Peter Sivey

THE EFFECTS OF AN INCENTIVE PROGRAM ON QUALITY OF CARE IN DIABETES MANAGEMENT

An incentive program for general practitioners to encourage systematic and igh-quality care in chronic disease management was introduced in Australia in 1999. There is little empirical evidence and ambiguous theoretical guidance on which effects to expect. This paper evaluates the impact of the incentive program on quality of care in diabetes, as measured by the probability of ordering an HbA1c test. The empirical analysis is conducted with a unique data set and a bivariate probit model to control for the self-selection process of practices into the program. The study finds that the incentive program increased the probability of an HbA1c test being ordered by 20 percentage points and that participation in the program is facilitated by the support of Divisions of General Practice.

Imperfect information in a quality-competitive hospital market

We examine the implications of policies to improve information about the qualities of profit-seeking duopoly hospitals which face the same regulated price and compete on quality. We show that if hospital costs of quality are similar then better information increases the quality of both hospitals. However, if the costs are sufficiently different improved information will reduce the quality of both hospitals. Moreover, even when quality increases, better information may increase or decrease patient welfare depending on whether an ex post or ex ante view of welfare is taken.

Are English treatment centres treating less complex patients

Activity-based funding involves remunerating healthcare providers a fixed price per patient in each payment category. However, no categorisation system can account perfectly for differences in patient complexity. Differences may be systematic if providers routinely attract high-risk patients or engage in patient selection. Such differences may be evident in the English National Health Service (NHS) following the introduction of treatment centres that concentrate on providing a small number of high-volume procedures. We analyse data for more than 3.3 million patients to assess whether the complexity of those treated in hospitals and treatment centres differs within twenty-nine payment categories, defined by Healthcare Resource Groups (HRGs). We find that patients treated in hospitals were more likely to come from more deprived areas, to have more diagnoses and to undergo significantly more procedures than patients seen by treatment centres, suggesting that hospitals are treating more complex cases. If these observed differences between hospitals and treatment centres drive costs, then payments should be refined to ensure fair reimbursement.

Competition, Prices and Quality in the Market for Physician Consultations

Prices for consultations with General Practitioners (GPs) in Australia are unregulated, and patients pay the difference between the price set by the GP and a fixed reimbursement from the national taxfunded Medicare insurance scheme. We construct a Vickrey-Salop model of GP price and quality competition and test its predictions using a dataset with individual GP-level data on prices, the proportion of patients who are charged no out-of-pocket fee, average consultation length, and characteristics of the GPs, their practices and their local areas. We measure the competition to which the GP is exposed by the distance to other GPs and allow for the endogeneity of GP location decisions with measures of area characteristics and area fixed-effects. Within areas, GPs with more distant competitors charge higher prices and a smaller proportion of their patients make no out-ofpocket payment. GPs with more distant competitors also have shorter consultations, though the effect is small and statistically insignificant.

Why Junior Doctors Don’t Want to Become General Practitioners: A Discrete Choice Experiment from the MABEL Longitudinal Study of Doctors

A number of studies suggest there is an over-supply of specialists and an undersupply of GPs in many developed countries. Previous econometric studies of specialty choice from the US suggest that a number of factors play a role, including expected future earnings, educational debt, and having predictable working hours. Given endogeneity issues in revealed preference studies, a stated-preference approach is warranted. This paper presents results from a discrete-choice experiment completed by a sample of 532 junior doctors in 2008 before they choose a specialty training program. This was conducted as part of the first wave of the MABEL (Medicine in Australia: Balancing Employment and Life) longitudinal survey of doctors. We include key job attributes such as future earnings and hours worked, but also allow the choice to be influenced by academic research opportunities, continuity of care and the amount of procedural work. Interactions of attributes with doctor characteristics, including gender, educational debt, and personality traits are also examined. We find the income/working hours trade-offs estimated from our discrete choice model are close to the actual wages of senior specialists, but much higher than those of senior GPs. In a policy simulation we find that increasing GPs’ earnings by

Preschool Children's Demand for Sugar Sweetened Beverages: Evidence from Stated-Preference Panel Data

50,000, increasing opportunities for procedural or academic work can increase the number of junior doctors choosing General Practice by between 8 and 16 percentage points, approximately 212 to 376 junior doctors per year. The results can inform policymakers looking to address unbalanced supply of doctors across specialties.

Differences in Length of Stay Between Public Hospitals, Treatment Centres and Private Providers: Selection or Efficiency?

Consumption of sugar sweetened beverages exhibits strong associations with weight gain, obesity, and dental caries, especially in young children. The aim of this paper is to examine the impact of price changes on children’s consumption of sugar-sweetened beverages. Using micro-level panel data obtained from a stated preference experiment, we specify a two-sided censoring semi-parametric demand system model with fixed effects. To overcome an estimation difficulty that is potentially a common issue to all applications studying microlevel consumption data, we propose a new consistent two-step estimation framework. The economic restrictions implied by consumption theory are imposed through a consistent and asymptotically efficient GMM estimator. Our results show that the uncompensated own-price elasticities for sugar-sweetened beverages range from -0.83 to -0.94, demonstrating inelastic but substantial price effects. The marginal effects of demand with respect to nutritional attributes of sugar-sweetened beverages are negligible overall, but are strongest for those in low-income households. High-income households are less responsive to price and not responsive at all to non-price attributes.

Do rural incentives payments affect entries and exits of general practitioners

We investigate differences in patients’ length of stay between National Health Service (NHS) public hospitals, public treatment centres and private treatment centres that provide elective (non-emergency) hip replacement to publicly-funded patients. We find that private treatment centres and public treatment centres have on average respectively 40% and 18% shorter length of stay compared to NHS public hospitals, even after controlling for differences in age, gender, number and type of diagnosis, deprivation and geographical variation. We therefore interpret such differences as due to efficiency as opposed to selection (treatment of less complex cases). Quantile regression suggests that the proportionate differences between different provider types are larger at the higher conditional quantiles of length of stay compared to the lower ones.

Should I stay or should I go? Hospital emergency department waiting times and demand: Should I stay or should I go? Hospital emergency department waiting times and demand

Many countries use financial incentive programs to attract physicians to work in rural areas. This paper examines the effectiveness of a policy reform in Australia that made some locations newly eligible for financial incentives and increased incentives for locations already eligible. The analysis uses panel data (2008-2014) on all Australian general practitioners (GPs) aggregated to small areas. We use a difference-in-differences approach to examine if the policy change affected GP entry or exit to the 755 newly eligible locations and the 787 always eligible locations relative to 2249 locations which were never eligible. The policy change increased the entry of newly-qualified GPs to newly eligible locations but had no effect on the entry and exit of other GPs. Our results suggest that location incentives should be targeted at newly qualified GPs.

Motivation and Competition in Health Care

In the absence of the price mechanism, hospital emergency departments rely on waiting times, alongside prioritisation mechanisms, to restrain demand and clear the market. This paper estimates by how much the number of treatments demanded is reduced by a higher waiting time. I use variation in waiting times for low-urgency patients caused by rare and resource-intensive high-urgency patients to estimate the relationship. I find that when waiting times are higher, more low-urgency patients are deterred from treatment and leave the hospital during the waiting period without being treated. The waiting time elasticity of demand for low-urgency patients is approximately -0.25 and is highest for the lowest-urgency patients.