To the extent possible, the sample research papers in the list follow a common format. They begin with a review of theory and then examine applications of the theory, relevant empirical evidence, policy implications, and future directions. This research paper format reflects the typical approach of economists to a topic. They begin by asking what theory or models exist to help in understanding the behavior of the participants in decisions related to the topic. Participants may be consumers, producers, resource owners, agents of government bodies, or third parties who are affected by but not in control of the decisions made by other participants.
The format of most research papers—theory, applications, empirical evidence, policy implications—is consistent with this common approach to economic analysis. Following the section on policy implications, most research papers discuss future directions—what are the new but related questions that are likely to be explored by economists; what new methods are being developed to analyze data on the topic; what insights from other disciplines are likely to be applied to this topic; what policies are likely to be developed related to the topic? Research papers collected here generally reflect this approach and the resulting format, but given the wide range of topics addressed, the format is not appropriate in every research paper. Some of the initial theory research papers, methodology research papers, and history research papers more logically follow a different structure, and common format has been sacrificed in favor of following the logic.
Mental health problems can exert considerable negative impacts on the sufferers themselves, as well as their friends and family members, their communities and society as a whole. The objective is this paper is to investigate the interdependence of mental health status among close family members. Given that the effects could be realized over many years we do not study mental health in a static situation, but instead, study the mental health dynamic. We also study the mechanisms behind mental health shock transmission. Our results suggest that mothers’ mental health has positive and significant impacts on adolescents’ mental health, even after controlling for a comprehensive group of individual, household, and community and area characteristics. Furthermore, we observe gender differences in this effect, with mother-daughter mental health interactions found to be stronger than interactions between father-daughter, mother-son and father-son. Also, mothers with higher education levels tend to have a greater influence on their children’s mental health status. This suggests that parenting quality is a possible mechanism behind the mother-child mental health interdependence.
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It is well known that married individuals are healthier than singles. While selection into marriage has been found to contribute to this relationship, current evidence suggests there is a also a significant protective role of marriage on health. In this paper, we study in detail this protective role of marriage. In particular, we explore how health transitions are affected by spousal characteristics that include age, education, physical and mental health status, cognition, labor force status, and employer provided health insurance status. We also explore how health behaviors are affected by these spousal characteristics. We study these effects separately for men and women using the HRS.
Cost-effectiveness analyses are primarily used to provide evidence for policy and funding decisions before health interventions are implemented. Retrospective economic evaluations have received less attention in the literature. By making use of data collected post-implementation, retrospective cost-effectiveness analyses of vaccine programs may substantially reduce uncertainty and provide a better assessment of the value for money achieved. As a case study, we conducted a retrospective economic evaluation to assess the cost-effectiveness of the nationally funded 7-valent pneumococcal conjugate vaccine (PCV7) program in Australia. This is the first study specifically designed to evaluate the cost-effectiveness of an existing vaccine program in Australia. We designed a static, deterministic model that describes transitions between health states for a population over time. We investigated health-related outcomes on which PCV7 may have had an impact, primarily invasive and non-invasive pneumococcal disease. We applied a healthcare perspective and included costs for the vaccination program as well as healthcare utilisation. Quality-of-life utility weight estimates were attached to the different health states in the model. The primary outcome calculated was an incremental cost per Quality Adjusted Life Year (QALY) gained. We conducted one-way and probabilistic sensitivity analysis, and examined a number of different scenarios. In the scenario where observed declines in all health outcomes were attributed to PCV7, the ICER was below A$50,000 per QALY gained. However, in scenarios where only declines with more robust evidence for attribution to the program were included, the cost-effectiveness was less clear-cut. We discuss how our results compare to previous pre-implementation cost-effectiveness studies on PCV7 in Australia, and how methodological choices impact on cost-effectiveness results. Retrospective cost-effectiveness analysis can provide important insight in our understanding of the value for money achieved by vaccination efforts.
Presenter Jongsay Yong, University of Melbourne
Abstract This paper investigates the productivity of Victorian public hospitals using hospital admission data for the five-year period 2007/08 to 2011/12. We construct measures of total factor productivity using aggregate output and input indices. Aggregate output index is constructed by enumerating all in-patient activities of a hospital and are aggregated using diagnostic related group costs as weights. Aggregate input is constructed by adding total dollar costs of labour, capital, and materials. Total factor productivity (TFP) is computed as the ratio of aggregate output index to aggregate input index. Preliminary results suggest that, without taking into account changes in quality, hospital TFP did not register any material changes during the five-year period. Closer inspection further reveals that tertiary hospitals generally perform best in productivity among all hospitals, and small hospitals tend to exhibit greater degrees of variations in TFP growth than other hospitals.
The Solomon Islands Ministry of Health and Medical Services (MHMS) delivers health care to over 500,000 people in predominantly rural areas across 10 provinces, including numerous remote islands. It has a budget of SBD 552 million (AUD 81 million), which is sourced from annual appropriations from national revenue and from development partners as part of the Health Sector Support Program (HSSP).
The MHMS is committed to providing free universal access to health services; and the current National Health Act restricts the collection of fees at health facilities to hospitals. A recent Patient Exit Survey undertaken in Solomon Islands found that despite this explicit restriction patient contributions are common across all facility levels for consultations and medical record books, excluding the National Referral Hospital in Honiara.
The accompanying Health Facilities Costing Survey found that revenue collected from patient contributions are the only sources of revenue managed by facilities. Health workers reported that these contributions are used to cover gaps in the salaries and supplies provided by the national and provincial health administrations.
A detailed analysis of who makes patient contributions suggests that the poor and women pay such fees more often, but they do not appear to be a barrier to access and are waived for those who cannot afford to pay. Evidence from a recent study in PNG (Wiltshire and Mako 2014) shows a similar context. While eradicating such fees is consistent with the MHMS policy and promotes the WHOs universal health care policy, it presents administrative challenges for the MHMS and has additional cost implications in getting cash to health facilities, and supporting them to manage it appropriately.
This paper will explore the options available to the MHMS and other low and middle income countries who wish to abolish user fees.
Presenter Choon Cheng, Victorian Department of Health
This paper measures risk-adjusted mortality and readmission rates of Victorian hospitals using hospital admission data for an 11-year period from 2001/02 to 2011/12. For the purpose of risk adjustment, a standard logistic model is developed to take into account differences in patient characteristics including age, gender, principal diagnosis, admission type, comorbidity and care type. In total more than 23 million admission episodes occurring in 310 hospitals are used in the analysis, which provides an overview of the quality of hospital care in Victoria. Preliminary findings suggest that quality of care has been improving over time, but small public hospitals consistently lag behind other hospital types. Further analyses suggest that there exist considerable degrees of heterogeneity among small public hospitals. Considerable degrees of heterogeneity also exist among private hospitals, although private hospitals generally perform better than public hospitals in risk adjusted mortality and readmissions.
Primary care in Australia: towards better quality and value for money
Chair: Professor Denzil Fiebig
Primary care has been the subject of substantial policy changes in recent times. Proposed government reforms have focused on changes to the funding of GP services as well as on organsisational aspects, including the establishment of regionally-based primary health networks (PHN). This organised session will examine some of the key policy challenges, covering issues relating to funding, efficiency, quality and equity in the field of primary care. Four papers from leading researchers in the fields of health economics and policy will be presented in this session: