Kees van Gool is a Deputy Director and Associate Professor at the Centre. He has extensive experience in international, national and regional health policy research. He is part of a leading team working on the financing and economics of primary care. Kees has previously contributed to and managed a variety of projects including work conducted for the Commonwealth Department of Health, MBF and the Australian Senate. He was a lead investigator in two independent reviews of the Extended Medicare Safety Net conducted for the Australian Government. He is currently a chief investigator at the Centre for Research Excellence on the Financing and Economics of Primary Care (REFinE), funded by the Australian Primary Health Care Institute (APHCRI) . He has worked extensively on cancer care, screening, cystic fibrosis and policy evaluation. He has quantitative skills in micro-economic modelling and has established a track record in using linked data. In 2011 he completed his PhD at the University of Technology Sydney, looking at the out-of-pocket costs faced by patients under Australia’s Medicare system. Kees has previously worked at the Department of Health, NSW Health and the OECD where he led a project on international health system performance and policy analysis on cardiovascular disease care and outcomes.
Health financing, primary care, health care costs, comparative health system performance and equity
Yu, S., van Gool, K., Kirby, S., Gardner, K., Robinson, L., Linehan, T., Harris, M.F. & Hall, J. 2018, 'The business of integrated care: implementing new models of care in a fee-for-service setting', Journal of Integrated Care.View/Download from: Publisher's site
McRae, I. & Van Gool, K. 2017, 'Variation in fees of medical specialists: problems, causes and solutions', Medical Journal of Australia, vol. 206, no. 4, pp. 162-163.
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: Publisher's site
Mu, C., De Abreu Lourenco, R., van Gool, K. & Hall, J. 2017, '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: Publisher's site
Johar, M., Mu, C., van Gool, K. & Wong, C.Y. 2017, 'Bleeding hearts, profiteers, or both specialist physician fees in an unregulated market', Health Economics, vol. 26, no. 4, pp. 528-535.View/Download from: UTS OPUS or Publisher's site
This study shows that, in an unregulated fee-setting environment, specialist physicians practise price discrimination on the basis of
their patients' income status. Our results are consistent with profit maximisation behaviour by specialists. These findings are based
on a large population survey that is linked to administrative medical claims records. We find that, for an initial consultation, specialist
physicians charge their high-income patients AU$26 more than their low-income patients. While this gap equates to a
19% lower fees for the poorest patients (bottom 25% of the household income distribution), it is unlikely to remove the substantial
financial barriers they face in accessing specialist care. There are large variations across specialties, with neurologists exhibiting the
largest fee gap between the high-income and low-income patients. Several possible channels for deducing the patient's income are
examined. We find that patient characteristics such as age, health concession card status and private health insurance status are all
used by specialists as proxies for income status. These characteristics are particularly important to further practise price discrimination
among the low-income patients but are less relevant for the high-income patients. Copyright © 2016 John Wiley & Sons, Ltd.
Wong, C., Greene, J., Dolja-Gore, X. & van Gool, K. 2017, 'The rise and fall in out-of-pocket costs in Australia: An analysis of the Strengthening Medicare Reforms', Health Economics, vol. 26, no. 8, pp. 962-979.View/Download from: UTS OPUS or Publisher's site
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.
Butler, K., Reeve, R., Arora, S., Viney, R., Goodall, S., van Gool, K. & Burns, L. 2016, 'The hidden costs of drug and alcohol use in hospital emergency departments', Drug and Alcohol Review, vol. 35, no. 3, pp. 359-366.View/Download from: UTS OPUS or Publisher's site
Reeve, R., Arora, S., Butler, K., Viney, R., Burns, L., Goodall, S. & van Gool, K. 2016, 'Evaluating the impact of hospital based drug and alcohol consultation liaison services', Journal of Substance Abuse Treatment, vol. 68, pp. 36-45.View/Download from: UTS OPUS or Publisher's site
Carinci, F., Van Gool, K., Mainz, J., Veillard, J., Pichora, E.C., Januel, J.M., Arispe, I., Kim, S.M., Klazinga, N.S. & Indicators, O.H.C.Q. 2015, 'Towards actionable international comparisons of health system performance: expert revision of the OECD framework and quality indicators', INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE, vol. 27, no. 2, pp. 137-146.View/Download from: Publisher's site
Gu, Y., García-Pérez, S., Massie, J. & van Gool, K. 2015, 'Cost of care for cystic fibrosis: an investigation of cost determinants using national registry data.', The European Journal of Health Economics, vol. 16, no. 7, pp. 709-717.View/Download from: Publisher's site
Cystic fibrosis (CF) is a progressive disease with treatments intensifying as patients get older and severity worsens. To inform policy makers about the cost burden in CF, it is crucial to understand what factors influence the costs and how they affect the costs. Based on 1,060 observations (from 731 patients) obtained from the Australian Data Registry, individual annual health care costs were calculated and a regression analysis was carried out to examine the impact of multiple variables on the costs. A method of retransformation and a hypothetical patient were used for cost analysis. We show that an additional one unit improvement of FEV1pp (i.e., forced expiratory volume in 1 s as a percentage of predicted volume) reduces the costs by 1.4 %, or for a hypothetical patient whose FEV1pp is 73 the cost reduction is A$252. The presence of chronic infections increases the costs by 69.9-163.5 % (A$12,852-A$30,047 for the hypothetical patient) depending on the type of infection. The type of CF genetic mutation and the patient's age both have significant effects on the costs. In particular, being homozygous for p.F508del increases the costs by 26.8 % compared to all the other gene mutations. We conclude that bacterial infections have a very strong influence on the costs, so reducing both the infection rates and the severity of the condition may lead to substantial cost savings. We also suggest that the patient's genetic profile should be considered as an important cost determinant.
Maggioni, A.P., Van Gool, K., Biondi, N., Urso, R., Klazinga, N., Ferrari, R., Maniadakis, N. & Tavazzi, L. 2015, 'Appropriateness of prescriptions of recommended treatments in Organisation for Economic Co-operation and Development (OECD) health systems: findings based on the Long-Term Registry of the European Society of Cardiology (ESC) on Heart Failure', Value in Health, vol. 18, no. 8, pp. 1098-1104.View/Download from: Publisher's site
Objective This observational study aimed to identify clinical variables and health system characteristics associated with incomplete guideline application in drug treatment of patients with chronic heart failure (HF) across 15 countries. Methods Three data sets were used: European Society of Cardiology Heart Failure Registry, Organisation for Economic Co-operation and Development's Health System Characteristics Survey, and Organisation for Economic Co-operation and Development Health Statistics 2013. Patient and country variables were examined by multilevel, multiple logistic regression. The study population consisted of ambulatory patients with chronic HF and reduced ejection fraction. Inappropriateness of prescription of pharmacological treatments was defined as patients not prescribed at least one of the two recommended treatments (angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers and beta-blockers) or treated with both medications but at suboptimal dosage and in absence of documented contraindication/intolerance. Results Of 4605 patients, 1097 (23.8%) received inappropriate drug prescriptions with a large variation within and across countries, with 18.5% of the total variability accounted for by between-country health structure characteristics. Patient-level characteristics such as having mitral regurgitation (odds ratio 1.4; 95% confidence interval 1.1-1.7) was significantly associated with inappropriate prescription of recommended drugs, whereas chronic obstructive pulmonary disease (odds ratio 0.7; 95% confidence interval 0.5-0.9) was associated with more appropriate prescriptions. Among the country-level variables, incentives or obligation to comply with guidelines increased the probability of prescription appropriateness. Conclusions Combining clinical variables with health system characteristics is a promising exercise to explain the appropriateness of recommended drug prescriptions. Such an understanding can help decision makers to...
Ward, R.L., Laaksonen, M.A., van Gool, K., Pearson, S.-.A., Daniels, B., Bastick, P., Norman, R., Hou, C., Haywood, P. & Haas, M. 2015, 'Cost of cancer care for patients undergoing chemotherapy: The Elements of Cancer Care study.', Asia-Pacific journal of clinical oncology, vol. 11, no. 2, pp. 178-186.View/Download from: Publisher's site
To determine the monthly treatment costs for each element of cancer care in patients receiving chemotherapy and to apportion the burden of cost by financing agent (Commonwealth, State government, private health insurer, patient).A cohort of 478 patients (54% breast, 33% colorectal and 13% non-small-cell lung cancer) were recruited from 12 centers representing metropolitan and regional settings in public and private sectors. Primary data were linked to secondary data held in New South Wales state (Admitted Patients and Emergency Department Data) and Commonwealth (Medicare and Pharmaceutical Benefits) databases. The monthly treatment costs of each element of care and the funding agent were calculated from secondary health data.Across all tumor types, the mean monthly treatment cost was $4162 (10%-90% quantiles $1018-$8098; range $2853 [adjuvant colorectal] to $5622 [metastatic lung]), with 54% of this cost borne by Commonwealth government, 26% by private health insurers, 14% by State government and 6% by patients. The mean monthly costs of treating metastatic disease were $1415 greater than those for adjuvant therapy. The mean monthly costs were contributed to by inpatient care ($1657, 40%), chemotherapy prescriptions ($1502, 36%), outpatient care ($452, 11%) and administration of chemotherapy ($364, 9%).All four funders have a shared incentive to reduce absolute monthly treatment costs since their proportional contribution is relatively constant for most tumor types and stages. There are opportunities to reduce cancer care costs by minimizing the risk of inpatient hospital admissions that arise from chemotherapy administration and by recognizing incentives for cost-shifting.
Pearce, A., Haas, M., Viney, R., Haywood, P., Pearson, S.-.A., van Gool, K., Srasuebkul, P. & Ward, R. 2015, 'Can administrative data be used to measure chemotherapy side effects?', Expert review of pharmacoeconomics & outcomes research, vol. 15, no. 2, pp. 215-222.View/Download from: Publisher's site
Many of the issues with using data from clinical trials and observational studies for economic evaluations are highlighted in the case of chemotherapy side effects. We present the results of an observational cohort study using linked administrative data. The chemotherapy side effects identified in the administrative data are compared with patient self-reports of such events. The results of these comparisons are then used to guide a discussion of the issues surrounding the use of administrative data to identify clinical events for the population of economic models. Although the advantages of easy access and generalizability of the results make administrative data an attractive option for populating economic models, this is not always possible because of the limitations of these data.
Pearce, A.M., Van Gool, K., Haywood, P. & Haas, M.R. 2014, 'Delays in access to affordable medicines: putting policy into perspective - Authors' response', Australian Health Review, vol. 38, no. 1, pp. 16-17.
Gallego, G., Van Gool, K., Casey, R. & Maddern, G. 2013, 'Surgeons' views of Health Technology Assessment in Australia: online pilot-survey', International Journal of Technology Assessment in Health Care, vol. 29, no. 3, pp. 309-314.View/Download from: UTS OPUS or Publisher's site
Introduction: Many governments have introduced health technology assessment (HTA) as an important tool to manage the uptake and use of health-related technologies efficiently. Although surgeons play a central role in the uptake and diffusion of new technologies, little is known about their opinion and understanding of the HTA role and process. Methods: A cross-sectional pilot study was conducted using an online questionnaire which was distributed to Fellows of the Royal Australasian College of Surgeons over a 4-week period. Information was sought about knowledge and views of the HTA process. Descriptive statistics were used to summarize the data, frequencies, and proportions were calculated. Results: Sixty-two surgeons completed the survey; of these, 55 percent reported their primary work place as a public hospital. Twenty-four percent of the participants reported that they had never heard of the HTA agency and 60 percent reported that surgical procedures are most likely to be introduced in the Australian healthcare system at the public hospital level (which is beyond the HTAs scope and dealt with at a state level). However, 61 percent considered that decisions about funding and adoption of new technologies should take place at the national level. Conclusions: This survey provides some evidence that many surgeons remain unaware of the federal governments HTA process but still value evidence-based information. In order for HTA to be an effective aid to rational adoption of health-related technologies, there is a need for an evidence-based approach that is integrated and is accepted and understood by the medical professions.
Reeve, R.D. & Van Gool, K. 2013, 'Modelling the relationship between child abuse and long-term health care costs and wellbeing: results from an Australian community-based survey', Economic Record, vol. 89, no. 286, pp. 300-318.View/Download from: UTS OPUS or Publisher's site
Childhood abuse is a serious social and economic problem. In Australia, there are 17,000 substantiated cases of physical and sexual child abuse each year. We model the relationship between childhood abuse and long-term health, health care costs and wellbeing using data from the 2007 National Survey of Mental Health and Wellbeing. We find that adults with a history of childhood abuse suffer from significantly more health conditions, incur higher annual health care costs and are more likely to harm themselves. Our results suggest that child abuse has long-lasting economic and welfare costs. The costs are greatest for those who experienced both physical and sexual abuse.
Van Gool, K., Norman, R., Hall, J.P., 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.
Norman, R., Van Gool, K., Hall, J.P., 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.
Haywood, P., de Raad, J., Van Gool, K., Haas, M.R., Gallego, G., Pearson, S., Faedo, M. & Ward, R.L. 2012, 'Title:Chemotherapy administration: modelling the costs of alternative protocols..', Pharmacoeconomics, vol. 30, no. 12, pp. 1173-1186.View/Download from: UTS OPUS or Publisher's site
Pearce, A.M., Van Gool, K., Haywood, P. & Haas, M.R. 2012, 'Delays in access to affordable medicines: putting policy into perspective', Australian Health Review, vol. 36, no. 4, pp. 412-418.View/Download from: UTS OPUS or Publisher's site
To save costs, the Australian Government recently deferred approval of seven new medicines recommended by the Pharmaceutical Benefits Advisory Committee (PBAC) for up to 7 months.Objectives: The aim of this research is to examine the timelines of PBAC applications following approval by the Therapeutic Goods Administration (TGA), allowing the recent Cabinet delays to be considered in the context of the overall medicines approval process. Methods. All new chemical entities and products for new indications approved in 2004 by the Australian Drug Evaluation Committee (ADEC) were identified. Outcomes of PBAC meetings from 2004 to 2010 were then searched to identify if and when these products were reviewed by PBAC. Results: ADEC recommended 63 eligible products for registration in 2004. Of the 113 submissions made to PBAC for these products, 66 were successful. Only 43% of the products were submitted to PBAC within 2 years, with an average 17-month delay from TGA approval of a product to consideration by the PBAC. Conclusions: Cabinet decisions to defer listing of new medicines delays access to new treatments. This occurred in addition to other longer delays, earlier in the approval process for medicines, resulting in a significant impact on the overall timeliness of listing.
de Raad, J., Van Gool, K., Haas, M.R., Haywood, P., Faedo, M., Gallego, G., Pearson, S. & Ward, R. 2010, 'Nursing takes time: Workload associated with administering cancer protocols', Clinical Journal of Oncology Nursing, vol. 14, no. 6, pp. 735-741.View/Download from: UTS OPUS or Publisher's site
New medicines and therapeutic combinations are tested and marketed every year. Healthcare decision makers have to make explicit choices about adopting new treatments and deal with the resource consequences of their choices. The aim of this article is to examine the nursing workload of administering alternative chemotherapy protocols as a driver of costs. Data collection (focus groups with chemotherapy nurses and a survey of nurse unit managers) was conducted to ascertain the time required to undertake chemotherapy-related tasks and the sources of variability in six chemotherapy centers in New South Wales, Australia. Four task types (patient education, patient assessment, administration, and patient communication) were identified as being associated with administering chemotherapy. On average, patient education required 48 minutes during the first visit and 18.5 minutes thereafter, patient assessment took 20.3 minutes, administration averaged 23 minutes, and patient communication required 24.2 minutes. Each center treated an average of 14 patients per day. Each patient received 3.3 hours of staff time (1.7 hours of direct contact time and 1.6 hours of noncontact time). The result of this research will allow healthcare decision makers and evaluators to predict the amount of nursing time required to administer chemotherapy based on the characteristics of a wide range of chemotherapy protocols.
Gallego, G., Van Gool, K. & Kelleher, D. 2009, 'Resource allocation and health technology assessment in Australia: Views from the local level', International Journal of Technology Assessment in Health Care, vol. 25, no. 2, pp. 134-140.View/Download from: UTS OPUS or Publisher's site
Objectives: Several studies have shown that a key determinant of successful health technology assessment (HTA) uptake is a clear, fair, and consistent decision-making process for the approval and introduction of health technologies. The aim of this study was to gauge healthcare providers' and managers' perceptions of local level decision making and determine whether these processes offer a conducive environment for HTA. An Area Health Service (AHS) aimed to use the results of this study to help design a new process of technology assessment and decision making. Methods: An online survey was sent to all health service managers and healthcare providers working in one AHS in Sydney, Australia. Questions related to perceptions of current health technology decisions in participants' own institution/facility and opinions on key criteria for successful decision-making processes. Results: Less than a third of participants agreed with the statements that local decision-making processes were appropriate, easy to understand, evidence-based, fair, or consistently applied. Decisions were reportedly largely influenced by total cost considerations as well as by the central state health departments and the Area executive. Conclusions: Although there are renewed initiatives in HTA in Australia, there is a risk that such investments will not be productive unless policy makers also examine the decision-making contexts within which HTA can successfully be implemented. The results of this survey show that this is especially true at the local level and that any HTA initiative should be accompanied by efforts to improve decision-making processes.
Van Gool, K., Savage, E.J., Viney, R.C., Haas, M.R. & Anderson, R. 2009, 'Who's getting caught? An analysis of the Australian Medicare Safety Net', The Australian Economic Review, vol. 42, no. 2, pp. 143-154.View/Download from: UTS OPUS or Publisher's site
The Medicare Safety Net (MSN) was introduced in March 2004 to provide financial relief for those who incur high out-of-pocket costs from medical services. The policy has the potential to improve equity. This study examines: (i) how the health and income profiles of small areas influence MSN expenditure; and (ii) the distribution of expenditure by medical service type. The results indicate that MSN expenditure is positively related to income and that patients who use private obstetricians and assisted reproductive services are the greatest beneficiaries. The MSN has possibly created greater inequities in Australia's health-care financing arrangements.
Gallego, G., Fowler, S. & Van Gool, K. 2008, 'Decision makers' perceptions of health technology decision making and priority setting at the institutional level', Australian Health Review, vol. 32, no. 3, pp. 520-527.View/Download from: UTS OPUS or Publisher's site
This study describes health care decision makers' perceptions about decision making processes for the introduction, diffusion and prioritisation of new health technologies at the regional and institutional level. The aim of the study was to aid the design of a new process of technology assessment and decision making for the Northern Sydney and Central Coast Area Health Service (NSCCAHS). Twelve in-depth, semi-structured interviews were conducted with senior health service managers, nurse managers and senior medical clinicians in the NSCCAHS. Interviewees described prioritisation and decision-making processes as "ad hoc". Safety and effectiveness were considered the most important criteria in decision making but budgetary consideration often drove decisions about the uptake and diffusion of new technologies. Current dissatisfaction with decision- making processes creates opportunities for reform, including the introduction of consistent local technology assessments.
Radhakrishnan, Y.M., Van Gool, K., Hall, J.P., Delatycki, M. & Massie, R.J. 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.
Jones, G., Savage, E.J. & Van Gool, K. 2008, 'The distribution of household health expenditures in Australia', The Economic Record, vol. 84, no. Special, pp. 99-114.View/Download from: UTS OPUS or Publisher's site
Out-of-pocket health expenditures in Australia are high in international comparisons and have been growing at a faster rate than most other health costs in recent years. This raises concerns about the extent to which out-of-pocket costs have constrained access to health services for low income households. Using data from the ABS Household Expenditure Survey 2003-2004, we model the relationships between health expenditure shares and equivalised total expenditure for categories of out-of-pocket health expenditures and analyse the extent of protection given by concession cards. To allow for flexibility in the relationship we adopt Yatchew's semi-parametric estimation technique. This is the first detailed distributional analysis of household health expenditures in Australia. We find mixed evidence for the protection health concession cards give against high out-of-pocket health expenditures. Despite higher levels of subsidy, households with concession cards do not have lower out-of-pocket expenditures than non-cardholder households except for the highest expenditure quintile. Cards provide most protection for GP out-of-pocket expenditures
Gallego, G. & Van Gool, K. 2007, 'Can we deny patients expensive drugs?', Australian Prescriber, vol. 30, pp. 59-60.
Van Gool, K., Gallego, G., Haas, M.R., Viney, R.C., Hall, J.P. & 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.
Birch, S., Haas, M.R., Savage, E.J. & Van Gool, K. 2007, 'Targeting services to reduce social inequalities in utilisation: An analysis of breast cancer screening in New South Wales', Australia and New Zealand Health Policy, vol. 4:12, pp. 1-9.View/Download from: UTS OPUS
Many jurisdictions have used public funding of health care to reduce or remove price at the point of delivery of services. Whilst this reduces an important barrier to accessing care, it does nothing to discriminate between groups considered to have greater or fewer needs. In this paper, we consider whether active targeted recruitment, in addition to offering a 'free' service, is associated with a reduction in social inequalities in self-reported utilization of the breast screening services in NSW, Australia.
Bridges, J.F., Stewart, M., King, M.T. & Van Gool, K. 2002, 'Adapting portfolio theory for the evaluation of multiple investments in health with as multiplicative extension for treatment synergies', HEPAC The European Journal of Health Economics, vol. 3, no. 1, pp. 47-53.View/Download from: UTS OPUS or Publisher's site
Portfolio theory is central to the analysis of risk in many areas of economics but is seldom used appropriately in health economics. This contribution examines the use of portfolio theory in the context of cost-effectiveness analysis (CEA). A number of modifications are needed to apply portfolio analysis to the economic evaluation of health care interventions. First, the method of reporting the results of a CEA, and consequently some of the underlying assumptions, needs to be modified. Second, portfolio theory needs to be expressed in terms of effects on individuals aggregated to a population. Finally, one needs to allow for the possibility of synergy between the various health interventions. This paper derives a general formula for a portfolio of health care interventions that allows for synergies between interventions where the population effects are aggregated from individual effects. A number of special cases are also derived to highlight the nature of the formulation of the modified portfolio theory. We conclude that, while modified portfolio theory adds a theoretical foundation to health care evaluations, it may not be operational until estimates of the correlation between interventions are available, and the question of uncertainty is resolved in health care evaluation. Also, while a synergy may be present at the individual level, when aggregated over a large population it may not be significant given the standard assumption of constant returns to scale.
Van Gool, K., Haas, M.R. & Viney, R.C. 2002, 'From flying doctor to virtual doctor: an economic perspective on Australia's telemedicine experience', Journal of Telemedicine and Telecare, vol. 8, pp. 249-254.View/Download from: UTS OPUS or Publisher's site
Hall, J.P. & 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.
Pulok, M., Van Gool, K.C. & 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.
Van Gool, K. 2017, 'Effectiveness and equity of cancer screening and treatment: An international perspective [Session Discussant]', 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.
Longden, T., Wong, C.Y., 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.
Van Gool, K. 2015, 'What does a stronger Medicare look like, and are current signals taking us there?', Melbourne Institute Public Economic Forum, Canberra.
Wright, M.C. & van Gool, K. 2015, 'Trends in primary care use in Australia and challenges in designing payment systems', iIHEA, 11th World Congress on Health Economics, Milan, Italy.
Reeve, R., Butler, K., Burns, L., Viney, R.C., Arora, S., Goodall, S. & van Gool, K. 2015, 'The costs and consequences of targeting AOD patients presenting to Hospital Emergency Departments', APSAD Annual Scientific Alcohol and Drug Conference, Perth.
Reeve, R., Butler, K., Burns, L., Viney, R.C., Arora, S., Goodall, S. & van Gool, K. 2015, 'Using multi-methods to evaluate clinical services: A case study', International Evaluation Conference, Melbourne.
Van Gool, K. 2014, 'The rise and fall in out-of-pocket costs for GP visits: An analysis of the Strengthening Medicare reforms', CAER 11th Annual Summer Workshop, Coogee.
Wong, C., Greene, J., Van Gool, K. & Dolja-Gore, X. 2014, 'The rise and fall in out-of-pocket costs in Australia: an analysis of the Strengthening Medicare reforms', 2014 PHC Research Conference, Canberra.
Reeve, R.D. & Van Gool, K. 2012, 'Persistent effects of child abuse in Australia', Australian Institute of Family Studies Conference, Melbourne.
Reeve, R.D. & Van Gool, K. 2011, 'Lifetime losses: the many costs of child abuse', iHEA 8th World Congress, Toronto, Canada.
Reeve, R.D. & Van Gool, K. 2011, 'The effect of child abuse on long term health and wellbeing: evidence from Australia', Mental Health Services Research Seminar: Achieving Outcomes in Mental Health Reform, Melbourne University.
Reeve, R.D., Van Gool, K. & Gu, Y. 2011, 'Modelling long run costs of child abuse', CAER Summer Workshop in Health Economics, Sydney.
Van Gool, K. 2011, 'Out-of-pocket costs and Medicare: The Howard years', CAER Summer Workshop in Health Economics, Sydney.
Reeve, R.D. & Van Gool, K. 2010, 'The long run health care costs of child abuse in Australia', Australian Conference of Health Economists, Sydney.
Van Gool, K. 2009, 'Evidence-based policy and politics: the curious case of the Medicare Safety Net', 6th Health Services and Policy Research Conference 2009, Brisbane.
Van Gool, K. 2009, 'The impact of out of pocket costs on cervical screening: Evidence from an Australian panel dataset', iHEA 7th World Congress, Beijing, China.
Faedo, M., Pearson, S., Bastick, P., Van Gool, K., Haywood, P., Haas, M.R. & Ward, R. 2009, 'Elements of Care Study: Tracking resource utilisation and costs in a cohort of NSW cancer patients', 6th Health Services and Policy Conference 2009, Brisbane.
Gallego, G., Van Gool, K., Haas, M.R. & Tannous, K. 2009, 'Once upon a time in a land far far away: the evidence on early childhood intervention programs and its relevance to the here and now', Australian Conference of Health Economists, Hobart.
Haas, M.R., Ward, R., Van Gool, K., Hall, J.P., 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.
Pearson, S., Faedo, M., Van Gool, K., Haas, M.R. & Ward, R. 2009, 'Using routinely collected health data to inform economic models of cancer care', 6th Health Services and Policy Research Conference 2009, Brisbane.
Pearce, A.M., Haas, M.R., Haywood, P., Van Gool, K., Gallego, G., Pearson, S., Faedo, M. & Ward, R. 2009, 'Chemotherapy, adverse events and costs', 6th Health Services and Policy Conference 2009, Brisbane.
Haywood, P., Van Gool, K., Haas, M.R. & Ward, R. 2008, 'A pragmatic approach to economic evaluation in an age of evidence based clinical guideline production', Australian Conference of Health Economists, Adelaide.
Out-of-pocket health expenditures in Australia are high in international comparisons and have been growing at a faster rate than most other health costs in recent years. This raises concerns about the extent to which out-of-pocket costs have constrained access to health services for low income households. Using data from the ABS Household Expenditure Survey 2003-2004, we model the relationships between health expenditure shares and equivalised total expenditure for categories of out-of-pocket health expenditures and analyse the extent of protection given by concession cards. To allow for flexibility in the relationship we adopt Yatchew's semi-parametric estimation technique. This is the first detailed distributional analysis of household health expenditures in Australia. We find mixed evidence for the protection health concession cards give against high out-of-pocket health expenditures. Despite higher levels of subsidy, households with concession cards do not have lower out-of-pocket expenditures than non-cardholder households except for the highest expenditure quintile. Cards provide most protection for GP out-of-pocket expenditures. © 2008 Economic Society of Australia.
Gallego, G. & Van Gool, K. 2007, 'Using the ethical framework of accountability for reasonableness to evaluate priority-setting decisions at the local level', Clinical Decisions, Ethical Challenges, Cairns.
Van Gool, K., Gallego, G., Haas, M.R. & Fisher, K. 2007, 'Economic Evaluation of Early childhood intervention programs: How hard is it to make rational investments for the future?', 29th Australian Conference for Health Economists, Brisbane.
Van Gool, K., Vu, M., Savage, E.J., Haas, M.R. & Birch, S. 2007, 'Equitable use of breast screening services in NSW: The role of income, age and locality', 29th Australian Conference for Health Economists, Brisbane.
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, M.R., Hall, J.P., Viney, R.C., 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.
Bridges, J.F., stewart, S., King, M.T. & Van Gool, K. 2001, 'Portfolio theory and the evaluation of public health interventions', The Proceedings of the Joint Statistical Meetings, American Statistical Association, Atlanta, Georgia.
Bridges, J.F., stewart, S., King, M.T. & Van Gool, K. 2001, 'Understanding the effects of a portfolio of medical interventions', 17th Annual meeting of the International Society of Technology Assessment in Health Care (ISTAHC), Philadelphia, USA.
Haas, M.R. & Van Gool, K. 2001, 'Estimating the benefits of preventing cardiovascular disease: when is an ounce of prevention worth a pound of cure?', 23rd Australian Health Economics Society Conference, Canberra.
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.
Haas, M.R., Savage, E.J., Van Gool, K. & Birch, S. 2001, 'Breast screening utilisation in NSW: the impact of income, region and ethnicity', Health Services Research Association of Australia and New Zealand Conference, Wellington, NZ.
van Gool, K., Hall, J.P. & REFinE Team Australian National University 2016, The REFinE-PHC Report Primary Health Care in Australia: towards a more sustainable and equitable health care system, Canberra.
De Abreu Lourenco, R., Haywood, P., Parkinson, B., van Gool, K. & Viney, R. CHERE 2015, The economic implications of a genomically guided approach to cancer: A report by the Centre for Health Economics Research and Evaluation for the Cancer Council, Sydney.
This report examines how genomically based approaches may also alter the way that new technologies are funded and adopted in the health care system. In particular, how they challenge the routine pathways by which technologies are diffused into routine practice. The report also focuses on how genomically guided technologies challenge current coverage decisions. It examines the economic evidence-base for assessing the cost and benefits of such technologies. In doing so, the report highlights the current limitations in this field of research as identified through a systematic review of recommendations made by Australian policy-makers, as well as through a review of the literature. This analysis is then used to develop a framework for economic evaluations with special reference to genomically based technologies. Finally, the report also identifies a number of key policy challenges for the efficient diffusion of genomically guided cancer care into the Australian health care system.
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.
Reeve, R., Arora, S., Viney, R., Goodall, S., van Gool, K., Knox, S. & Kenny, P.M. NSW Health 2014, Evaluation of NSW Health Drug and Alcohol Consultation Liaison Services. Report for the Mental Health Drug and Alcohol Office (MHDAO), North Sydney.View/Download from: UTS OPUS
Van Gool, K., Savage, E.J., Johar, M., Knox, S.A., Jones, G. & Viney, R.C. Commonwealth of Australia 2011, Extended Medicare Safety Net review of capping arrangements report 2011: a report by the Centre for Health Economics Research and Evaluation, pp. 1-130, Canberra.View/Download from: UTS OPUS
Hilferty, F., Mullan, K., Van Gool, K., Chan, S., Eastman, C., Reeve, R.D., Heese, K., Haas, M.R., Newton, B., Griffiths, M. & Katz, I. Social Policy Research Centre 2010, The evaluation of Brighter Futures, NSW Community Services' early intervention program: Final report, pp. 1-305, Australia.View/Download from: UTS OPUS
This report presents the findings of the evaluation of the NSW Community Services` early intervention program, Brighter Futures. Brighter Futures is an innovative program, which has changed the practice of child abuse prevention services in NSW. The program has broken new ground nationally and internationally by developing an evidence-based service model; requiring caseworkers to use validated instruments for assessment and reporting; and being delivered through a cross-sectoral partnership between Community Services and non-government organisations. It is also innovative in specifically targeting families who are at most risk of entering the child protection system.
Savage, E.J., Van Gool, K., Haas, M.R., Viney, R.C. & Vu, M. Department of Health & Ageing 2009, Extended Medicare safety net review report 2009 : a report by CHERE prepared for the Australian Government Department of Health & Ageing, pp. 1-80, Canberra.
Haas, M.R., Hall, J.P., Gallego, G., Goodall, S., Norman, R., Van Gool, K. & Viney, R.C. 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, M.R., Hall, J.P., Gallego, G., Goodall, S., Norman, R., Van Gool, K. & Viney, R.C. CHERE, University of Technology, Sydney 2008, Framework and methodology for national blood supply change proposals: Part 2, pp. 1-33, Sydney.
Van Gool, K. & Bridges, J.F. CHERE 2000, Cost effectiveness study of nutrition interventions used in the prevention of coronary heart disease, CHERE Project Report No 11, Sydney.
Van Gool, K., Norman, R., Delatycki, M., Hall, J.P. & 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.
Reeve, R.D. & Van Gool, K. 2010, 'The long run impact of child abuse on health care costs and wellbeing in Australia. CHERE Working Paper 2010/10'.
There are approximately 55,000 substantiated child abuse or neglect cases in Australia each year, according to Australian Institute of Health and Welfare data, 2005-06 to 2008-09 (AIHW2010). In 2008-09, one third of child maltreatment cases related to physical or sexual abuse. Our paper examines the relationship between physical and sexual abuse of children and adult physical and mental health conditions and associated health care costs in Australia. The analysis utilises confidentialised unit record file data from the National Survey of Mental Health and Wellbeing 2007, which includes 8841 persons aged from 16 to 85. The econometric results indicate that Australians with a history of being abused as a child suffer from significantly more physical and mental health conditions as adults and incur higher annual health care costs. In addition, we investigate the associations between child abuse, incarceration and self harm and the intergenerational impact of abuse, to extend the understanding of the long run costs of child abuse in Australia. We conclude that prevention child abuse is expected to generate long term socio-economic benefits.
Van Gool, K., Haas, M.R., Gallego, G., Tannous, K. & Katz, I. 2009, 'Framework for the cost benefit analysis of the NSW Department of Community Services Brighter Futures Program. CHERE Working Paper 2009/4', CHERE Working Paper 2009/4.
BreastScreen Australia provides free mammography services to women in the target age group of 50 to 69 years. The program uses a variety of measures to recruit women to the service and, subsequently, encourage them to screen at two year intervals. One of the stated aims of the program is to provide equitable access to all women in the target age group. This paper analyses the extent to which systematic variation can be observed amongst women in terms of their screening behaviour, focusing on those who have never screened or are irregular screeners. Data on self reported utilisation of breast screening services was obtained from the 2002/04 NSW Health Surveys. A multinomial logit (MNL) model was used to examine the role of socioeconomic status, cultural background, education and region of residence on breast screening behaviour. The results show that lower income is associated with a woman never screening or screening irregularly. Region of residence is an important predictor of screening behaviour, although the degree of remoteness was not influential in determining participation. A higher number of hours worked was associated with women being more likely to screen irregularly. These results provide evidence of persistent and systematic variation in screening uptake and regular participation. The results also point towards targeted recruitment and retainment strategies that may provide the greatest potential benefits.
Van Gool, K., Haas, M.R., Sainsbury, P. & Gilbert, R. 2007, 'When is an ounce of prevention worth a pound of cure? The case of cardiovascular disease, CHERE Working Paper 2007/1', CHERE Working Paper.
Van Gool, K., Gallego, G., Haas, M.R., Viney, R.C., Hall, J.P. & Ward, R. 2007, 'Incorporating economic evidence into cancer care: searching for the missing link, CHERE Working Paper 2007/3', CHERE Working Paper.
Vu, M., Van Gool, K., Savage, E.J., Haas, M.R. & Birch, S. 2007, 'The use of breast screening services in NSW: Are we moving towards greater equity? [Draft - not for quotation or citation], CHERE Working Paper 2007/7', CHERE Working Paper.
Van Gool, K., Savage, E.J., Viney, R.C., Haas, M.R. & Anderson, R. 2006, 'Catastrophic insurance: Impact of the Australian Medicare Safety Net on fees, service use and out-of-pocket costs, CHERE Working Paper 2006/9', CHERE Working Paper 2006/9.
Van Gool, K., Savage, E.J., Viney, R.C., Haas, M.R. & Anderson, R. 2006, 'Who's getting caught? An analysis of the Australian Medicare Safety Net, CHERE Working Paper 2006/8', CHERE Working Paper 2006/8.
In speeches delivered 24 hours apart, Labor leader Bill Shorten and Prime Minister Malcolm Turnbull made conflicting claims about the state of bulk-billing rates in Australia.
A bulk-billed consultation occurs when the fee charged by the doctor or medical provider is equal to the benefit paid by Medicare - leaving zero out-of-pocket cost to the patient. The percentage of Medicare-funded consultations that are bulk-billed is referred to as the bulk-billing rates. These rates are widely seen as a proxy indicator of the accessibility of Medicare-funded health care.
Shorten said that bulk-billing rates are falling. The next day, Turnbull stood at the same lectern and said bulk-billing rates are at record levels.
Who was right?