioritisation and decision-making processes as ?ad hoc?. Safety and effectiveness were considered the most important criteria in decision making but budgetary consideration often drove decisions about the uptake and diffusion of new technologies. Current dissatisfaction with decision- making processes creates opportunities for reform, including the introduction of consistent local technology assessments.
Publisher: Cambridge University Press (CUP)
Date: 17-06-2013
DOI: 10.1017/S026646231300024X
Abstract: Introduction: Many governments have introduced health technology assessment (HTA) as an important tool to manage the uptake and use of health-related technologies efficiently. Although surgeons play a central role in the uptake and diffusion of new technologies, little is known about their opinion and understanding of the HTA role and process. Methods: A cross-sectional pilot study was conducted using an online questionnaire which was distributed to Fellows of the Royal Australasian College of Surgeons over a 4-week period. Information was sought about knowledge and views of the HTA process. Descriptive statistics were used to summarize the data, frequencies, and proportions were calculated. Results: Sixty-two surgeons completed the survey of these, 55 percent reported their primary work place as a public hospital. Twenty-four percent of the participants reported that they had never heard of the HTA agency and 60 percent reported that surgical procedures are most likely to be introduced in the Australian healthcare system at the public hospital level (which is beyond the HTA's scope and dealt with at a state level). However, 61 percent considered that decisions about funding and adoption of new technologies should take place at the national level. Conclusions: This survey provides some evidence that many surgeons remain unaware of the federal government's HTA process but still value evidence-based information. In order for HTA to be an effective aid to rational adoption of health-related technologies, there is a need for an evidence-based approach that is integrated and is accepted and understood by the medical professions.
Publisher: Elsevier BV
Date: 02-2008
DOI: 10.1016/J.HEALTHPOL.2007.07.007
Abstract: To critically examine the economic evidence regarding cystic fibrosis (CF) carrier screening and to understand issues relating to the transferability of international findings to any national context for policy decisions. A systematic literature search identified 14 studies (out of 29 economic studies on CF) focusing on preconception or prenatal screening between 1990 and 2006. These studies were then assessed against international benchmarks on conducting and reporting of economic evaluations, costing methodology used and focusing on the transferability of the evidence to national contexts. The primary outcome measures varied considerably between studies and there was considerable ambiguity and variation on how costs were estimated. The Incremental Cost Effectiveness Ratio (ICER) and net savings, for preconception and prenatal screening were inconsistent and varied significantly, even after adjusting for timing and exchange rates. Differences in screening participation rates, reproductive choices, test sensitivity, cost of test and lifetime cost of care make up a large part of the ICER variations. The heterogeneity in study design, model inputs and reporting of economic evaluations of CF carrier screening makes comparability and transferability across countries and even within countries difficult. This reinforces the need to assess any technology within the relevant context, and to not simply generalize from reported studies. In turn, this adds to the complex task of making efficient resource allocation decisions in the area of CF carrier screening. Our evaluation adds weight to the calls for revisiting the way economic studies are conducted and reported.
Publisher: Springer Science and Business Media LLC
Date: 2007
DOI: 10.2165/00019053-200725120-00006
Abstract: Like other countries, Australia has had some success in incorporating economic evidence into national healthcare decisions. However, it has been recognised that this coverage does not extend to the local hospital or health region level. An extensive body of research has identified barriers to the use of economic evidence at the local level, leading some commentators to suggest that economic evaluation should only be targeted at national decision-making bodies. Yet, local decision makers in Australia and elsewhere make important choices about the uptake and diffusion of healthcare technologies. We propose a number of interrelated options to address the barriers that currently prohibit the use of economic evaluation by local decision makers in many jurisdictions. These include wider dissemination of user friendly models, inclusion of assessments of the cost impact of interventions on various budgets, and the establishment of an authoritative body that ensures the production of high quality economic models. It is argued that these options can have a significant impact on the way economic evaluations are conducted, reported, disseminated and used.
Publisher: Elsevier BV
Date: 05-2019
Publisher: Wiley
Date: 28-08-2008
Publisher: Public Library of Science (PLoS)
Date: 28-03-2022
DOI: 10.1371/JOURNAL.PNTD.0010288
Abstract: Crusted scabies is a debilitating dermatological condition. Although still relatively rare in the urban areas of Australia, rates of crusted scabies in remote Aboriginal communities in the Northern Territory (NT) are reported to be among the highest in the world. To estimate the health system costs associated with diagnosing, treating and managing crusted scabies. A disease pathway model was developed to identify the major phases of managing crusted scabies. In recognition of the higher resource use required to treat more severe cases, the pathway differentiates between crusted scabies severity grades. The disease pathway model was populated with data from a clinical audit of 42 crusted scabies patients diagnosed in the Top-End of Australia’s Northern Territory between July 1, 2016 and May 1, 2018. These data were combined with standard Australian unit costs to calculate the expected costs per patient over a 12-month period, as well as the overall population cost for treating crusted scabies. The expected health care cost per patient diagnosed with crusted scabies is $35,418 Australian dollars (AUD) (95% CI: $27,000 to $43,800), resulting in an overall cost of $1,558,392AUD (95% CI: $1,188,000 to $1,927,200) for managing all patients diagnosed in the Northern Territory in a given year (2018). By far, the biggest component of the health care costs falls on the hospital system. This is the first cost-of-illness analysis for treating crusted scabies. Such analysis will be of value to policy makers and researchers by informing future evaluations of crusted scabies prevention programs and resource allocation decisions. Further research is needed on the wider costs of crusted scabies including non-financial impacts such as the loss in quality of life as well as the burden of care and loss of well-being for patients, families and communities.
Location: France
No related grants have been discovered for Kees van Gool.