Jane Hall is Distinguished Professor of Health Economics in the UTS Business School and the Director of Strategy for the Centre. She was the founding Director of CHERE and held that position until 2012. She is a President Elect of the Academy of Social Sciences in Australia; and also a Fellow of the Australian Academy of Health and Medical Sciences. She received the National Health and Medical Research Council Outstanding Contribution Award in 2017; and was named as one of Australian Financial Review/Westpac100 Women of Influence in 2016. In 2012 she was recognized with a UTS Vice-Chancellor's Award for Research Excellence in Research Leadership. In 2011 she was awarded the inaugural Professional Award made by the Health Services Research Association of Australia and New Zealand, for her outstanding contributions to research, developing the field and mentoring others.
She has worked across many areas of health economics, including health technology assessment, measurement of quality of life, end of life care, health workforce, the economics of primary care and funding and financing issues. She is involved in health policy issues internationally through her involvement with the Commonwealth Fund International Program in Health Policy and Practice. Jane has been an active member of numerous committees and working parties. She is a member of the Independent Hospital Pricing Authority.
Can supervise: YES
Economic evaluation of public health programs; evaluation of informal (unpaid) care; the implications of genetic screening; and health workforce issues.
Humans have an almost unbounded ability to adapt their behaviour to perform different tasks. In the laboratory, this flexibility is sometimes viewed as a nuisance factor that prevents access to the underlying cognitive mechanisms of interest. For example, in order to study automatic lexical processing, psycholinguists have used masked priming or evoked potentials to measure 'automatic' lexical processing. However, the pattern of masked priming can be radically altered by changing the task. In lexical decision, priming is observed for words but not for nonwords, yet in a same-different matching task, priming is observed for same responses but not for different responses, regardless of whether the target is a word or a nonword (Norris & Kinoshita, 2008). Here we show that evoked potentials are equally sensitive to the nature of required decision, with the neural activity normally associated with lexical processing being seen for both words and nonwords on same trials, and for neither on different trials.
Longden, T, Hall, J & Van Gool, K 2018, 'Supplier-induced demand for urgent after-hours primary care services', Health Economics, vol. 27, no. 10, pp. 1594-1608.View/Download from: UTS OPUS or Publisher's site
Longden, T, Wong, C, Haywood, P, Hall, J & Van Gool, K 2018, 'The prevalence of persistence and related health status: An analysis of persistently high healthcare costs in the short term and medium term', Social Science and Medicine, vol. 211, pp. 147-156.View/Download from: UTS OPUS or Publisher's site
Mu, C, De Abreu Lourenco, R, van Gool, K & Hall, J 2018, 'Is low priced primary care bad for quality? Evidence from Australian general practice', Applied Economics, vol. 50, no. 5, pp. 475-491.View/Download from: UTS OPUS or Publisher's site
Wong, C & Hall, J 2018, 'Does patients' experience of general practice affect the use of emergency departments? Evidence from Australia', Health Policy, vol. 122, no. 2, pp. 126-133.View/Download from: UTS OPUS or Publisher's site
Wright, MC, Hall, J, Van Gool, K & Haas, M 2018, 'How common is multiple general practice attendance in Australia?', Australian Journal of General Practice, vol. 47, no. 5, pp. 289-296.View/Download from: UTS OPUS
Background and objectives
Australians can seek general practice care from multiple general practitioners (GPs) in multiple locations. This provides high levels of patient choice but may reduce continuity of care. The aim of this study was to estimate the prevalence of attendance at multiple general practices in Australia, and identify patient characteristics associated with multiple practice attendances.
A cross-sectional survey of 2477 Australian adults was conducted online in July 2013. Respondents reported whether they had attended more than one general practice in the past year, and whether they had a usual general practice and GP. Demographic information, health service use and practice characteristics were also obtained from the survey.
Over one-quarter of the sample reported attending more than one practice in the previous year. Multiple practice attendance is less common with increasing age, and less likely for survey respondents from regional Australia, compared with respondents from metropolitan areas. Multiple practice attenders are just as likely as single practice attenders to have a usual GP. Discussion
A significant proportion of general practice care is delivered away from usual practices. This may have implications for health policy, in terms of continuity and quality of primary care.
Yu, S, van Gool, K, Kirby, S, Gardner, K, Robinson, L, Linehan, T, Harris, MF & Hall, J 2018, 'The business of integrated care: implementing new models of care in a fee-for-service setting', Journal of Integrated Care, vol. 26, no. 1, pp. 16-28.View/Download from: UTS OPUS or Publisher's site
McRae, I, Van Gool, K, Hall, J & Yen, L 2017, 'The role of cost on failure to access prescribed pharmaceuticals – the case of statins', Applied Health Economics and Health Policy, vol. 15, no. 5, pp. 625-634.View/Download from: UTS OPUS or Publisher's site
De Abreu Lourenco, R, Kenny, P, Haas, MR & Hall, J 2017, 'Factors affecting general practitioner charges and Medicare bulk-billing: results of a survey of Australians - erratum.', Med J Aust, vol. 206, no. 7, pp. 326-326.View/Download from: UTS OPUS
De Abreu Lourenco, R, Haas, M, Hall, J & Viney, R 2017, 'Valuing meta-health effects for use in economic evaluations to inform reimbursement decisions: a review of the evidence', PharmacoEconomics, vol. 35, no. 3, pp. 347-362.View/Download from: UTS OPUS or Publisher's site
This review explores the evidence from the literature regarding how meta-health effects (effects other than health resulting from the consumption of health care) are valued for use in economic evaluations.
A systematic review of the published literature (the EMBASE, MEDLINE, PsycINFO, CINAHL, EconLit and SocINDEX databases were searched for publications in March 2016, plus manual searching) investigated the associations between study methods and the resulting values for meta-health effects estimated for use in economic evaluations. The review considered which meta-health effects were being valued and how this differed by evaluation approach, intervention investigated, source of funds and year of publication. Detailed reasons for differences observed between values for comparable meta-health effects were explored, accounting for the method of valuation.
The search of the literature revealed 71 studies of interest; 35% involved drug interventions, with convenience, information and process of care the three meta-health effects most often investigated. Key associations with the meta-health effects were the evaluation method, the intervention, and the source of funds. Relative values for meta-health effects ranged from 0.9% to 68% of the overall value reported in a study. For a given meta-health effect, the magnitude of the effect evaluated and how the meta-health effect was described and framed relative to overall health explained the differences in relative values.
Evidence from the literature shows variability in how meta-health effects are being measured for use in economic evaluations. Understanding the sources of that variability is important if decision makers are to have confidence in how meta-health effects are valued.
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, diverting 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.
Johnson, S, Clayton, S, Butow, P, Silvester, W, Detering, K, Hall, JP, Kiely, B, Cebon, J, Clarke, S, Michael, N, Belle, M, Stockler, M, Beale, P & Tattersall, MHN 2016, 'Advance care planning in patients with incurable cancer: study protocol for a randomised controlled trial', BMJ Open, vol. 6, no. 12, pp. e012387-e012387.View/Download from: UTS OPUS or Publisher's site
Srivastava, R, Reynolds, G, Hall, JP & Downie, J 2016, 'Costs of children with medical complexity in Australian public hospitals', Journal of Paediatrics and Child Health, vol. 52, no. 5, pp. 566-571.View/Download from: UTS OPUS or Publisher's site
Kenny, PM, Reeve, R & Hall, J 2016, 'Satisfaction with nursing education, job satisfaction and work intentions of new graduate nurses', Nurse Education Today, vol. 36, pp. 230-235.View/Download from: Publisher's site
Advances in cancer detection and treatment pose a challenge to traditional cancer services focused on the acute delivery of specialist care. In The Lancet Oncology Commission,1 Greg Rubin and colleagues set out an exhaustive charter for the role of primary care services, and the primary care physician (PCP). The authors suggest 18 action points for a greater role for the PCP from detection to palliation.
The Australian health care system appears remarkably successful in delivering good health outcomes with reasonable cost control. Australians enjoy one of the longest life expectancies and a long healthy life expectancy, while costs as a proportion of the gross domestic product remain around the median among countries in the Organization for Economic Cooperation and Development (OECD; see table
Selected Characteristics of the Health Care System and Health Outcomes in Australia. and case histories; to compare this country with others, see the interactive graphic).1 Universal, tax-financed comprehensive health insurance, Australian Medicare, has been largely stable for three decades. Yet this performance has been achieved through, or despite, the interplay of public and private financing, public and private service provision, and a division of responsibilities between the federal and state governments. The main political parties clash over the role of government and whether national health insurance in its current form should continue.
Australian Medicare was established in 1984, after a period of tumultuous change. Australia has moved through numerous approaches to health care financing: private insurance with public subsidies (pre-1974), publicly financed national universal health insurance (Medibank, 1974–1976), predominantly private insurance with public subsidies (1976–1984), publicly financed national universal health insurance (Medicare, 1984–1996), publicly financed national universal health insurance with publicly subsidized private health insurance (1996–2013), and publicly financed national universal health insurance with means testing for private insurance subsidies (2013 to present). The rationale for government subsidies for private insurers alongside a public universal insurance scheme has never seemed clear; perhaps it is best seen as the compromise between the 'strife of interests masquerading as a conflict of principles' that, according to health p...
Objective: To examine the uptake of financial incentive payments in
general practice, and identify what types of practitioners are more likely to
participate in these schemes.
Design and setting: Analysis of data on general practitioners and GP
registrars from the Medicine in Australia — Balancing Employment and Life
(MABEL) longitudinal panel survey of medical practitioners in Australia,
from 2008 to 2011.
Main outcome measures: Income received by GPs from government
incentive schemes and grants and factors associated with the likelihood of
claiming such incentives.
Results: Around half of GPs reported receiving income from financial
incentives in 2008, and there was a small fall in this proportion by 2011.
There was considerable movement into and out of the incentives schemes,
with more GPs exiting than taking up grants and payments. GPs working in
larger practices with greater administrative support, GPs practising in rural
areas and those who were principals or partners in practices were more
likely to use grants and incentive payments.
Conclusions: Administrative support available to GPs appears to be an
increasingly important predictor of incentive use, suggesting that the
administrative burden of claiming incentives is large and not always worth
the effort. It is, therefore, crucial to consider such costs (especially relative
to the size of the payment) when designing incentive payments. As market
conditions are also likely to influence participation in incentive schemes, the
impact of incentives can change over time and these schemes should be
De Abreu Lourenco, R, Kenny, P, Haas, MR & Hall, JP 2015, 'Factors affecting general practitioner charges and Medicare bulk-billing: results of a survey of Australians.', The Medical journal of Australia, vol. 202, no. 2, pp. 87-90.
To identify factors affecting bulk-billing by general practitioners in Australia.A community-based survey was administered to Australians aged 16 years or older in July 2013 via an online panel. Survey questions focused on patient characteristics, visit characteristics, practice characteristics.Factors associated with GP bulk-billing.2477 respondents completed the survey, of whom 2064 (83.33%) reported that the practice that they went to for their most recent GP visit bulk billed some or all patients. Overall, 1763 respondents (71.17%) reported that their most recent GP visit was bulk billed. Taking into account the duration of visits and the corresponding Medicare Benefits Schedule rebate, the mean out-of-pocket cost for those who were not bulk billed was $34.09. RESULTS of a multivariate logistic regression analysis suggest that the odds of being bulk billed was negatively associated with larger practice size, respondents having had an appointment for their visit, higher household income and inner or outer regional area of residence. It was positively associated with the presence of a chronic disease, being a concession card holder and having private health insurance. There was no association between bulk-billing and duration of GP visit, age or sex.Our results indicate that there are associations between patient characteristics and bulk-billing, and between general practice characteristics and bulk-billing. This suggests that caution is needed when considering changes to GP fees and Medicare rebates because of the many possible paths by which patients' access to services could be affected. Our results do not support the view that bulk-billing is associated with shorter consultation times.
Norman, R & Hall, JP 2014, 'Can hospital-based doctors change their working hours? Evidence from Australia', Internal Medicine Journal, vol. 44, no. 7, pp. 658-664.View/Download from: Publisher's site
Background and Aims To explore factors predicting hospital-based doctors desire to work less, and then their success in making that change. Methods Consecutive waves of an Australian longitudinal survey of doctors (Medicine in Australia Balancing Employment and Life). There were 6285 and 6337 hospital-based completers in the two waves, consisting of specialists, hospital-based non-specialists and specialist registrars. Results Forty-eight per cent stated a preference to reduce hours. Predictive characteristics were being female and working more than 40?h/week (both P < 0.01). An inverted U-shape relationship was observed for age, with younger and older doctors less likely to state the preference. Factors associated with not wanting to reduce working hours were being in excellent health and being satisfied with work (both P < 0.01). Of those who wanted to reduce working hours, only 32% successfully managed to do so in the subsequent year (defined by a reduction of at least 5?h/week). Predictors of successfully reducing hours were being older, female and working more than 40?h/week (all P < 0.01). Conclusion Several factors predict the desire of hospital-based doctors to reduce hours and then their subsequent success in doing so. Designing policies that seek to reduce attrition may alleviate some of the ongoing pressures in the Australian hospital system.
Norman, R & Hall, JP 2014, 'The desire and capability of Australian general practitioners to change their working hours', Medical Journal of Australia, vol. 200, no. 7, pp. 399-402.View/Download from: UTS OPUS or Publisher's site
Objective: To explore factors associated with general practitioners desire to work less and their success in making that change. Design, participants and setting: Waves 3 and 4 (conducted in 2010 and 2011) of a national longitudinal survey of Australian doctors in clinical practice (Medicine in Australia: Balancing Employment and Life). Of the broader group of medical practitioners in the survey, there were 3664 and 3436 GP completers in Waves 3 and 4, respectively. Main outcome measures: The association between the desire to reduce hours and doctor, job and geographic characteristics; the association between predictors of the capability to reduce hours and these same doctor, job and geographic characteristics. Results: Over 40% of GPs stated a preference to reduce their working hours. Characteristics that predicted this preference were being middle-aged, being female, working = 40 hours per week (all P < 0.01), and being on call (P = 0.03). Factors associated with not wanting to reduce working hours were being in excellent health, being satisfied or very satisfied with work (both P < 0.01), and not being a partner in a practice (P < 0.01 for a number of alternative options [ie, associates, contractors and locums]). Of those who wanted to reduce working hours, 26.8% successfully managed to do so in the subsequent year (where reduction was defined as reducing hours by at least 5 per week). Predictors of successfully reducing hours were being younger, female and working = 40 hours per week (all P < 0.01). Conclusion: A number of factors appear to determine both the desire of GPs to reduce hours and their subsequent success in doing so. Declining working hours have contributed to the perceived shortage in GPs. Therefore, designing policies that address not just the absolute number of medical graduates but also their subsequent level of work may alleviate some of the pressures on the Australian primary health care system.
This paper estimates the impact of informal caregiving on self-reported well-being. It uses a sample of 23,285 respondents of the first eleven waves of the Household, Income and Labour Dynamics in Australia (HILDA). We apply a relatively new analytical method that enables us to estimate fixed effects ordered logit to analyse subjective well-being. The econometric estimates show that providing informal care has a negative effect on subjective well-being. The empirical evidence of our paper could be helpful to inform policy makers to better understand the impact of caregiving and design the appropriate long term care policies and support services.
Kenny, P, King, MT & Hall, J 2014, 'The physical functioning and mental health of informal carers: evidence of care-giving impacts from an Australian population-based cohort.', Health & social care in the community, vol. 22, no. 6, pp. 646-659.View/Download from: UTS OPUS or Publisher's site
Informal carers represent a substantial proportion of the population in many countries and health is an important factor in their capacity to continue care-giving. This study investigated the impact of care-giving on the mental and physical health of informal carers, taking account of contextual factors, including family and work. We examined health changes from before care-giving commenced to 2 and 4 years after, using longitudinal data from the Household Income and Labour Dynamics in Australia survey. The sample comprised 424 carers and 424 propensity score-matched non-carers. Health was self-assessed, measured with the SF-36 Health Survey Mental Health (MH) and Physical Functioning (PF) scales. Care-giving was classified as non-carer, low (<5 hours/week), moderate (5-19 hours/week) and high (20 or more hours/week). PF and MH change scores were regressed on baseline scores, care-giving, covariates (including work, family and socio-demographic characteristics) and interactions to identify impacts for subgroups. The physical and mental health impacts differed by gender, and care-giving hours and carer work hours were important contextual factors. Deterioration in both PF and MH was worse for females after 2 years and deterioration in MH was worse for males after 4 years. Among carers aged 40-64 years, there was a 17-point decline in PF (P = 0.009) and a 14-point decline in MH (P < 0.0001) after 2 years for female high caregivers working full-time and 9.3 point improvement (P = 0.02) for non-working male high caregivers. Change was not significant for non-carers. The study found that not all carers suffer adverse health impacts; however, the combination of high levels of care-giving with workforce participation can increase the risk of negative physical and mental health effects (particularly in female carers). Working carers providing high levels of care represent a vulnerable subgroup where supportive and preventive services might be focused.
Milton-Wildey, KK, Kenny, PM, Parmenter, G & Hall, JP 2014, 'Educational preparation for clinical nursing: the satisfaction of students and new graduates from two Australian universities', Nurse Education Today, vol. 34, pp. 648-654.View/Download from: Publisher's site
BACKGROUND: Attrition rates among young and newly registered nurses are high; the capacity of nurse education programmes to prepare nurses for their professional role and the extent to which they are supported during the transition from student to registered nurse may be important factors. OBJECTIVES: This paper examines nursing student and recent graduate satisfaction with their education, focusing on their preparation for work. DESIGN: A descriptive cohort design was used, combining qualitative and quantitative methods to measure and interpret satisfaction. SETTING: Two Australian universities, one urban and one regional. PARTICIPANTS: 530 undergraduate nursing students and recent graduates from the Bachelor of Nursing programmes at the two universities. METHODS: Data were collected via an online survey. Satisfaction with the programmes was measured with closed format questions covering different aspects of the programmes and a single open ended question. Responses were compared between older and younger respondents and between graduates and students at different stages of the programme. RESULTS: Older students were more dissatisfied than younger students with the amount and type of training and their preparation for nursing work. First year students reported the highest levels of satisfaction, and third year students the lowest. The majority of graduates and third year students thought that the programme only partly prepared them for work in nursing. The free text comments particularly highlighted concerns with the amount and quality of clinical education. CONCLUSIONS: Programmes need to take account of the learning requirements of students to maximise the integration of theory and skill development in hospital environments with limited staffing and resources. The clinical environment and support received impact on the quality of learning and satisfaction of student nurses. Students who are dissatisfied with their educational and clinical experiences may choos...
Hall, JP, Kenny, PM, Hossain, I, Street, D & Knox, SA 2014, 'Providing informal care in terminal illness: an analysis of preferences for support using a discrete choice experiment', Medical Decision Making, vol. 34, no. 6, pp. 731-745.View/Download from: UTS OPUS or Publisher's site
Background: The trend for terminally ill patients to receive much of their end-of-life care at home necessitates the design of services to facilitate this. Care at home also requires that informal care be provided by family members and friends. This study investigated informal carers' preferences for support services to aid the development of end-of-life health care services. METHODS: This cross-sectional study used 2 discrete choice experiments to ascertain the preferences of carers supporting patients with different levels of care need, determined by the assistance needed with personal care and labeled High Care (HC) and Low Care (LC). The sample included 168 informal carers of people receiving palliative care at home from 2 palliative care services in Sydney, Australia. Data were collected in face-to-face interviews; carers chose between 2 hypothetical plans of support services and their current services. Data were analyzed with generalized multinomial logit models that were used to calculate the impact of each attribute on the probability of a carer choosing a service plan. RESULTS: Preferred support included nursing services; the probability of choosing a plan increased significantly if it included nurse home visits and phone advice (P < 0.001). HC carers also wanted doctor home visits, home respite, and help with personal care (P < 0.05), and LC carers wanted help with household tasks, transport, and a case coordinator (P < 0.001). On average, both groups of carers preferred their current services, but this varied with characteristics of the carer and the caregiving situation. CONCLUSIONS: The most valued services are those that support carers in their caregiving role; however, supportive care preferences vary with the different circumstances of patients and carers.
Doiron, D, Hall, JP, Kenny, PM & Street, D 2014, 'Job preferences of students and new graduates in nursing', Applied Economics, vol. 46, no. 9, pp. 924-939.View/Download from: UTS OPUS or Publisher's site
This article investigates the preferences of student and newly graduated nurses for pecuniary and nonpecuniary aspects of nursing jobs. It is the first study applying methods based on discrete choice experiments to a developed country nursing workforce. It is also the first to focus on the transition through university training and into work. This is particularly important as junior nurses have the lowest retention levels in the profession. We sample 526 individuals from nursing programmes in two Australian universities. Flexible and newly developed models combining heteroscedasticity with unobserved heterogeneity in scale and preference weights are estimated.Overall, salary remains the most important feature in increasing the probability that a job will be selected. `Supportive management/staff and `quality of care follow as the most important attributes from a list of 11 nonpecuniary characteristics. However, the subset of new graduates rank `supportive management/staff above salary increases, emphasizing the importance of a supportive workplace in the transition from university to the workplace. We find substantial preference heterogeneity and some attributes, such as the opportunity for clinical rotations, are found to be attractive to some nurses while seen as negative by others. Nursing retention could be improved by designing different employment packages to appeal to these different tastes.
Hall, J.P. 2013, 'The tale of out of pocket spending on health care', Medical Journal of Australia, vol. in press.
Hall, JP 2013, 'The development of health economics in Australia and its contribution to policy', The Australian Economic Review, vol. 46, no. 2, pp. 196-201.View/Download from: UTS OPUS or Publisher's site
It is the best of times and the worst of times. Bulk-billing rates for non-referred attendances (principally general practitioners) have reached over 82%.1 Yet there has been renewed attention focused on the growing financial burden that out-of-pocket (OOP) payments impose on patients.2 The apparent contradiction can be reconciled, but to do that we need to get beyond the headline figures. All health care financing, whether provided through government, social agencies or private providers, aims to ensure that individuals are not excluded from receiving costly health care when they need it. When patients face charges, their use of health services is lowered, with OOP expenditures having a greater impact on the use of health care by those with less financial means. So at first glance it seems inconsistent to impose copayments in a system set up to reduce barriers to use.
Van Gool, K, Norman, R, Hall, JP, Massie, J & Delatycki, M 2013, 'Understanding the costs of care for cystic fibrosis: an analysis by age and health state', Value in Health, vol. 16, no. 2, pp. 345-355.View/Download from: UTS OPUS or Publisher's site
Objectives: 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. Methods: 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. Results: 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%). Conclusions: 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.
Outcome measurement in the economic evaluation of health care considers outcomes independent of to whom they accrue. This article reports on a discrete choice experiment designed to elicit population preferences regarding the allocation of health gain between hypothetical groups of potential patients. A random-effects probit model is estimated, and a technique for converting these results into equity weights for use in economic evaluation is adopted. On average, the modelling predicts a relatively high social value on health gains accruing to nonsmokers, carers, those with a low income and those with an expected age of death less than 45?years. Respondents tend to favour individuals with similar characteristics to themselves. These results challenge the conventional practice of assuming constant equity weighting. For decision makers, whether a formal equity weighting system represents an improvement on more informal approaches to weighing up equity and efficiency concerns remains uncertain
Greene, J & Hall, JP 2012, 'The comparability of emergency department waiting time performance data', Medical Journal of Australia, vol. 197, no. 6, pp. 345-348.View/Download from: UTS OPUS or Publisher's site
Objective: To examine whether the reported urgency mix of an emergency department's (ED's) patients is associated with its waiting time performance. Design and setting: Cross-sectional analysis of data on patient urgency mix and hospital ED performance reported on the MyHospitals website for July 2009 - June 2010. Main outcome measures: ED performance assessed as the proportion of patients whose care was initiated within the recommended time frame for each of four triage categories. Results: Data for 158 hospitals showed that EDs with a higher proportion of patients assigned to the emergency category have poorer waiting time performance, after adjusting for hospital characteristics. Conversely, EDs with a higher proportion of patients assigned to the non-urgent category perform better. if performance scores were adjusted for reported patient urgency mix and hospital peer group, mean adjustments would be modest in size (3.7-7.1 percentage points, depending on the category), but for individual EDs the differences could be large (as large as 31 percentage points) and hospital waiting time performance rankings would be substantively impacted. Conclusion: Since ED performance is related to reported patient urgency mix, adjusting for casemix in the ED may be warranted to ensure valid comparisons between hospitals. Further investigation of the validity of performance measures and appropriate adjustment for differences in hospital and patient characteristics is required if public reporting is to meet its goals.
Greene, J & Hall, JP 2012, 'The comparability of emergency department waiting time performance data: reply', Medical Journal of Australia, vol. 197, no. 11/12, pp. 618-618.
Norman, R, Van Gool, K, Hall, JP, Delatycki, M & Massie, J 2012, 'Cost-effectiveness of carrier screening for cystic fibrosis in Australia', Journal of Cystic Fibrosis, vol. 11, no. 4, pp. 281-287.View/Download from: UTS OPUS or Publisher's site
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. Methods: 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. Results: 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. Conclusions: 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.
Haas, MR, Hall, JP, Viney, RC & Gallego, G 2012, 'Breaking up is hard to do: why disinvestment in medical technology is harder than investment', Australian Health Review, vol. 36, no. 2, pp. 148-152.View/Download from: UTS OPUS or Publisher's site
disinvestment, health technology assessment
Hall, J.P. 2011, 'Designing the health system for the 21st Century', Academy of the Social Sciences in Australia. Dialogue, vol. 31, no. 2, pp. 10-15.
Hall, J.P. 2011, 'Medical research funding has been saved: now we need to spend wisely', The Conversation, vol. May 11.
The Australian Prime Minister and State premiers, after an intense period of negotiation, announced `the most significant reform to Australias health and hospitals system since the introduction of Medicare, and one of the largest reforms to service delivery in the history of the Federation (Council of Australian Governments, 2010a). The Australian health-care system has remained structurally stable since the introduction of national tax financed universal health care in 1984, with subsequent governments mostly preferring incremental change (Hall, 1999). The most interesting feature of Australian health care to those outside Australia has been the public subsidy of private health insurance, despite universal free access to public hospitals, universal subsidies for medical care and most prescription pharmaceuticals. Within Australia, the role of private health insurance and the cost of its subsidy have been the dominant national issue, while other components of the system have been unchanged. This new agreement is strongly focussed on public hospitals. Whether this will indeed prove the start of significant reform or merely a side-step is yet to be determined.
This article examines the Medicare Select proposal. It describes the features of the model and the extent to which it is consistent with other reforms proposed or implemented in other countries, and then analyses the conditions necessary for the purported benefits to be realised.
Kenny, PM, Hall, JP, Zapart, S & Davis, P 2010, 'Informal care and home-based palliative care: The health-related quality of life of carers', Journal of Pain and Symptom Management, vol. 40, no. 1, pp. 35-48.View/Download from: UTS OPUS or Publisher's site
Health is an important factor in the capacity of family and friends (informal carers) to continue providing care for palliative care patients at home. This study investigates associations between the health-related quality of life (HRQOL) of current informal carers and characteristics of the carers and their caregiving situation, in a sample of Australian carers of palliative care patients. The cross-sectional study used the Short Form-36 Health Survey to measure HRQOL. It found carers to have better physical health and worse mental health than the general population. Of 178 carers, 35% reported their health to be worse than it was one year ago. Multiple regression analyses found that the HRQOL of carers whose health had deteriorated in the previous year was associated with the patients care needs but not the carers time input, unlike the carers reporting stable health. Clinicians caring for palliative care patients should be alert to the potential health impairments of informal carers and ensure that they are adequately supported in their caregiving role and have access to appropriate treatment and preventive health care.
Mitchell, P, Pirkis, J, Hall, JP & Haas, MR 2009, 'Partnerships for knowledge exchange in health services research, policy and practice', Journal of Health Services Research & Policy, vol. 14, no. 2, pp. 104-111.View/Download from: UTS OPUS or Publisher's site
Within the health services research community there is a growing strength of feeling that ongoing partnerships between researchers and decision-makers are critically important to effective transfer and exchange of knowledge generated from health services research. A body of literature is emerging around this idea that favours a particular model of partnership based on decision-maker involvement in research. This model is also gaining favour among health research funding bodies internationally. We argue that it is premature for the health services community to privilege any particular model of partnership between researchers and decision-makers. Rather a diversity of models should be conceptualized, explored in theory and practice, and evaluated. We identify seven dimensions that could be used to describe and differentiate models of partnerships for knowledge exchange and illustrate how these dimensions could be applied to analysing partnerships, using three case studies from recent and ongoing health services research partnerships in Australia.
Kenny, PM, Hall, JP, King, MT & Lancsar, E 2009, 'Sources of variation in the costs of health care for asthma patients in Australia', Journal of Health Services Research & Policy, vol. 14, no. 3, pp. 133-140.View/Download from: UTS OPUS or Publisher's site
Objectives: Individuals with chronic conditions, such as asthma, on average incur high health care costs, though good control can reduce costs and improve health outcomes. However, there may be substantial variation between patients in their use of services and therefore costs. Our objective was to investigate the sources of such variation in health system and out-of-pocket costs for people with asthma. Methods: A longitudinal observational study of 252 people with asthma in New South Wales, Australia, followed for three years, using six-monthly postal surveys and individual administrative data. Factors associated with costs were investigated using generalized linear mixed models. Results: There was substantial variability in costs between individuals but relatively little within-person change over time for the majority. Costs to the health system and out-of-pocket costs were higher with increasing asthma-related health problems and increasing age. Health system costs were less for patients living outside the state capital (Sydney) and for those in the middle income group relative to high and low income groups. Conclusions: Those with poorly-controlled asthma and the elderly require more carefully targeted strategies to improve their health and ensure appropriate use of resources. Access to appropriate services for those living outside of major cities should be improved. Co-payments for the middle-income groups and those living outside major cities should be reduced to improve equity in the use of services.
Background There is a severe shortage of nurses in Australia. Policy makers and researchers are especially concerned that retention levels of nurses in the health workforce have worsened over the last decade. There are also concerns that rapidly growing private sector hospitals are attracting qualified nurses away from the public sector. To date no systematic analysis of trends in nursing retention rates over time has been conducted due to the lack of consistent panel data. Results A 1.4 percentage point improvement in retention has led to a 10% increase in the overall supply of nurses in NSW. There has also been a substantial aging of the workforce, due to greater retention and an increase in mature age entrants. The improvement in retention is found in all types of premises and is largest in nursing homes. There is a substantial amount of year to year movement in and out of the workforce and across premises. The shortage of nurses in public hospitals is due to a slowdown in entry rather than competition from the rapidly growing private sector hospitals.
Hall, J.P. 2008, 'Don't panic on private insurance', Medical observer, vol. May 23, pp. 22-22.
Radhakrishnan, YM, Van Gool, K, Hall, JP, Delatycki, M & Massie, RJ 2008, 'Economic evaluation of cystic fibrosis screening: A review of the literature', Health Policy, vol. 85, no. 2, pp. 133-147.View/Download from: UTS OPUS or Publisher's site
Objectives 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. Methods 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. Results 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.
Van Doorslaer, E, Clarke, P, Savage, EJ & Hall, JP 2008, 'Horizontal inequities in Australia's mixed public/private health care system', Health Policy, vol. 86, no. 1, pp. 97-108.View/Download from: UTS OPUS or Publisher's site
Recent comparative evidence from OECD countries suggests that Australia's mixed publicprivate health system does a good job in ensuring high and fairly equal access to doctor, hospital and dental care services. This paper provides some further analysis of the same data from the Australian National Health Survey for 2001 to examine whether the general finding of horizontal equity remains when the full potential of the data is realized. We extend the common core cross-country comparative analysis by expanding the set of indicators used in the procedure of standardizing for health care need differences, by providing a separate analysis for the use for general practitioner and specialist care and by differentiating between admissions as public and private patients. Overall, our analysis confirms that in 2001 Medicare largely did seem to be attaining an equitable distribution of health care access: Australians in need of care did get to see a doctor and to be admitted to a hospital. However, they were not equally likely to see the same doctor and to end up in the same hospital bed. As in other OECD countries, higher income Australians are more likely to consult a specialist, all else equal, while lower income patients are more likely to consult a general practitioner. The unequal distribution of private health insurance coverage by income contributes to the phenomenon that the better-off and the less well-off do not receive the same mix of services. There is a risk that as in some other OECD countries the principle of equal access for equal need may be further compromised by the future expansion of the private sector in secondary care services. To the extent that such inequalities in use may translate in inequalities in health outcomes, there may be some reason for concern.
Hall, JP & Viney, RC 2008, 'National health reform needs strategic investment in health services research', Medical Journal of Australia, vol. 188, no. 1, pp. 33-35.View/Download from: UTS OPUS or Publisher's site
With new funding for the National Health and Medical Research Council (NHMRC) to provide an evidence base for policy and practice reform, it is timely to revisit Australia's recent experiences with health services research and policy development. We provide a broad review of the contribution of Australian health services research to the development of health policy over the past 20 years. We conclude that three preconditions are necessary to influence policy: political will; sustained funding to encourage methodological rigour and build decision makers' confidence; and the development of sufficient capacity and skills.
Lancsar, E.J., Hall, J.P., King, M., Kenny, P., Louviere, J.J., Fiebig, D.G., Hossain, I., Thien, F.C.K., Reddel, H.K. & Jenkins, C.R. 2007, 'Using discrete choice experiments to investigate subject preferences for preventive asthma medication', RESPIROLOGY, vol. 12, no. 1, pp. 127-136.View/Download from: Publisher's site
Anderson, R, Allen, K, Nisselle, A, Gurrin, L, Hall, JP, Powell, L & Delatycki, M 2007, 'Exploring The Cost-effectiveness Of Community Genetic Screening For Hereditary Haemochromatosis A Life-time Simulation Using A Markov Model', American Journal Of Hematology, vol. 82, no. 6, pp. 579-579.
King, MT, Hall, JP, Lanscar, E, Fiebig, DG, Hossain, I, Louviere, JJ, Reddel, H & Jenkins, CR 2007, 'Patient preferences for managing asthma: results from a discrete choice experiment', Health Economics, vol. 16, no. 7, pp. 703-717.View/Download from: UTS OPUS or Publisher's site
Effective control of asthma requires regular preventive medication. Poor medication adherence suggests that patient preferences for medications may differ from the concerns of the prescribing clinicians. This study investigated patient preferences for preventive medications across symptom control, daily activities, medication side-effects, convenience and costs, using a discrete choice experiment embedded in a randomized clinical trial involving patients with mildmoderate persistent asthma. The present data were collected after patients had received 6 weeks treatment with one of two drugs. Three choice options were presented, to continue with the current drug, to change to an alternative, hypothetical drug, or to take no preventive medication. Analysis used random parameter multinomial logit. Most respondents chose to continue with their current drug in most choice situations but this tendency differed depending on which medication they had been allocated. Respondents valued their ability to participate in usual daily activities and sport, preferred minimal symptoms, and were less likely to choose drugs with side-effects. Cost was also significant, but other convenience attributes were not. Demographic characteristics did not improve the model fit. This study illustrates how discrete choice experiments may be embedded in a clinical trial to provide insights into patient preferences.
Lancsar, E, Hall, JP, King, MT, Kenny, PM, Louviere, JJ, Fiebig, DG, Hossain, I, Thien, FC, Reddel, H & Jenkins, CR 2007, 'Using discrete choice experiments to investigate subject preferences for preventive asthma medication', Respirology, vol. 12, no. 1, pp. 127-136.View/Download from: UTS OPUS or Publisher's site
Background and objective: Long-term adherence to inhaled corticosteroids is poor despite the crucial role of preventer medications in achieving good asthma outcomes. This study was undertaken to explore patient preferences in relation to their current inhaled corticosteroid medication, a hypothetical preventer or no medication. Methods: A discrete choice experiment was conducted in 57 adults with mildmoderate asthma and airway hyper-responsiveness, who were using inhaled corticosteroid =500 µg/day (beclomethasone equivalent). In the discrete choice experiment, subjects evaluated 16 hypothetical scenarios made up of 10 attributes that described the process and outcomes of taking asthma medication, with two to four levels for each attribute. For each scenario, subjects chose between the hypothetical medication, the medication they were currently taking and no asthma medication. A random parameter multinomial logit model was estimated to quantify subject preferences for the aspects of taking asthma medication and the influence of attributes on medication decisions. Results: Subjects consistently made choices in favour of being able to do strenuous and sporting activities with or without reliever, experiencing no side-effects and never having to monitor their peak flow. Frequency of collecting prescriptions, frequency of taking the medication, its route of administration and the strength of the doctor recommendation about the medication were not significant determinants of choice. Conclusions: The results of this study suggest that patients prefer a preventer that confers capacity to maximize physical activity, has no side-effects and does not require daily peak flow monitoring.
Zapart, S, Kenny, PM, Hall, JP, Servis, B & Wiley, S 2007, 'Home-based palliative care in Sydney, Australia: the carer's perspective on the provision of informal care', Health & Social Care In The Community, vol. 15, no. 2, pp. 97-107.View/Download from: UTS OPUS or Publisher's site
The provision of home-based palliative care requires a substantial unpaid contribution from family and friends (i.e. informal care). The present cross-sectional descriptive study, conducted between September 2003 and April 2004, describes this contributi
Van Gool, K, Gallego, G, Haas, MR, Viney, RC, Hall, JP & Ward, R 2007, 'Economic evidence at the local level: Options for making it more useful', Pharmacoeconomics, vol. 25, no. 12, pp. 1055-1062.View/Download from: UTS OPUS or Publisher's site
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.
Hall, J.P. 2006, 'Financing Australian healthcare.', Hospital and Healthcare, vol. -, no. March, pp. 31-31.
Hall, JP, Fiebig, DG, King, MT, Hossain, I & Louviere, JJ 2006, 'What influences participation in genetic carrier testing? Results from a discrete choice experiment', Journal of Health Economics, vol. 25, no. 3, pp. 520-537.View/Download from: UTS OPUS or Publisher's site
This study explores factors that influence participation in genetic testing programs and the acceptance of multiple tests. Tay Sachs and cystic fibrosis are both genetically determined recessive disorders with differing severity, treatment availability,
Kovoor, P, Lee, AK, Carozzi, F, Wiseman, V, Byth, K, Zecchin, RP, Dickson, C, King, MT, Hall, JP, Ross, D, Uther, J & Denniss, AR 2006, 'Return to normal activities including work at two weeks after myocardial infarction', American Journal of Cardiology, vol. 97, no. 7, pp. 952-958.View/Download from: UTS OPUS or Publisher's site
Patients are generally advised to return to full normal activities, including work, 6 to 8 weeks after acute myocardial infarction (AMI). We assessed the outcomes of early return to normal activities, including work at 2 weeks, after AMI in patients who were stratified to be at a low risk for future cardiac events. Patients were considered for randomization before discharge if they had no angina, had left ventricular ejection fraction >40%, a negative result from a symptom-limited exercise stress test for ischemia (<2 mm ST depression) at 1 week, and achieved >7 METs. Patients with left ventricular ejection fraction <40% were included only if they did not have inducible ventricular tachycardia at electrophysiologic studies. Seventy-two patients were randomized to return to normal activities at 2 weeks and 70 patients to undergo standard cardiac rehabilitation and return to normal activities at 6 weeks after AMI. There were no deaths or heart failure in either group. There was no significant difference in the incidence of reinfarction, revascularization, left ventricular function, lipids, body mass index, smoking, or exercise test results at 6 months. In conclusion, return to full normal activities, including work at 2 weeks, after AMI appears to be safe in patients who are stratified to a low-risk group. This should have significant medical and socioeconomic implications.
Kovoor, P., Love, A., Hall, J., Kruit, R., Sadick, N., Ho, D., Adelstein, B.A. & Ross, D.L. 2005, 'Randomized double-blind trial of sotalol versus lignocaine in out-of-hospital refractory cardiac arrest due to ventricular tachyarrhythmia.', Internal medicine journal, vol. 35, no. 9, pp. 518-525.
AIM: We aimed to compare the efficacy of sotalol versus lignocaine for the treatment of patients with out-of-hospital ventricular fibrillation refractory to > or = 4 defibrillatory shocks. BACKGROUND: The outcome of patients in ventricular fibrillation refractory to > or = 4 defibrillatory shocks is poor. In a previous randomized trial, sotalol was superior to lignocaine for acute termination of ventricular tachycardia not causing loss of consciousness. METHODS: Patients of the Ambulance Service of New South Wales treated by paramedics with continued ventricular fibrillation despite standard resuscitation and > or = 4 defibrillatory monophasic shocks were eligible. Drug doses were sotalol 100 mg or lignocaine 100 mg, given as i.v. boluses. A further 2 min of cardiopulmonary resuscitation was given and then defibrillation was repeated twice. If this failed, half the initial dose of the trial drug was repeated and a further > or = 2 shocks were given. RESULTS: Sixty patients were randomized to sotalol and 69 randomized to lignocaine. There was no significant difference between the two groups in the clinical characteristics of the patients or in the number of shocks received. Outcomes in the sotalol and lignocaine groups were survival to hospital admission in 7 (12%) and 16 (23%), respectively (P = 0.09), and survival to hospital discharge in 2 (3%) and 5 (7%), respectively (P = 0.33). CONCLUSIONS: Sotalol is not superior to lignocaine for treatment of ventricular fibrillation refractory to multiple shocks. The overall outcome of this group of patients is poor regardless of the pharmacological intervention (lignocaine or sotalol).
Anderson, R, Haywood, P, Usherwood, T, Haas, MR & Hall, JP 2005, 'Alternatives to for-profit corporatisation: The view from general practice', Australian Journal of Primary Health, vol. 11, no. 2, pp. 78-86.View/Download from: UTS OPUS
Hall, J.P. 2005, 'Book Review: 'The politics of Medicare: who gets what, when and how' by Gwendolyn Gray', Health Economics, vol. 14, no. 8, pp. 869-870.
Hall, JP 2005, 'Health care workforce planning: can it ever work?', Journal of Health Services Research and Policy, vol. 10, no. 2, pp. 65-66.
Hall, JP & Maynard, A 2005, 'Healthcare lessons from Australia: what can Michael Howard learn from John Howard?', British Medical Journal, vol. 330, no. 7487, pp. 357-359.View/Download from: UTS OPUS or Publisher's site
Pirkis, J, Goldfeld, S, Peacock, S, Dodson, S, Haas, MR, Cumming, J, Hall, JP & Boulton, A 2005, 'Assessing the capacity of the health services research community in Australia and New Zealand', Australia and New Zealand Health Policy, vol. 2, no. 4, pp. 1-10.View/Download from: UTS OPUS
Warren, E, Anderson, R, Proos, AI, Burnett, L, Barlow-Stewart, K & Hall, JP 2005, 'Cost-effectiveness of a school-based Tay-Sachs and cystic fibrosis genetic carrier screening program', Genetics In Medicine, vol. 7, no. 7, pp. 484-494.View/Download from: UTS OPUS or Publisher's site
Purpose: To explore the cost-effectiveness of school-based multidisease genetic carrier screening. Method: Decision analysis of the cost-effectiveness of a school-based Tay-Sachs disease and cystic fibrosis genetic carrier screening program, relative to
Kenny, PM, Lancsar, E, Hall, JP, King, MT & Chaplin, M 2005, 'The individual and health sector costs of asthma: the first year of a longitudinal study in New South Wales', Australian & New Zealand Journal of Public Health, vol. 29, no. 5, pp. 429-435.View/Download from: UTS OPUS or Publisher's site
Objective: To identify the resources used and the costs incurred by people with asthma for health care and non-health care products and services to manage asthma. Methods: A prospective, longitudinal study, using self-reported and administrative data, co
Hall, J.P. 2004, 'Election 2004 Paying for Health Care', Australian Review of Public Affairs, vol. -, pp. 1-6.
Jones, G, Savage, EJ & Hall, JP 2004, 'Pricing of general practice in Australia: some recent proposals to reform Medicare', Journal of Health Services Research and Policy, vol. 9, no. 2, pp. 63-68.View/Download from: UTS OPUS or Publisher's site
Beutels, P, Van Doorslaer, E, Van Damme, P & Hall, J 2003, 'Methodological issues and new developments in the economic evaluation of vaccines.', Expert review of vaccines, vol. 2, no. 5, pp. 649-660.View/Download from: Publisher's site
The application of economic evaluation in healthcare, including vaccination programs, has increased exponentially since the 1980s. There are a number of aspects of economic evaluation of vaccine programs that present particular challenges to the analyst. These include the development of the appropriate epidemiological models from which to estimate the costs and benefits; the accurate prediction of uptake rates; the incorporation of quality adjusted survival gains; and the inclusion of intangible but nonetheless important benefits and costs associated with infectious disease and vaccination. The estimation of marginal intervention costs presents specific difficulties, especially for multivalent vaccines and valuing costs and benefits over time is heavily influenced by the choice of discount rate, which is still a controversial topic. Developments in the next 5 years are likely to address all of these issues and result in more sophisticated and accurate models of vaccination programs.
Beutels, P., Van Doorslaer, E., Van Damme, P. & Hall, J.P. 2003, 'Methodological issues and new developments in the economic evaluation of vaccines', Expert review of vaccines, vol. 2, no. 5, pp. 89-100.View/Download from: UTS OPUS
Hall, JP 2003, 'Australian Health Policy Research And Development', Medical Journal Of Australia, vol. 178, no. 7, pp. 356-356.
Kenny, PM, Hall, JP, Viney, RC & Haas, MR 2003, 'Do participants understand a stated preference health survey? a qualitative approach to assessing validity', International Journal of Technology Assessment in Health Care, vol. 19, no. 4, pp. 664-681.View/Download from: UTS OPUS
Glasziou, P.P., Eckermann, S.D., Mulray, S.E., Simes, R.J., Martin, A.J., Kirby, A.C., Hall, J.P., Caleo, S., White, H.D. & Tonkin, A.M. 2002, 'Cholesterol-lowering therapy with pravastin in patients with average cholesterol levels and established ischaemic heart disease: is it cost-effective?', Medical Journal of Australia, vol. 177, pp. 420-426.View/Download from: UTS OPUS
Glasziou, PP, Eckermann, SD, Mulray, SE, Simes, RJ, Martin, AJ, Kirby, AC, Hall, JP, Caleo, S, White, HD & Tonkin, AM 2002, 'Cholesterol-lowering therapy with pravastatin in patients with average cholesterol levels and established ischaemic heart disease: is it cost-effective?', MEDICAL JOURNAL OF AUSTRALIA, vol. 177, no. 8, pp. 428-434.
Hall, JP, Wiseman, V, King, MT, Ross, DL, Kovoor, P, Zecchin, RP, Moir, FM & Denniss, AR 2002, 'Economic evaluation of a randomised trial of early return to normal activities versus cardiac rehabilitation after acute myocardial infarction', Heart, Lung and Circulation, vol. 11, pp. 10-18.View/Download from: UTS OPUS or Publisher's site
Hall, JP, Kenny, PM, King, MT, Louviere, JJ, Viney, RC & Yeoh, A 2002, 'Using stated preference discrete choice modelling to evaluate the introduction of varicella vaccination', Health Economics, vol. 11, no. 5, pp. 457-465.View/Download from: UTS OPUS or Publisher's site
Applications of stated preference discrete choice modelling (SPDCM) in health economics have been used to estimate consumer willingness to pay and to broaden the range of consequences considered in economic evaluation. This paper demonstrates how SPDCM can be used to predict participation rates, using the case of varicella (chickenpox) vaccination. Varicella vaccination may be cost effective compared to other public health programs, but this conclusion is sensitive to the proportion of the target population immunised. A choice experiment was conducted on a sample of Australian parents to predict uptake across a range of hypothetical programs. Immunisation rates would be increased by providing immunisation at no cost, by requiring it for school entry, by increasing immunisation rates in the community and decreasing the incidence of mild and severe side effects. There were two significant interactions; price modified the effect of both support from authorities and severe side effects. Country of birth was the only significant demographic characteristic. Depending on aspects of the immunisation program, the immunisation rates of children with Australian-born parents varied from 9% to 99% while for the children with parents born outside Australia they varied from 40% to 99%. This demonstrates how SPDCM can be used to understand the levels of attributes that will induce a change in the decision to immunise, the modification of the effect of one attribute by another, and subgroups in the population. Such insights can contribute to the optimal design and targeting of health programs.
Van Gool, K, Lancsar, E, Viney, RC, Hall, JP & Haywood, P 2002, 'Diagnosis and prognosis of Australia's health information for evidence based policy', Journal of Health Services Research & Policy, vol. 7, no. 1, pp. 40-45.View/Download from: UTS OPUS or Publisher's site
Hall, J.P. 2001, 'Quality of health care: an international problem', Healthcover, vol. 11, pp. 25-27.
Hall, JP 2001, 'Health services research in Australia', Australian Health Review, vol. 24, pp. 35-38.
Hall, JP 2001, 'Health, health care and social welfare', The Australian Economic Review, vol. 34, pp. 320-331.
Hall, JP, Caleo, S, Stevenson, J & Meares, R 2001, 'An economic analysis of psychotherapy for borderline personality disorder patients', Journal of Mental Health Policy and Economics, vol. 4, pp. 3-8.
King, MT, Hall, JP & Harnett, P 2001, 'A randomised crossover trial of chemotherapy in the home: patient preferences and cost analysis', Medical Journal of Australia, vol. 174, no. 6, pp. 312-312.
Haas, MR, Chapman, S, Viney, RC, Hall, JP & Ferguson, A 2001, 'The news on health care costs: a study of reporting in the Australian print media for 1996', Journal of Health Services Research and Policy, vol. 6, pp. 78-84.
Hall, J.P. 2000, 'Health For All The Impossible Dream?', Lancet, vol. 356, no. 0, pp. 0-0.
King, MT, Hall, JP, Caleo, S, Gurney, H & Harnett, P 2000, 'Home Or Hospital? An Evaluation Of The Costs, Preferences, And Outcomes Of Domiciliary Chemotherapy', International Journal Of Health Services, vol. 30, no. 3, pp. 557-579.
The study compares the costs and outcomes of domiciliary and hospital-based chemotherapy, using a prospective randomized cross-over design. Eighty-seven eligible patients were recruited from oncology services at two metropolitan hospitals in Sydney, Aust
Lowin, A, Slater, J, Hall, JP & Alperstein, G 2000, 'Cost Effectiveness Analysis Of School Based Mantoux Screening For Tb Infection', Australian And New Zealand Journal Of Public Health, vol. 24, no. 3, pp. 247-253.View/Download from: Publisher's site
OBJECTIVE To assess the cost-effectiveness of adding school based Mantoux screening programs to the New South Wales current TB prevention strategy. METHOD A decision analysis model compared the costs and consequences of screening strategies against the c
Kenny, PJ, King, L, Shiell, A, Seymour, J, Hall, JP, Langlands, A & Boyages, J 2000, 'Early Stage Breast Cancer Costs And Quality Of Life One Year After Treatment By Mastectomy Or Conservative Surgery And Radiation Therapy', Breast, vol. 9, no. 1, pp. 37-44.View/Download from: Publisher's site
This paper reports a descriptive study of the costs and quality of life (QoL) outcome of treatments for early stage breast cancer in a cohort of Australian women, one year after initial surgical treatment. Mastectomy without breast reconstruction is comp
King, MT, Kenny, PJ, Shiell, A, Hall, JP & Boyages, J 2000, 'Quality Of Life Three Months And One Year After First Treatment For Early Stage Breast Cancer Influence Of Treatment And Patient Characteristics', Quality Of Life Research, vol. 9, no. 7, pp. 789-800.View/Download from: Publisher's site
This paper reports the quality of life (QoL) of a large cohort of Australian women three and twelve months after surgery for early stage breast cancer (ESBC), and shows that the impact of disease and treatment on QoL differed by age, education and marita
Kenny, P, King, MT, Sheill, A, Seymour, J, Hall, J, Langlands, A & Boyages, J 2000, 'Erratum: Early stage breast cancer: Costs and quality of life one year after treatment by mastectomy or conservative surgery and radiation therapy (Breast (2000) vol. 9 (1) (37-44))', Breast, vol. 9, no. 5, p. 299.View/Download from: Publisher's site
Australia is similar to the United States in that it is a federation of states, its medical profession is well organized and politically powerful, and it has a substantial private sector. Unlike the United States, Australia provides universal access to health care and has controlled its total health care spending to around 8.5 percent of gross domestic product (GDP). This paper reviews the role of private health insurance and recent initiatives to support this; the strategies used to control costs in the fee-for-service sector; and the capacity for experimentation in health care financing within a national system that guarantees universal access.
Hall, JP, Lourenco, R & Viney, RC 1999, 'Carrots And Sticks - The Fall And Fall Of Private Health Insurance In Australia', Health Economics, vol. 8, no. 8, pp. 653-660.View/Download from: UTS OPUS or 3.0.CO;2-I">Publisher's site
Garmany, JD, Gonzalez, F, Ketron, M, Bismark, L, Hall, J, Terry, K, Wilhoit, K & King, M 1998, 'Implementation of critical incident stress debriefing at the Johnson City Medical Center Emergency Department.', Tennessee nurse, vol. 61, no. 4, pp. 20-22.
Glasziou, PP, Mulray, SE, Hall, JP, Martin, AJ, Harris, P, Thompson, P, Tonkin, AM & Simes, RJ 1998, 'Cost-effectiveness Of Pravastatin In Patients With Coronary Heart Disease And Average Cholesterol Levels', Medical Decision Making, vol. 18, no. 4, pp. 475-475.
Economic evaluation is the comparative analysis of alternative courses of action in terms of both costs and consequences. Economic evaluation can also be called economic appraisal or the cost-benefit approach. The basis of economic evaluation lies in comparing costs and benefits of an intervention, program or service. The most important reasons for undertaking an economic evaluation are that resources (e.g., money, time, staff, equipment) are scarce compared with the demands made on them, and that such resource constraints require choices to be made. In this paper, four types of economic evaluations (cost-minimisation, cost-effectiveness, cost-utility and cost-benefit analyses) are described.
Hall, JP, Viney, RC & Haas, MR 1998, 'Taking A Count The Evaluation Of Genetic Testing', Australian And New Zealand Journal Of Public Health, vol. 22, no. 7, pp. 754-758.View/Download from: Publisher's site
While some forms of genetic testing have been available for decades, the progress of the Human Genome Project will expand the possibilities for testing. Evaluation of genetic testing is warranted because health care services have an opportunity cost and
Tonkin, A, Aylward, P, Colquhoun, D, Glasziou, P, Harris, P, MacMahon, S, Magnus, P, Newel, D, Nestel, P, Sharpe, N, Hunt, D, Shaw, J, Simes, RJ, Thompson, P, Thomson, A, West, M, White, H, Simes, S, Hague, W, Caleo, S, Hall, J, Martin, A, Mulray, S, Barter, P, Beilin, L, Collins, R, McNeil, J, Meier, P, Willimott, H, Smithers, D, Wallace, P, Sullivan, D, Keech, A & Ischaemic, L-TIP 1998, 'Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels', NEW ENGLAND JOURNAL OF MEDICINE, vol. 339, no. 19, pp. 1349-1357.
Glasziou, PP, Simes, RJ, Hall, J & Donaldson, C 1997, 'Design of a cost-effectiveness study within a randomized trial: The LIPID trial for secondary prevention of IHD', CONTROLLED CLINICAL TRIALS, vol. 18, no. 5, pp. 464-476.View/Download from: Publisher's site
Hall, J 1996, 'The challenge of health outcomes.', Journal of quality in clinical practice, vol. 16, no. 1, pp. 5-15.
The health outcomes initiative can be seen as another passing phase in health-care management or taken as a serious challenge to the planning, management and evaluation of health services. This paper explores those challenges. Implementation of the health outcomes initiative will require the application of valid, reliable and appropriately sensitive measures, the use of a broad approach to research, development and monitoring in such a way that it is an intrinsic part of service delivery, the adoption of policy and practice that is firmly based on evidence of outcomes, and the development of an approach to research that emphasises generalizability.
Hall, JP 1996, 'Consumer Utility, Social Welfare, And Genetic Testing - A Response To 'genetic Testing An Economic And Contractarian Analysis''', Journal Of Health Economics, vol. 15, no. 3, pp. 377-380.View/Download from: UTS OPUS or Publisher's site
In a recent issue of this journal, Tabarrok provided an economic analysis of genetic testing (Tabarrok, 1994). As genetic research progresses, the identification of individuals at risk of particular diseases, early treatment for those affected and the avoidance of inherited genetic disorders will become more frequent. As Tabarrok states (p. 76) "this ... is accompanied by benefits and costs". His analysis then proceeds to identify the costs and benefits of genetic testing, describe the moral dilemmas and inefficiencies created by testing and propose a solution to the testing problem.The essence of his analysis is this. First, the benefits of genetic testing are improved health, which will be achieved through effective and often earlier therapy, the avoidance of additionaI risks by susceptible individuals and, through pre-pregnancy and antenatal testing, what is in effect selective breeding. Second, the cost of testing will be relatively low. Third, the individual faced with the option of testing has a small probability of a high loss as those with "'bad genes"
Richardson, J, Hall, J & Salkeld, G 1996, 'The measurement of utility in multiphase health states', International Journal of Technology Assessment in Health Care, vol. 12, no. 1, pp. 151-162.View/Download from: Publisher's site
To examine the validity of the additive quality-adjusted life year model used to evaluate a multiphase health state, data from a pilot study of mammography were used to determine whether the values assigned to a multiphase postmastectorny health state could be estimated from a combination of the independently rated constituent health state values. The results suggest that they cannot.
Richardson, J, Hall, JP & Salkeld, G 1996, 'The Measurement Of Utility In Multiphase Health States', International Journal Of Technology Assessment In Health Care, vol. 12, no. 1, pp. 151-162.View/Download from: Publisher's site
To examine the validity of the additive quality-adjusted life year model used to evaluate a multiphase health state, data from a pilot study of mammography were used to determine whether the values assigned to a multiphase postmastectomy health state cou
General practice reform is occurring in a number of countries. Little is known, however, of the effects of remunerating general practitioners on the costs and outcomes of care. Valuable lessons can be learned for the scope and design of future research,
McIntyre, P, Hall, JP & Leeder, S 1994, 'An Economic-analysis Of Alternatives For Childhood Immunization Against Haemophilus-influenzae Type-b Disease', Australian Journal Of Public Health, vol. 18, no. 4, pp. 394-400.
Cost-effectiveness and cost-utility analyses of immunisation strategies against invasive Haemophilus influenzae type b (Hib) disease in Australia were based on a hypothetical birth cohort of 250000 non-Aboriginal Australian children. The model predicted
de Souza, P 1993, 'A cost-utility approach to the use of 5-fluorouracil and levamisole as adjuvant chemotherapy for Dukes' C colonic carcinoma.', The Medical journal of Australia, vol. 158, no. 12, p. 866.
Gerard, K, Dobson, M & Hall, JP 1993, 'Framing And Labeling Effects In Health Descriptions - Quality Adjusted Life Years For Treatment Of Breast-cancer', Journal Of Clinical Epidemiology, vol. 46, no. 1, pp. 77-84.View/Download from: Publisher's site
At present there is a growing interest in the use of cost-utility analysis (CUA) to a point where it merits serious consideration by health care decision makers. However, there remain a number of theoretical and practical issues to be resolved including
Smith, RD, Hall, J, Gurney, H & Harnett, PR 1993, 'A cost-utility approach to the use of 5-fluorouracil and levamisole as adjuvant chemotherapy for Dukes' C colonic carcinoma.', The Medical journal of Australia, vol. 158, no. 5, pp. 319-322.
OBJECTIVE: To perform an economic evaluation of the joint use of 5-fluorouracil and levamisole as adjuvant chemotherapy in patients with fully resected Dukes' Stage C carcinoma of the colon, compared with resection and no chemotherapy. The evaluation was prompted by a study (N Engl J Med 1990; 322: 352-358) which recommended a new treatment standard for colon cancer: a 52-week course of fluorouracil, with levamisole every second week, as adjuvant chemotherapy. This recommendation raised several concerns, particularly about the quality of life of patients undergoing such a long course of chemotherapy and the costs to the health care system. METHODS: The cost of the surgery plus chemotherapy was estimated and compared with the cost of surgery alone. Descriptions of quality of life were developed from interviews with patients and health professionals, and the time trade off technique was then used to derive utility weights from a small sample (16) which were used to adjust length of life to reflect quality, in terms of a "quality adjusted life year" (QALY). RESULTS: Chemotherapy increases the total cost of treating a patient with colon cancer by $7000, from $6000 to $13,000. Incorporating quality of life reduced the extra benefit gained from the chemotherapy from 2.4 life years to 0.4 QALYs. Thus the result is a cost of $17,500 to achieve an extra QALY from this particular treatment. CONCLUSIONS: The results of this analysis are only tentative, as the quality of life descriptions were not measured over time but from a cross-sectional survey of patients, and the valuations of health states were derived from a small sample. However, we believe them to be indicative, and conclude that it is perhaps more appropriate for the use of chemotherapy to be an option rather than standard treatment until further research on these aspects is complete.
The Oregon Plan is an ambitious attempt to address the widespread problem in the United States of a growing number of individuals who are without private health insurance and are not eligible for federal assistance programs. Its aim is to provide univers
Hall, JP, Gerard, K, Salkeld, G & Richardson, J 1992, 'A Cost Utility Analysis Of Mammography Screening In Australia', Social Science & Medicine, vol. 34, no. 9, pp. 993-1004.View/Download from: UTS OPUS or Publisher's site
Cost utility analysis is the preferred method of analysis when quality of life instead is an important outcome of the project being appraised. However, there are several methodological issues to be resolved in implementing cost utility analysis, includin
Mooney, G, Hall, JP, Donaldson, C & Gerard, K 1992, 'Reweighing Heat - Response to Culyer, van Doorslaer and Wagstaff', Journal Of Health Economics, vol. 11, no. 2, pp. 199-205.View/Download from: Publisher's site
Hall, J & McGuire, A 1991, 'Health economics in Australia.', Australian journal of public health, vol. 15, no. 2, pp. 78-80.
Mooney, G, Hall, JP, Donaldson, C & Gerard, K 1991, 'Utilisation As A Measure Of Equity : Weighing Heat', Journal Of Health Economics, vol. 10, no. 4, pp. 475-480.View/Download from: UTS OPUS or Publisher's site
Gerard, K, Salkeld, G & Hall, J 1990, 'Counting the costs of mammography screening: First year results from the Sydney study (I: Reply)', Medical Journal of Australia, vol. 153, no. 3, p. 175.
Gerard, K, Salkeld, G & Hall, J 1990, 'Counting the costs of mammography screening: first year results from the Sydney study.', The Medical journal of Australia, vol. 152, no. 9, pp. 466-471.
Population-based mammography screening is a highly specialized service which aims to improve the early detection of breast cancer. This is achieved through the installation of a dedicated mix of medical technology and professional skills. It is therefore a resource-intensive activity so the benefits foregone by deploying these resources for mammography screening ought to be determined to investigate the relative efficiency of such a commitment. This paper describes the costing methodology used in the evaluation of the Sydney Breast X-ray Programme and presents the health service costs for the first 12 months of operation. In the first year when attendance was under 5000 it cost $118.93 to screen a woman, $13,817 to detect a cancer and $18,720 to detect an impalpable cancer. However, costs are expected to fall in subsequent years as attendance reaches capacity level. The first screening round will detect prevalent cancers; costs will change with subsequent screening rounds as incident cancers are detected. We are cautious in extrapolating the costs of a national programme from these results. However, on the basis of our data and disregarding treatment costs, a national programme which screened 70% of all Australian women over the age of 45 years every two years would add between $60 million and $100 million to the national health bill each year.
Hall, J 1990, 'What every doctor should know about economics (I: Reply)', Medical Journal of Australia, vol. 152, no. 7, p. 388.
Hall, J & Mooney, G 1990, 'What every doctor should know about economics. Part 1. The benefits of costing.', The Medical journal of Australia, vol. 152, no. 1, pp. 29-31.
Hall, J & Mooney, G 1990, 'What every doctor should know about economics. Part 2. The benefits of economic appraisal.', The Medical journal of Australia, vol. 152, no. 2, pp. 80-82.
In this article we have discussed a number of aspects of economic appraisal. Economic evaluation considers both costs and benefits. Cost-benefit analysis requires the evaluation of health in dollar terms but allows the comparison of health programmes with other programmes or the evaluation of one project alone. Because of the problems that are associated with placing a monetary value on life and health, cost-benefit analysis has not been used in the health field as extensively as has cost-effectiveness analysis. Cost-effectiveness analysis is used to compare alternative programmes with the same health goal. The importance of quality as well as length of life as health outcomes has led to the development of cost-utility analysis. Finally, a good economic evaluation of health care requires the collaboration of clinicians and health economists.
Hall, J 1989, 'Best medical practice in practice: measuring efficiency in mammography screening.', The International journal of health planning and management, vol. 4, no. 3, pp. 235-246.View/Download from: Publisher's site
Breast cancer, screening and mammography have caused considerable debate in several countries. This article explores the concept of best medical practice in the context of mammographic screening for breast cancer. Maximizing the use of technology, ignores the risks intrinsic to technological intervention. To do no harm in modern medical practice means largely doing nothing. Best medical practice, therefore, requires a balancing of benefits and risks so that best practice is that which does more good than harm. At the same time, not all interventions that do more good than harm can be funded out of the current health care budget. Thus, best medical practice is economically efficient practice. From the conceptual notion of what is best medical practice, this article turns to the problem of what that means in practical terms. Can we recognize best medical practice when it occurs? The identification, measurement and valuation of costs and benefits are discussed as a specific case study, in the context of breast cancer screening. Many of the difficulties involved here, particularly on the benefit side, are highlighted, especially in the context of QALYs. Yet, whatever the difficulties involved they have to be seen in the context of otherwise settling for something less i.e. inefficient medical practice.
Walker, QJ, Salkeld, G, Hall, J, O'Rourke, I, Bull, CA, Tiver, KW & Langlands, AO 1989, 'The management of oesophageal carcinoma: radiotherapy or surgery? Cost considerations.', European journal of cancer & clinical oncology, vol. 25, no. 11, pp. 1657-1662.View/Download from: Publisher's site
A cost comparison has been made between two treatment modalities used with curative intent for carcinoma of the oesophagus, for 144 patients seen between December 1979 and December 1985. Forty-two patients were selected for radical oesophagectomy. In this paper these are compared with 50 patients who underwent radical radiotherapy. The median survival of both groups was identical (12 months). The remaining 52 patients underwent a variety of palliative procedures and are not considered further. Components of management were identified and costed on the basis of direct resource use by the hospital. Surgically treated patients on average cost $A13,638 in 1987 dollars, whereas those treated by radiotherapy cost $A3533. The major factors accounting for this cost difference were the necessary perioperative intensive management in the surgical group, the inevitable perioperative complications and the subsequent prolonged hospitalization of a proportion of patients. The cost of the management of the complications of radiation therapy are included but were not a major factor in overall costs for the irradiated group. This cost differential must influence the continuation of current strategies in which radical surgery, rather than irradiation, is the selected routine curative approach for oesophageal cancer particularly in the absence of evidence of higher survival.
Hall, JP 1988, 'Methods For The Economic-evaluation Of Health-care Programs - Drummond,mf, Stoddart,gl, Torrance,gw', Community Health Studies, vol. 12, no. 2, pp. 224-224.
Hall, JP, Heller, R, Dobson, A, Lloyd, D, Sansonfisher, R & Leeder, S 1988, 'A Cost-effectiveness Analysis Of Alternative Strategies For The Prevention Of Heart-disease', Medical Journal of Australia, vol. 148, no. 6, pp. 271-277.
Hall, JP, Heller, RF, Dobson, AJ, Lloyd, DM, Sanson-Fisher, RW & Leeder, SR 1988, 'A cost-effectiveness analysis of alternative strategies for the prevention of heart disease.', The Medical journal of Australia, vol. 148, no. 6, pp. 273-277.
The identification of risk factors, such as a raised cholesterol level, hypertension, cigarette smoking, and obesity, permits the prediction of the possible development of ischaemic heart disease and has led to attempts at its prevention through modification of these factors. A high risk of developing ischaemic heart disease is also associated with age, specific socioeconomic groups, a family history of ischaemic heart disease, and preexisting evidence of the disease. Preventive strategies have either sought to reduce the average levels of risk in the general population or to identify by population screening individuals or groups who are at particular risk and to reduce their level of risk. Differing methods of risk-factor identification and modification are appropriate for each of the high-risk groups. For a number of strategies that are directed at either the whole population or high-risk groups we have estimated the costs of identification and risk-factor modification and the probable benefits of undertaking such a strategy. A strategy which educates the whole population by way of the media costs considerably less than does any strategy that involves the identification of individuals at high risk. At a medium cost estimate, with a reduction in risk of only 1%, such an approach costs approximately $8000 per case that is prevented; when risk reduction approaches 3% it actually results in a saving of health-care expenditure within five years. The costs of the other strategies vary between $12,000 and $26,000 per case that is prevented in a five-year period.
Waters, J & Hall, J 1988, 'Staff satisfaction in short stay wards.', Australian health review : a publication of the Australian Hospital Association, vol. 11, no. 4, pp. 302-310.
Two Short Stay Wards (SSWs) have been opened in a large teaching hospital in Sydney's outer Western suburbs, as a means of overcoming budget constraints and a shortage of nurses prepared to work conventional rosters. This paper reports a survey of the attitudes of medical and nursing staff using these two SSWs. Overall, medical personnel were found to hold positive attitudes to the SSWs and reported higher patient turnover as a result of their opening. Identified barriers to usage of the wards included scheduling of operating suite time, and lack of flexibility in the booking, admission and movement of SSW patients. Nurses who work in the SSWs have chosen to work under these special nursing conditions. They were found to be particularly satisfied with their work hours, rapport with patients and other staff, the high patient turnover and varied case mix. Sources of dissatisfaction included Friday night duty and deployment, and the administrative procedures practised by medical staff, including difficulties in contacting them.
Hall, J, Hall, N, Fisher, E & Killer, D 1987, 'Measurement of outcomes of general practice: comparison of three health status measures.', Family practice, vol. 4, no. 2, pp. 117-122.View/Download from: Publisher's site
The broad range of medical problems seen in general practice means that the assessment of health outcomes shares much with the assessment of health status in the general community. The last two decades have seen considerable progress in health status measurement for this purpose. This paper reports the use of three such measures in a general practice setting. The 'Rand health insurance study battery', the 'sickness impact profile' and the 'general health questionnaire' were tested in two general practices in Sydney, Australia, to determine patient compliance, to assess the range of scores and discriminative ability of the instruments, and to compare the different instruments. There was a high degree of acceptance of the questionnaires, showing that patients visiting their general practitioners are prepared to complete such questionnaires. The range of scores obtained was less skewed for the Rand measures than for the sickness impact profile or the general health questionnaire, suggesting that the Rand measures should be the preferred general health status measure.
Hall, J & Masters, G 1986, 'Measuring outcomes of health services: a review of some available measures.', Community health studies, vol. 10, no. 2, pp. 147-155.
Hall, JP, Dickinson, JA & Mcdonald, M 1985, 'Income From Private Medical-practice In Australia - A Comment', Community Health Studies, vol. 9, no. 1, pp. 69-70.
Progress in health promotion and preventive programme planning is limited by a lack of data on the development of current activities. A cross sectional survey of hospitals, community health centres, and other health agencies in New South Wales was therefore undertaken to determine the nature and extent of health promotion programmes being conducted in the period July to December 1983. A subsample of 1198 preventive programmes in child and family health was identified, making up 26% of all programmes operating in this period. Results indicate that three major types of programme are being conducted in child health. These are in the areas of (1) parent education and support, (2) school health education, including drug and alcohol education and personal development, and (3) child safety and first aid. Although the nature of these programmes generally corresponds with current thinking on what priorities in health promotion should be, results also indicate that evaluation of these programmes is limited. Most programmes assess only what participants think of the programme rather than assessing changes in knowledge, attitude, behaviour, or health status. Improvements in evaluation practice are required if preventive intervention programmes are to undertake seriously the task of altering the pattern of diseases and problems in childhood and adolescence.
Dickinson, JA, Hall, JP, Logan, J & Mcdonald, M 1984, 'An Economic-model Of General-practice', Medical Journal Of Australia, vol. 140, no. 11, pp. 652-658.
Dickinson, JA, Swinkels, W & Hall, JP 1984, 'Computerized Modeling Of Financial Structures In General-practice', Community Health Studies, vol. 8, no. 2, pp. 262-263.
Hall, JP & Dickinson, JA 1984, 'Teaching-research Methods', Community Health Studies, vol. 8, no. 1, pp. 140-141.
Hall, JP & Menyhart, J 1984, 'Health-insurance In Western Sydney - Results From A Community Survey', Community Health Studies, vol. 8, no. 2, pp. 265-265.
Hall, JP, Dickinson, JA & Swinkels, W 1984, 'Incomes In General-practice', Community Health Studies, vol. 8, no. 2, pp. 265-265.
Hall, JP, Menyhard, J, Hall, N & Tweedie, R 1984, 'Measuring Health-status In Health-program Evaluation', Community Health Studies, vol. 8, no. 2, pp. 266-266.
Hawe, P, Degeling, D, Murphy, AJ & Hall, JP 1984, 'Health Promotion Program Goals And Evaluation - Preliminary-results From A Survey In Nsw', Community Health Studies, vol. 8, no. 2, pp. 266-266.
MANT, A & HALL, J 1982, 'TRENDS IN PSYCHOTROPIC-DRUGS DISPENSING 1967-1977 - THE IMPACT OF GOVERNMENT CONTROLS IN AUSTRALIA', SOCIAL SCIENCE & MEDICINE, vol. 16, no. 6, pp. 699-706.View/Download from: Publisher's site
SPITZER, WO, DOBSON, AJ, HALL, J, CHESTERMAN, E, LEVI, J, SHEPHERD, R, BATTISTA, RN & CATCHLOVE, BR 1981, 'MEASURING THE QUALITY OF LIFE OF CANCER-PATIENTS - A CONCISE QL-INDEX FOR USE BY PHYSICIANS', JOURNAL OF CHRONIC DISEASES, vol. 34, no. 12, pp. 585-597.View/Download from: Publisher's site
Catchlove, BR, Wilson, RM, Spring, S & Hall, J 1979, 'Routine investigations in elective surgical patients. Their use and cost effectiveness in a teaching hospital', Medical Journal of Australia, vol. 2, no. 3, pp. 107-110.
An analysis of the utilization of diagnostic services in a group of 91 patients who were admitted to a teaching hospital for routine surgery is presented. The results indicate a very high utilization of services - 55% of patients had an ECG, 87% of patients had a chest X-ray examination, 93% of patients had a biochemical profile and 94% of patients had a full blood count performed at least once during their stay in hospital. The total costs (calculated on standard charges) for diagnositc tests were $4317.80 ($47.44 per patient). The majority of the tests were performed preoperatively, and no operation was cancelled, or even postponed, because of the result of investigations.
Catchlove, BR, Spring, S, Garrick, C & Hall, J 1978, 'Medical training and the costs of health care', Medical Journal of Australia, vol. 2, no. 7, pp. 318-321.
Interns who were appointed in 1978 were surveyed on their knowledge of hospital costs, on their attitudes to cost containment, and on their undergraduate training in the economic and political issues which currently affect the medical profession. It appears that medical students trained at New South Wales universities receive little instruction in costs, financial mechanisms, or the economic implications of health care; and it also appears that undergraduate training does not develop their awareness of current issues such as cost containment, peer review, and quality assurance.
Viney, RC, Hall, J, Duckett, S & Moran, S 2018, 'Health economics' in The future of precision medicine in Australia, Australian Council of Learned Academies (ACOLA), Melbourne, pp. 100-113.View/Download from: UTS OPUS
Hall, JP & Van Gool, K 2017, 'Improving the productivity of health services' in Improving service sector productivity: the economic imperative, Committee for Economic Development of Australia (CEDA), Melbourne, pp. 35-46.
Hall, JP 2016, 'Maynard the globe trotter' in Cookson, R, Goddard, M & Sheldon, T (eds), Maynard Matters: Critical thinking on health policy, University of York, York, pp. 55-60.View/Download from: UTS OPUS
Alan is a frequent guest speaker in different parts of
the world. However his hosts, be they policy makers,
clinicians or health service managers, are seldom soothed by
congratulations on their latest reform attempts or offered the
latest panacea from the National Health Service in England.
Rather, they are challenged to specify their objectives and
to support their strategies with data and evidence. Alan was
always particularly annoyed at reorganisation that passed
as reform – successive 're-disorganisation' as he termed it
– which consumed scarce resources in terms of funds and
Hall, JP & van Gool, K 2016, 'Ageing, entitlement and funding health care' in Kendig, H, McDonald, P & Piggott, J (eds), Population ageing and Australia's future, The Australian National University, Canberra, pp. 261-279.
Hall, JP 2011, 'Disease prevention, health care, and economics' in Glied, S & Smith, PC (eds), The Oxford Handbook of Health Economics, Oxford University Press, Oxford, pp. 555-577.View/Download from: UTS OPUS
THE prevention of disease covers a wide range of ac tivities that can occur both within and outside the health system. In the developed countries, the increased life expectancy associated with the control of infectious and many acute diseases, has resulted in an increasing prevalence of chronic and other continuing diseases. Although environmental conditions are far more prominent as a cause of disease in the developing countries (Pruss-astun et aJ. 200S), nonetheless, these countries are also dealing with the increasing burden of chronic disease, including cardiovascular disease, cancers, diabetes and depression, which become more prevalent with aging (WHO 2008). Many of these conditions and diseases are associated with risk factors or precursors which make them, in theory at least, preventable. Less disease and illness would deliver on one of the widely accepted health system goals of improving the health of the population.
Hall, J.P. 2009, 'Health services research in Australia' in Mullner, R.M. (ed), Encyclopedia of Health Services Research, SAGE Publications, Inc, Chicago.
Fiebig, D.G. & Hall, J.P. 2005, 'Quantitative Tools for Microeconomic Policy Analysis' in Banks, G. (ed), Quantitative Tools for Microeconomic Policy Analysis, Productivity Commission, Melbourne, Australia, pp. 119-136.
Hall, J.P. & Savage, E.J. 2005, 'The role of the private sector in the Australian healthcare system' in Maynard, A. (ed), The Public-Private Mix for Health, Radcliffe Publishing, Abingdon, UK, pp. 247-278.View/Download from: UTS OPUS
Hall, JP 2018, 'Building research strength in health economics in Australia [Plenary]', 40th Annual Australian Health Economics Society Conference, Hobart.
Hall, JP 2018, 'Improving the performance of Australia's health system [invited]', 8th National Health Reform Summit: 'Equity Efficiency and Sustainability', Canberra.
Wright, MC, Hall, J, Haas, M, Van Gool, K & Yu, S 2018, 'The relationship between continuity of care and cervical cancer screening', 40th Annual Australian Health Economics Society Conference, Hobart.
Addo, R, Hall, J, Goodall, S & Haas, M 2017, 'The knowledge and perception of Ghanaian decision makers and researchers towards the use of health technology assessment for health decision making [Conference Presentation]', iHEA Boston World Congress, Boston, USA.
Fiebig, D, Van Gool, K, Hall, J & Yu, S 2017, 'Provider moral hazard and insurance eligibility: The case of Australia's Medicare safety net program [Conference Presentation]', iHEA Boston World Congress, Boston, USA.
Pulok, M, Van Gool, KC & Hall, J 2017, 'Revisiting horizontal inequity of health care use: An analysis of regional variation in Australia [Conference Presentation]', 39th Annual Australian Health Economics Society Conference, Sydney.
Longden, T, Wong, CY, Haywood, P, Hall, J & van Gool, K 2016, 'A question of persistence and related health states: an analysis of persistently high healthcare costs in the short term and long term', Australian Health Economics Society Conference, Fremantle, Australia.
Wong, C, Longden, T, van Gool, K & Hall, J 2016, 'Morbidity interactions and the cost of healthcare: an analysis of a largesample administrative dataset of primary care, hospital pharmaceutical and total healthcare costs', Australian Health Economics Society Conference, Perth.
De Abreu Lourenco, R, Haas, M, Hall, J, Parish, K, Stuart, D & Viney, R 2016, 'Placing a value on avoiding cancer recurrence: women's preferences for contralateral prophylactic mastectomy', 38th Annual Australian Health Economics Society Conference, Perth.
Lourenco, RDA, Haas, M, Hall, J, Parish, K, Stuart, D & Viney, R 2016, 'Women's preferences for avoiding cancer recurrence: a focus on contralateral prophylactic mastectomy', Asia-pacific Journal of Clinical Oncology, pp. 137-137.
Hall, JP 2015, 'GP visits on diabetes outcomes: methods and initial findings from WA and NSW person-linked data', 9th Health Services and Policy Research Conference (HSRAANZ), Health Services and Policy Research Conference (HSRAANZ), Melbourne.
Wong, C & Hall, J 2015, 'Does the quality of general practitioners affect the use of emergency departments? Evidence from a survey of Australian adults', Primary Health Care Research Conference, Adelaide.
Hall, J.P. 2014, 'Using Incentives to drive quality primary care: is it all about money?', 2nd International Primary Health Care Conference [invited speaker], Brisbane.
Hall, J.P. 2013, 'Primary health care in Australia: how can research support health system development? [Plenary]', 8th Health Services and Policy Research Conference, Wellington, New Zealand.
Hall, J.P. 2013, 'The health economics perspective on end of life care', End of Life Issues and Decision Making Forum, Canberra.
Hall, J.P. 2013, 'Uptake of government incentive schemes and grants in Australian primary care', 8th Health Services and Policy Research Conference, Wellington, New Zealand.
Hall, J.P. & De Abreu Lourenco, R. 2013, 'A (rural) health system for the 21st century: Financing our health care system - the place and pace of reform', 12th National Rural Health Conference, Adelaide.
Kecmanovic, M. & Hall, J.P. 2013, 'Uptake of government incentive schemes and grants in Australian primary care', 8th Health Services and Policy Research Conference, Wellington, New Zealand.
De Abreu Lourenco, R., Kenny, P.M. & Hall, J.P. 2013, 'Factors linked to patient GP payments: results of a survey of Australian patients', 8th Health Services and Policy Research Conference, Wellington, New Zealand.
Hall, J.P. 2011, 'Hospital Performance Reporting', Melbourne Institute for Applied Economic Research Economic Forum, Melbourne.
Hall, J.P. 2011, 'Hospital Performance Reporting', Melbourne Institute for Applied Economic Research Economic Forum, Canberra.
Hall, J.P. 2011, 'Making caring count: the cost and value of caring', Carers NSW Biennial Conference, Sydney.
Hall, J.P. 2011, 'Overview of medicines regulation and funding in Australia', China-Australia Workshop on Drug Policy and National Essential Medicine System. Hosted by the China National Health Development Research Center, Beijing.
Hall, J.P. 2011, 'The Australian Pharmaceutical Benefits Scheme: The methods of carrying out the drug evaluation process', Drug Policy and National Essential Medicine System. Hosted by the China National Health Development Research Center, Beijing.
Knox, S.A., Hall, J.P. & Cumming, J. 2011, 'Quality of primary care and emergency department use: A comparison of Australia, New Zealand and the USA', 7th Health Services and Policy Research Conference, Adelaide.
Gu, Y., Fiebig, D.G., Kohn, R. & Hall, J.P. 2010, 'Monetary valuation of informal carers' needs using a discrete choice experiment: a Bayesian approach', 1st Australian Workshop on Econometrics and Health Economics, Melbourne.
Haas, MR, Ward, R, Van Gool, K, Hall, JP, Stewart, B, Pearson, S, Links, M & Board, N 2009, 'Economic Modelling applied to Cancer Protocols: EM-CAP', 6th Health Services and Policy Research Conference 2009, Brisbane.
Hall, J.P. 2009, 'Choice at what cost? Voluntary health insurance in Australia', iHEA 7th World Congress, Beijing, China.
Hall, J.P. 2009, 'Discrete choice experiments: what is the question? Invited Plenary', Australian Conference of Health Economists, Hobart, Tas.
Hall, J.P. 2009, 'Does management matter? Australian management practices research project', Royal Australian College of Medical Administrators Annual Conference, Citygate Central, Sydney.
Hall, J.P. 2009, 'Health and Hospitals Reform Commission: "New Models of Care" Discussant', Australian Financial Review Health Conference 2009, Sydney.
Hossain, I., Hall, J.P., Fiebig, D.G. & King, M.T. 2009, 'How do preferences elicited through DCEs vary over time and with changing experience? The case of preferences for asthma medications', iHEA 7th World Congress, Beijing, China.
Haas, MR, Viney, RC, Gallego, G & Hall, JP 2009, 'Implementing guidelines for reimbursement in Australia: How the PBAC & MSAC use comparative cost-effectiveness', International Network Health Policy and Reform Meeting, Krakow, Poland.
Hall, J.P. & Kenny, P. 2008, 'The training and job decisions of nurses', Faculty of Nursing Midwifery and Health Research Showcase, University of Technology Sydney.
Hossain, I., Hall, J.P., Fiebig, D.G. & King, M.T. 2008, 'How do preferences elicited through DCEs vary over time and with changing experience? The case of preferences for asthma medications', Australian Conference of Health Economists, Adelaide.
Kenny, P., Hall, J.P., Zapart, S., Davis, P. & Hossain, I. 2008, 'Informal care and home-based palliative care: a discrete choice experiment to assess the carers' preferences for support services', Quality of Life Research, Springer, Montevideo, Uruguay.
Norman, R, Goodall, S, Gallego, G & Hall, JP 2008, 'The trade-off between equality of outcome and efficiency in healthcare: A discrete choice experiment', Australian Conference of Health Economists, Adelaide.
Kenny, P.M., Hall, J.P., Zapart, S., Davis, P. & Hossain, I. 2008, 'Informal care and home-based palliative care: a discrete choice experiment to assess the carers' preferences for support services', Uruguay.
Hall, J.P., Louviere, J.J. & Kenny, P.M. 2007, 'Understanding the preferences of informal caregivers providing palliative care at home', iHEA 6th World Congress on Health Economics, Copenhagen, Denmark.
Kenny, P.M., Hall, J.P., Zapart, S., Davis, P. & Hossain, I. 2007, 'Informal care and home-based palliative care: the carersâ preferences for support', 5th Health Services & Policy Research Conference, Auckland.
Gallego, G., Van Gool, K., Hall, J.P. & Kelleher, D. 2006, 'Introduction of new health care technologies at the institutional level: how is it being done?', Workshop for Early Health Services Researchers, Sydney.
Van Gool, K, Gallego, G, Haas, MR, Hall, JP, Viney, RC, Ward, R, Links, M, Stewart, B, Board, N & Pearson, S 2006, 'Incorporating economic evidence into cancer care: searching for the missing link', Australian Conference of Health Economists, Perth.
Hall, J.P., King, M.T., Fiebig, D.G., Hossain, I. & Louviere, J.J. 2004, 'Understanding consumer preferences and measuring utility for genetic screening', Quality of Life Research 2004; 13(9)., 11th Annual Conference of the International Society for Quality of Life Research, Springer, Hong Kong, pp. 1569-1569.
Jones, G, Savage, E & Hall, J 2004, 'Pricing of general practice in Australia: some recent proposals to reform Medicare.', Journal of health services research & policy, pp. 63-68.View/Download from: Publisher's site
In the Australian Medicare system, general practitioners (GPs) are paid on a fee-for-service basis. A practitioner can choose to bill the government directly (termed bulk billing) and receive 85% of a regulated fee as full payment. Bulk billed consultations are free to the patient. However, GPs are free to charge above the regulated fee. The patient can then claim a rebate from the government but only the equivalent of 85% of the regulated Medicare fee. Such copayments for GP consultations cannot be covered by private health insurance. In the ten years following the introduction of Medicare in 1984, the bulk billing rate for GP consultations steadily increased to 84%. Since then the rate has fallen to below 68%. In April 2003 the Minister for Health announced a reform package under the title A Fairer Medicare which aimed, among other things, to increase the availability of bulk billing for some patients. A key feature of the proposal involved changes to the way that GPs are reimbursed. Following political opposition that would have prevented it passing both houses of the federal parliament, a revised version, MedicarePlus, was released in November 2003. This paper describes the factors influencing a GP's choice to bulk bill and examines the two proposals, in this context.
Anderson, R., Eyeson-Annan, M., Banks, C. & Hall, J.P. 2001, 'Assessing the economic benefits of population health surveys: the example of the NSW Health Survey', 23rd Australian Health Economics Society Conference, Canberra.
Hall, J.P. 2001, 'Do public health advocates have to be extra-welfarists?', 23rd Australian Health Economics Society Conference, Canberra.
Hall, J.P. 2001, 'Setting priorities in drug and alcohol treatment services', Australian Professional Society on Alcohol and Other Drugs (APSAD), Sydney.
Hall, J.P. 2001, 'The future of health services research in Australia', National Demonstration Hospitals Program Phase 3 Conference, Sydney.
Hall, J.P. 2001, 'The public view of private health insurance', Health Policy Institute Colloquium, University of Sydney.
Hall, J.P. & Haywood, P. 2001, 'The introduction of economics into evidence based guideline construction', 2nd New Zealand Australia Health Services & Policy Research Conference, Wellington, NZ.
Hall, J.P., King, M.T., Louviere, J.J. & De Abreu Lourenco, R. 2001, 'Choice modelling: What do consumers value from carrier status screening? An application of choice modelling.', International Health Economics Association (iHEA) 3rd World Conference, York, UK.
Hall, JP & Haas, MR 2001, 'Research and public policy: If health economics is the answer, what is the question?', Where to with Health Economics, Royal Childrenâ¿¿s Hospital and Murdoch Childrenâ¿¿s Research Institute, Melbourne.
Haywood, P. & Hall, J.P. 2001, 'The introduction of economics into evidence based guideline construction', 23rd Australian Health Economics Society Conference, Canberra.
Haywood, P. & Hall, J.P. 2001, 'The introduction of integrated care arrangements', 2nd New Zealand Australia Health Services & Policy Research Conference, Wellington, NZ.
Pollicino, C. & Hall, J.P. 2001, 'Managing elective surgical waiting lists: A new approach', 2nd New Zealand Australia Health Services & Policy Research Conference, Wellington, NZ.
Kenny, PM, Hall, JP, Viney, RC, Haas, MR & King, MT 2001, 'Validity of choice modelling for measuring consumer preferences in health', 2nd New Zealand Australia Health Services & Policy Research Conference, Wellington, NZ.
Lancsar, E., Van Gool, K., Viney, R.C. & Hall, J.P. 2001, 'Funds pooling in Australia: diving into the deep end', 2nd New Zealand Australia Health Services & Policy Research Conference, Wellington, NZ.
Van Gool, K., Lancsar, E., Viney, R.C. & Hall, J.P. 2001, 'The Australian health care system: Where does it hurt?', 2nd New Zealand Australia Health Services & Policy Research Conference, Wellington, NZ.
Goodall, S, Kenny, P, Mu, C, Hall, JP, Norman, R, Cumming, J, Street, D, Greene, J & REFinE Team Australian National University 2016, REFinE-PHC: Preferences and choice in primary care Consumers and providers, Canberra.
Van Gool, K, Woods, M, Hall, J, Haas, M & Yu, S CHERE 2015, Sustainability, efficiency and equity in health care: The role of funding arrangements in Australia. A report by the Centre for Health Economics Research and Evaluation for the Australian Healthcare and Hospitals Association (AHHA), Sydney.
Van Gool, K, Woods, M, Hall, J, Haas, M, Yu, S & Wright, M CHERE 2015, Primary Health Networks as a disruptive force for positive change: A report by the Centre for Health Economics Research and Evaluation for the Australian Healthcare and Hospitals Association (AHHA), Sydney.
Hall, J.P. Academy of the Social Sciences in Australia 2010, Designing the structure for Australia's health system. Occasional Paper 2010 Number 1, pp. 1-29, Canberra, Australia.View/Download from: UTS OPUS
Public hospitals and their performance was the major health issue in the 2007 national election. The now Prime Minister, as Opposition leader, announced that he would develop a national reform plan 'designed to eliminate duplication and overlap between the States and the Commonwealth' and 'to move beyond the blame game'.1 He also stated his intention to hold a national referendum to allow the Commonwealth to take over the running of public hospitals if reform could not be achieved cooperatively with the States by the middle of 2009.
Haas, MR, Hall, JP, Gallego, G, Goodall, S, Norman, R, Van Gool, K & Viney, RC CHERE, University of Technology, Sydney 2008, Development of an evaluation framework and methodology for national blood supply change proposals: Final report, pp. 1-105, Sydney.
Haas, MR, Hall, JP, Gallego, G, Goodall, S, Norman, R, Van Gool, K & Viney, RC CHERE, University of Technology, Sydney 2008, Framework and methodology for national blood supply change proposals: Part 2, pp. 1-33, Sydney.
Duffield, C.M., Roche, M.A., O'Brien-Pallas, L., Diers, D., Aisbett, C., King, M.T., Aisbett, K. & Hall, J.P. Centre for Health Services Management, UTS 2007, Glueing it together: nurses, their work environment and patient safety., pp. 1-243, Sydney.
Doiron, D., Hall, J.P. & Jones, G. CHERE 2005, Trends in the nursing workforce in New South Wales, CHERE Research Report 23, Sydney.
Administrative panel data on NSW nurses covering the 90s are used to address several trends in the nursing workforce: the attrition and ageing of nurses, the hours of work in nursing, the allocation of the nursing workforce across job premises in particular across the public and private sectors, and the effects of personal, job and other characteristics on retention in nursing. Findings include: evidence of ageing of the nursing workforce due to a slower entry and an increase in retention; a reduction in the proportion of full-time workers and an increase in the number of hours for part-timers resulting in no change in the average number of hours of work; an improvement in retention in all job premises especially nursing homes; and a substantial amount of year to year churning in and out of the workforce and across premises. Retention probits show very little changes over time either in the estimated coefficients or in the distribution of characteristics.
Hall, JP CHERE 2004, Can we design a market for competitive health insurance?, CHERE Discussion Paper No 53, Sydney.
The topic of this paper is whether it is possible, given the current state of knowledge and technology, to design the appropriate market structure for managed competition. The next section reviews market failure in the private health insurance market. The subsequent two sections describe the principles of managed competition and its development and application in other countries. Then, the paper outlines recent developments in private health insurance policy in Australia, and proposals to apply managed competition in this country. The required design of the managed competition market place is described, and four major issues, risk adjustment, budget holding, consumer behaviour, and insurer behaviour, are identified. The final sections of the paper review the evidence on these four issues to determine if managed competition can be implemented, given current knowledge
Kenny, PM, Mahmic, A, Lancsar, E, Anderson, R, King, MT & Hall, JP CHERE 2003, Diaries or questionnaires for collecting self-reported healthcare utilisation and patient cost data?, CHERE Project Report No 20, Sydney.
Hall, JP CHERE 2001, The public view of private health insurance, CHERE Discussion Paper 45, Sydney.
Kenny, P., King, M.T., Shiell, A., Seymour, J., Boyages, J. & Hall, J.P. CHERE 2000, Quality of life three months and one year anter treatment for early stage breast cnacer, CHERE Discussion Paper No 42, Sydney.
De Abreau Lourenco, R, Foulds, K, Smoker, I & Hall, JP CHERE 1999, Australian Health Care System, CHERE Discussion Paper No 38, Sydney.
Hall, JP, Caleo, S & Stevenson, J CHERE 1999, Economic analysis of psychotherapy for borderline personality disorder patients, CHERE Project Report No 9, Sydney.
Haas, MR, Chapman, S, Viney, RC, Hall, JP & Ferguson, AC CHERE 1999, The news on health economics: a study of resource allocation in health in the Australian print media for 1996, CHERE Discussion Paper No 40, Sydney.
Caleo, S & Hall, JP CHERE 1998, Measles elimination: Costing of a national measles immunisation 'catch up' program, CHERE Project Report No 7, Sydney.
Slater, J., Hall, J.P., Lowin, A. & Alperstein, G. CHERE 1998, Cost effectiveness analysis of school based Mantoux screening for TB in Central Sydney, CHERE Discussion Paper No 37, Sydney.
Cooper, L & Hall, JP CHERE 1997, Cost of organ and tissue donation in NSW - Report the NSW Department of Health, CHERE Project Report No 3, Sydney.
Aristides, M, Shiell, A, Hall, JP, Cameron, S & Madeline, J CHERE 1993, Out of hours: an evaluation of the continuing community cancer care program in western Sydney, CHERE Discussion Paper No 20, Sydney.
Davey, P., Hall, J.P. & Seymour, J. CHERE 1993, Cost effectiveness of pravastatin for secondary prevention of IHD - feasibility and pilot study., CHERE Discussion Paper No 17, Sydney.
LIPID is a randomised controlled trial which is being undertaken jointly by the National Heart Foundation of Australia and the NHMRC Clinical Trials Centre. Its aim is to determine whether HMG-CoA reductase inhibitors reduce coronary heart disease mortality in post myocardial infarction or unstable angina pectoris patients. The cost-effectiveness sub-study, which is being undertaken in collaboration with the Centre for Health Economics Research and Evaluation aims to measure the cost-effectiveness of the intervention. The purpose of the feasibility and pilot costing study is to investigate the most feasible approach for deriving cost estimates of resources used. More specifically, the aim was to examine developments in information systems in NSW and the ACT and to undertake a costing of critical care wards (intensive and coronary care units) in four distinctly different types of hospital. These were a NSW city teaching hospital; a NSW non city teaching hospital; a country hospital and an interstate hospital. The main findings of the study were that it is possible to produce satisfactory unit prices for bed day stay in different hospitals in NSW and the ACT; the prices between the different types of hospital do not appear to vary greatly; and the likely improvements in information systems over the next 2-3 years will provide a superior data set, enabling simpler and more accurate costings to be undertaken at that time. It was therefore recommended that the generation of a full set of costs be left until towards the end of the LIPID study; any future costing be preceded by modelling to assess the sensitivity of the cost-effectiveness analysis results to the accuracy of the variable; and the development of in hospital cost data be closely monitored.
Hall, JP CHERE 1993, The impact of the economic evaluation of health care on policy and practice, CHERE Discussion Paper No 22, Sydney.
Hall, JP & Shiell, A CHERE 1993, Health outcomes: a health economics perspective, CHERE Discussion Paper No 19, Sydney.
Scott, A. & Hall, J.P. CHERE 1993, Incentives for efficiency in general practice: theory & evidence., CHERE Discussion Paper No 18, Sydney.
Improving the efficiency of general practice requires an understanding of the effects of changes in incentives on General Practitioner (GP) behaviour. In this paper, the theoretical and empirical evidence on how incentives influence GP behaviour and the efficiency of medical practice is reviewed. Two issues are addressed; what mechanisms might promote efficiency in general practice?; and, how can GP behaviour be changed? The empirical evidence suggests that GP behaviour can be changed through remunerative, competitive and educational incentives, and that income is an important determinant of behaviour. However, there are weaknesses in the methods adopted and deficiencies in data which limit the generalisability of the results of most studies. The paucity of evidence in this area leaves much scope for future research. Changes in general practice remuneration and organisation should be properly evaluated if efficient practice is to be promoted.
Shiell, A, Hall, JP, Jan, S & Seymour, J CHERE 1993, Advancing health in NSW: planning in an economic framework, CHERE Discussion Paper No 23, Sydney.
Smith, R & Hall, JP CHERE 1993, The cost of operating a national renal/pancreas transplant unit, CHERE Discussion Paper No 13, Sydney.
Smith, R, Hall, JP, Harnett, P & Gurney, H CHERE 1993, A preliminary cost utility analysis of adjuvant chemotherapy for resected colonic carcinoma, CHERE Discussion Paper No 15, Sydney.
Donaldson, C & Hall, JP CHERE 1991, Economic evaluation of health care Guidelines for costing, CHERE Discussion Paper No 1, Sydney.
Hall, JP & Mooney, G CHERE 1991, Estimating benefits for economic evaluation, CHERE Discussion Paper No 2, Sydney.
Hall, J.P. 2012, 'National clinical standards and cost-effectiveness. CHERE Working Paper 2012/03', CHERE Working Papers.
Kenny, PM, Doiron, D, Hall, JP, Street, D, Milton-Wildey, KK & Parmenter, G 2012, 'The training and job decisions of nurses: the first year of a longitudinal study investigating nurse recruitment and retention. CHERE Working Paper 2012/02', CHERE Working Papers.
Van Gool, K, Norman, R, Delatycki, M, Hall, JP & Massie, J 2011, 'Understanding the costs of care for cystic fibrosis: an analysis by age and severity. CHERE Working Paper 2011/1', CHERE Working Papers.
Haas, MR, Hall, JP & Gallego, G 2009, 'Evidence for funding, organising and delivering health care services targeting secondary prevention and management of chronic conditions. CHERE Working Paper 2009/6'.
Objectives Individuals with chronic conditions represent a high healthcare cost group and understanding the cost variation among individuals is important for developing appropriate policy. This study aimed to investigate the sources of variation in the cost of healthcare for a cohort of people with asthma. It examines the costs to the health system and patient out-of-pocket costs. Methods A longitudinal observational study of asthma-related healthcare costs in a cohort of people with asthma (n=252). Participants were followed for three years using six-monthly postal surveys and individual administrative data. The factors associated with health system and patient out-of-pocket costs were investigated using generalised linear mixed models. Results There was substantial variability around the average costs of healthcare for asthma which were associated with asthma-related health measures and socio-demographic variables. The health system costs were less for those living in regional areas relative to Sydney residents and both the health system and patient out-of-pocket costs were highest in the oldest age group and lowest for children. The health system and patient out-of-pocket costs were highest for the high income group while the middle income group had the lowest total cost. Conclusions Our findings suggest that variations should be explored in developing strategies for chronic disease management and that Australia has achieved reasonable equity in access. However, out-of-pocket costs may be a deterrent for the middle income group, which should be a general concern for policies targeting the most disadvantaged group to the exclusion of concern with universal access.
Hall, J.P., Kenny, P.M. & Hossain, I. 2007, 'The provision of informal care in terminal illness: An analysis of carers' needs using a discrete choice experiment. CHERE Working paper 2007/12', CHERE Working Paper.
Van Gool, K, Gallego, G, Haas, MR, Viney, RC, Hall, JP & Ward, R 2007, 'Incorporating economic evidence into cancer care: searching for the missing link, CHERE Working Paper 2007/3', CHERE Working Paper.
Hall, J.P. 2006, 'Life death and dollars: Does Medicare need major surgery? CHERE Distinguished Lecture Monograph', CHERE working Paper Series.
Hall, J.P., Gafni, A. & Birch, S. 2006, 'Health economics critiques of welfarism and their compatibility with Sen's capabilities approach. CHERE Working Paper 2006/16', CHERE Working Paper Series.