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Dr Meliyanni Johar

Biography

Dr Meliyanni Johar received first class Honours in Economics from the University of Sydney in 2005 and a PhD in Economics from the University of New South Wales in November 2009. She joined the Economics Discipline Group in July 2011 as a Research Fellow (Health Economics) and became a Senior Research Fellow in the EDG in 2012. Previously, she was affiliated with the Centre for Health Economics Research and Evaluation (CHERE), UTS. Dr Johar’s research is mainly in applied econometrics. She has published in top journals such as the Journal of Health Economics, the Journal of Applied Econometrics, the Social Science and Medicine, the Economic Record and Health Economics. She was also a co-leader of the “Review of Extended Medicare Safety Net Capping” commissioned for the Australian Department of Health and Ageing in 2010. She is a co-author of the chapter “Waiting times policies in the Australian health system” in the OECD book Waiting times policies in the health sector: what works? In 2012, Meliyanni won the UTS Vice Chancellor's Early Career Research Excellence Award, and in 2013, she was awarded an ARC Discovery Early Career Researcher Award.

Associate Professor, Economics Discipline Group
Core Member, Centre for the Study of Choice
B.Com (Hons) USYD, PhD
Member, International Health Economics Association
Member, Australian Health Economics Society
Download CV  (PDF, 175 Kb, 5 pages)
Phone
+61 2 9514 4742
Fax
+61 2 9514 4730
Room
CB91.4.31501
Can supervise: Yes

Book Chapters

Johar, M., Jones, G., Savage, E.J., Sharma, A. & Harris, A. 2013, 'Australia' in Luigi Siciliani, Michael Borowitz and Valerie Moran (eds), Waiting times policies in the health sector: What works?, OECD, US, pp. 71-97.

Conference Papers

Johar, M., Jones, G., Keane, M., Savage, E.J. & Stavrunova, O. 2010, 'Expected waiting times and the decision to buy private health insurance', 1st Australasian Workshop on Econometrics and Health Economics, Melbourne, March 2010.
Johar, M., Jones, G., Keane, M., Savage, E.J. & Stavrunova, O. 2010, 'The demand for private health insurance: Do waiting lists or waiting times matter?', American Society of Health Economists Conference, Cornell University, USA, June 2010.
Johar, M., Jones, G., Keane, M., Savage, E.J. & Stavrunova, O. 2010, 'The demand for private health insurance: Do waiting lists or waiting times matter?', European Conference of Health Economics, Helsinki, Finland, July 2010.
Johar, M., Jones, G., Keane, M., Savage, E.J. & Stavrunova, O. 2009, 'The influence of waiting times on the decision to purchase private health insurance', Labour Econometrics Workshop, Brisbane, August 2009.

Journal Articles

Johar, M., Jones, G. & Savage, E.J. 2014, 'What explains the quality and price of GP services? An investigation using linked survey and administrative data', Health Economics, vol. 23, no. 9, pp. 1115-1133.
Johar, M., Fiebig, D.G., Haas, M.R. & Viney, R.C. 2013, 'Using repeated choice experiments to evaluate the impact of policy changes on cervical screening', Applied Economics, vol. 45, no. 14, pp. 1845-1855.
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Australia was one of the first countries to introduce a publicly funded Human Papilloma Virus (HPV) vaccine program, and its introduction coincided with a media campaign to promote regular cervical screening. One issue with HPV vaccination is how it impacts on demand for screening. This study examines changes in women's screening preferences following these two interventions, using a novel approach to policy evaluation based on repeated discrete choice experiments. The study extends our previous analysis of attitudes to screening by taking advantage of the timing of the choice experiments to examine the impact of the two policy changes on determinants of screening. We find that, unexpectedly, willingness to screen is generally lower post-interventions. The reason for this trend appears to be related to HPV vaccination. We also find that interventions have minor impacts on how women value screening attributes. Our approach allows us to examine the impact of provider behaviour. A simulation demonstrates that under certain conditions, participation rates can be increased by 40% to 50% if health providers actively encourage women to undertake a cervical screening test.
Johar, M., Jones, G. & Savage, E.J. 2013, 'Emergency admissions and elective surgery waiting times', Health Economics, vol. 22, no. 6, pp. 749-756.
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An average patient waits between 2 and 3 months for an elective procedure in Australian public hospitals. Approximately 60% of all admissions occur through an emergency department, and bed competition from emergency admission provides one path by which waiting times for elective procedures may be lengthened. In this article, we investigated the extent to which public hospital waiting times are affected by the volume of emergency admissions and whether there is a differential impact by elective patient payment status. The latter has equity implications if the potential health cost associated with delayed treatment falls on public patients with lower ability to pay. Using annual data from public hospitals in the state of New South Wales, we found that, for a given available bed capacity, a one standard deviation increase in a hospital's emergency admissions lengthens waiting times by 19 days on average. However, paying (private) patients experience no delay overall. In fact, for some procedures, higher levels of emergency admissions are associated with lower private patient waiting times.
Johar, M., Jones, G., Keane, M., Savage, E.J. & Stavrunova, O. 2013, 'Discrimination in a universal health system: Explaining socioeconomic waiting times gaps', Journal Of Health Economics, vol. 32, no. 1, pp. 181-194.
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One of the core goals of a universal health care system is to eliminate discrimination on the basis of socioeconomic status. We test for discrimination using patient waiting times for non-emergency treatment in public hospitals. Waiting time should reflect patients+ clinical need with priority given to more urgent cases. Using data from Australia, we find evidence of prioritisation of the most socioeconomically advantaged patients at all quantiles of the waiting time distribution. These patients also benefit from variation in supply endowments. These results challenge the universal health system+s core principle of equitable treatment.
Johar, M., Jones, G. & Savage, E.J. 2013, 'The effect of lifestyle choices on emergency department use in Australia', Health Policy, vol. 110, no. 2-3, pp. 280-290.
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Background: Much attention has been paid to patient access to emergency services, focusing on hospital reforms, yet very little is known about the characteristics of those presenting to emergency departments. Objectives: By exploiting linkage of emergency records and a representative survey of the 45 and older population in Australia, we provide unique insights into the role of lifestyle in predicting emergency presentations. Methods: A generalized linear regression model is used to estimate the impact of lifestyles on emergency presentations one year ahead. We control for extensive individual characteristics and area fixed-effects. Results: Not smoking, having healthy body weight, taking vitamins, and exercising vigorously and regularly can reduce emergency presentations and also prevent subsequent admissions from emergency. There is no evidence that heavy drinking leads to more frequent emergency visits, but we find a high tendency for heavy drinkers to smoke and be in poor health, which are both major predictors of emergency visits. Conclusions: Targeted public health interventions on smoking, body mass and exercise may reduce emergency visits. Effective public health interventions which target body mass, exercise, current smoking and smoking initiation, may have the effect of reducing ED usage and subsequent admission.
Ellis, R., Fiebig, D.G., Johar, M., Jones, G. & Savage, E.J. 2013, 'Explaining health care expenditure variation: Large-sample evidence using linked survey and health administrative data', Health Economics, vol. 22, no. 9, pp. 1093-1110.
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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. We use this data to distinguish between cost variations due to health shocks and those that are intrinsic (fixed) to an individual over three years. We find that high fixed expenditures are positively associated with age, especially older males, poor health, obesity, smoking, cancer, stroke and heart conditions. Being foreign born, speaking a foreign language at home and low income are more strongly associated with higher time-varying expenditures, suggesting greater exposure to adverse health shocks
Johar, M. & Savage, E.J. 2013, 'Discovering unhealthiness: Evidence from cluster analysis', Annals of Epidemiology, vol. 23, no. 10, pp. 614-619.
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Purpose This study examines information on an array of health limitations, chronic conditions, treatments, and drug consumptions to reveal the prevalence and severity of unhealthiness that are not directly observed. Methods Cluster analysis is applied to 265,468 individuals who participated in the 45 and Up Study in Australia. Results Among the study participants, 8% of those age 45-54 years, 10% of those age 55-64, 13% of those age 65-74, and 17% of those age 75 and older were classified as unhealthy. For the youngest individuals, unhealthiness is characterized by moderate-to-high mental distress, a poor physical health score equivalent to the score associated with having four major limitations in physical functioning, teeth health less than good, and having been diagnosed with at least two chronic conditions. The oldest individuals also suffer from these limitations, as well as dependence on at least three different drug groups and two medical treatments, but they are in better mental health state. Conclusions Understanding unhealthiness across population groups will result in more effective allocation of health resources. Older populations require more resources to be devoted to the management of physical health and chronic illnesses.
Suziedelyte, A. & Johar, M. 2013, 'Can you trust survey responses? Evidence using objective health measures', Economics Letters, vol. 121, no. 2, pp. 163-166.
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We investigate the common assumption in applied research that reporting errors are negligible in variables where there is no clear incentive for misreporting. Using major medical operations, we find high misreporting rates, but the coefficients of their predictors remain unbiased.
Johar, M., Jones, G., Keane, M., Savage, E.J. & Stavrunova, O. 2012, 'Geographic differences in hospital waiting times', Economic Record, vol. 88, no. 281, pp. 165-181.
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Access to elective surgery in Australian public hospitals is rationed using waiting lists. In this article, we undertake a DiNardo-Fortin-Lemieux reweighting approach to attribute variation in waiting time to clinical need or to discrimination. Using data from NSW public patients in 2004-2005, we find the discrimination effect dominates clinical need especially in the upper tail of the waiting time distribution. We find evidence of favourable treatment of patients who reside in remote areas and discrimination in favour of patients residing in particular Area Health Services. These findings have policy implications for the design of equitable quality targets for public hospitals.
Johar, M. 2012, 'Do doctors charge high income patients more?', Economics Letters, vol. 117, no. 3, pp. 596-599.
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When doctors are unconstrained in setting fees, they charge higher fees to high income patients. For a standard GP consultation, the average fee gap is 25% of a minimum price. Competition closes this gap, but not local area income.
Johar, M. & Savage, E.J. 2012, 'Sources of advantageous selection: Evidence using actual health expenditure risk', Economics Letters, vol. 116, no. 3, pp. 579-582.
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In a market where insurers are not allowed to risk rate, we find evidence of advantageous selection using observed health expenditure risk. Selection is driven by income and optimism about the future. This may explain insurers' profitability, despite community rating.
Johar, M. & Katayama, H. 2012, 'Quantile regression analysis of body mass on wages', Health Economics, vol. 21, no. 5, pp. 597-611.
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Using the National Longitudinal Survey of Youth 1979, we explore the relationship between body mass and wages. We use quantile regression to provide a broad description of the relationship across the wage distribution. We also allow the relationship to vary by the degree of social skills involved in different jobs. Our results find that for female workers body mass and wages are negatively correlated at all points in their wage distribution. The strength of the relationship is larger at higher-wage levels. For male workers, the relationship is relatively constant across wage distribution but heterogeneous across ethnic groups. When controlling for the endogeneity of body mass, we find that additional body mass has a negative causal impact on the wages of white females earning more than the median wages and of white males around the median wages. Among these workers, the wage penalties are larger for those employed in jobs that require extensive social skills. These findings may suggest that labor markets reward white workers for good physical shape differently, depending on the level of wages and the type of job a worker has.
Johar, M., Jones, G. & Savage, E.J. 2012, 'Healthcare expenditure profile of older Australians: Evidence from linked survey and health administrative data', Economic Papers, vol. 31, no. 4, pp. 451-463.
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This article provides a comprehensive profile of individual healthcare expenditure using the 45 and Up Study of over 267,000 NSW residents linked to administrative medical service records. Individuals aged 45 and over consume two-thirds of healthcare expenditure in Australia. We compute annual total healthcare expenditure comprising hospital admissions, emergency presentations, out-of-hospital medical consultations and diagnostic tests and subsidised drugs. The average annual expenditure in the sample is $4334 in 2009 dollars. Less than 3 per cent have zero expenditure. Health service mix varies with age, with the share of hospital expenditure increasing with age. The age trends of total expenditure and its components are then examined by key demographic, socioeconomic and health characteristics, providing important insights into future healthcare demand and a foundation for future research into the drivers of healthcare expenditures and the distribution of health subsidies.
Johar, M. & Maruyama, S. 2011, 'Intergenerational cohabitation in modern Indonesia: Filial support and dependence', Health Economics, vol. 20, no. S1, pp. 87-104.
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Informal filial care plays an important role for elderly parents facing health challenges. Ageing, however, exacerbates the burden of filial care because the ratio of older to younger individuals is higher and disabled parents live longer. The well-being of elderly parents is even more insecure in Asian developing countries that are undergoing unprecedented ageing and drastic changes in social norms and values, whereas old-age support systems have yet to be developed. In this paper, we investigate factors that influence cohabitation decision by elderly parents and their adult children using the longitudinal Indonesian Family Life Survey (IFLS). Focusing on new cohabitation in which a parent who lives independently starts to cohabitate with a child, we conduct transition analysis to make a more convincing causal interpretation than the standard cross-sectional approach. We find that, while parental needs are important, cohabitation is influenced to a larger extent by the costs and gains of children. The elderly facing health and economic challenges are at higher risk of not receiving filial support than other elderly individuals.
Johar, M., Jones, G., Keane, M., Savage, E.J. & Stavrunova, O. 2011, 'Waiting times for elective surgery and the decision to buy private health insurance', Health Economics, vol. 20, no. S1, pp. 68-86.
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More than 45% of Australians buy health insurance for private treatment in hospital. This is despite having access to universal and free public hospital treatment. Anecdotal evidence suggests that avoidance of long waits for public treatment is one possible explanation for the high rate of insurance coverage. In this study, we investigate the effect of waiting on individual decisions to buy private health insurance. Individuals are assumed to form an expectation of their own waiting time as a function of their demographics and health status. We model waiting times using administrative data on the population hospitalised for elective procedures in public hospitals and use the parameter estimates to impute the expected waiting time and the probability of a long wait for a representative sample of the population. We find that expected waiting time does not increase the probability of buying insurance but a high probability of experiencing a long wait does. On average, waiting time has no significant impact on insurance. In addition, we find that favourable selection into private insurance, measured by self-assessed health, is no longer significant once waiting time variables are included. This result suggests that a source of favourable selection may be aversion to waiting among healthier people.
Johar, M. & Rammohan, A. 2011, 'The role of family networks and gender on borrowing behavior in Indonesia', Journal of Developing Areas, vol. 45, no. Fall, pp. 111-134.
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In this paper, we use the nationally representative Indonesian Family Life Survey dataset (IFLS-3), to examine if access to loans from informal networks such as family and friends influences borrowing behavior in formal credit markets. Our empirical results show that there is a gender dimension to borrowing behavior, with females being more likely to receive loans from family members. However, access to loans from family does not lower their propensity to seek out formal credit. For males, access to family loans does not affect borrowing propensity but it increases the size of borrowing from the formal sector. From a policy perspective, our results indicate that education plays an important role in improving an individual.s access to financial credit markets and reducing their dependence on internal networks.
Johar, M. & Savage, E.J. 2010, 'Do private patients have shorter waiting times for elective surgery? Evidence from New South Wales public hospitals', Economic Papers, vol. 29, no. 2, pp. 128-142.
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The Productivity Commission (2008) identified waiting times for elective surgery as a measure of governments+ success in providing accessible health care. At the 2007 COAG meeting, the Prime Minister identified reduction of elective surgery waiting times in public hospitals as a major policy priority. To date, the analysis of waiting time data has been limited to summary statistics by medical procedure, doctor specialty and state. In this paper, we look behind the summary statistics and analyse the extent to which private patients are prioritised over comparable public patients in public hospitals. Our empirical evidence is based on waiting list and admission data from public hospitals in NSW for 2004+2005. We find that private patients have substantially shorter waiting times, and tend to be admitted ahead of their listing rank, especially for procedures that have low urgency levels. We also explore the benefits and costs of this preferential treatment on waiting times.
Johar, M. 2010, 'The effect of a public health card program on the supply of health care', Social Science & Medicine, vol. 70, no. 10, pp. 1527-1535.
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The supply-side responsiveness to public programs targeted to consumers is not widely studied. However, it is unlikely that supply variables remain constant, particularly when their link to the demand initiative is weak. The aim of this study is to provide such analysis, using the experience of the Indonesian health card program, which is a demand-sided program. Without an increase in staff or an appropriate salary revision, the salary payment system of the public sector may not adequately reward the existing health workers, lowering their incentives to maintain their public position. Using data from the Indonesian Family Life Surveys on public health centres, the leading providers of outpatient services in the public sector, this study found some evidence that the health card program resulted in a reduction in the number of full-time GPs working in these facilities. Other conditions not related to workers' compensation, such as infrastructure conditions and registration fees, were not adversely affected. Identification of this program's effect is achieved by variations in time and the intensity of health card distribution across communities. The findings highlight the importance of public policy management in general, and sheds light on physicians' behaviour in developing countries, about which we know very little.
Johar, M. 2010, 'Three essays on econometric evaluation of public health interventions [thesis abstract]', Bulletin of Indonesian Economic Studies, vol. 46, no. 1, pp. 112-113.
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This dissertation consists of three independent essays evaluating the impact of public health interventions in Indonesia and Australia. The fi rst two essays concern the health card program in Indonesia. The program aims to allow poor households access to primary health care by providing a price subsidy for treatment at public health facilities. The data are derived from a longitudinal study of households, the Indonesian Family Life Survey (IFLS).
Johar, M. 2009, 'The Impact of the Indonesian Health Card Program: A Matching Estimator Approach', Journal Of Health Economics, vol. 28, no. 1, pp. 35-53.
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This study evaluates the effectiveness of a pro-poor nation-wide health card program, which provides free basic health care at public health facilities in Indonesia. To quantify the effect of the program, it departs from the traditional regression-based approach in the literature. It employs propensity score matching to reduce the selection bias due to non-random health card distribution. The setting of the program and the richness of the data set support this strategy in providing accurate estimates of the program's effect on its recipients. The results indicate that, in general, the health card program only has limited impact on the consumption of primary health care by its recipients. This finding suggests the presence of other factors counteracting the generous demand incentive.
Rammohan, A. & Johar, M. 2009, 'The determinants of married women's autonomy in Indonesia', Feminist Economics, vol. 15, no. 4, pp. 31-55.
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This paper investigates the determinants of married women's autonomy in Indonesia using the 2000 Indonesian Family Life Survey 3 (IFLS3). It considers the role of kinship norms and the effect of labor force participation on married women's autonomy. The measure of autonomy is based on self-reported answers to an array of questions relating to decision-making authority in the household. They include own-clothing, child-related and personal autonomy, physical mobility, and economic autonomy. The analysis examines if variations in women's autonomy are due to the prevailing kinship norms related to marriage in the community. In keeping with the anthropological literature, the analysis finds that living in patrilocal communities reduces physical autonomy for married women, whereas living in uxorilocal communities improves personal and child-related decision-making autonomy. Estimation results show that labor force participation, higher educational attainment, and increases in household wealth all have positive effects on married women's autonomy in Indonesia.

Other research activity

Johar, M., Fiebig, D.G., Haas, M.R. & Viney, R.C. 2009, 'Evaluating changes in women's attitudes towards cervical screening following a screening promotion campaign and a free vaccination program. CHERE Working Paper 2009/3', CHERE Working Paper.
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This study examines behavioural changes brought about by two interventions introduced to lower the incidence of cervical cancer in Australia. The first intervention is a media campaign promoting regular screening behaviour to women. The second intervention is a vaccination program providing a free HPV vaccine, Gardasil, to young women launched in the same period. The results using data from discrete choice experiments find that in general, given individual characteristics, the interventions have minor impact on how women value screening attributes. The interventions however alter women++s inherent taste for screening. Unexpectedly, willingness to screen is generally lower post-interventions. The reason for this trend appears to be related to HPV events. For instance, the reduction in screening participation is particularly marked among young women who are eligible for the vaccination program. There is also a larger aversion towards testing among women who gained information on HPV facts and HPV-related measures. Thus, in the face of HPV innovations, screening promotions need to account for these factors. A simulation exercise is then performed to assess the plausibility of several strategies to increase the screening rate. The results nominate supply-side policies, in particular those targeted to health providers, as the most effective strategy.