Quality-based benefit design in health insurance : the impact of a product benefit design change on the utilisation of oral health services by members of a private health insurance fund in regional and rural New South Wales, Australia

Objective: To examine the impact on dental utilisation following the introduction of a participating provider scheme (Regional and Rural Oral Health Program {RROHP)). In this model dentists receive higher third party payments from a private health insurance fund for delivering an agreed range of preventive and diagnostic benefits at no out-ofpocket cost to insured patients. Data source/Study setting: Hospitals Contribution Fund of Australia (HCF) dental claims for all members resident in New South Wales over the six financial years from l99811999 to 200312004. Study design: This cohort study involves before and after analyses of dental claims experience over a six year period for approximately 81,000 individuals in the intervention group (HCF members resident in regional and rural New South Wales, Australia) and 267,000 in the control group (HCF members resident in the Sydney area). Only claims for individuals who were members of HCF at 31 December 1997 were included. The analysis groups claims into the three years prior to the establishment of the RROHP and the three years subsequent to implementation. Data collection/Extraction methods: The analysis is based on all claims submitted by users of services for visits between 1 July 1988 and 30 June 2004. In these data approximately 1,000,000 services were provided to the intervention group and approximately 4,900,000 in the control group. Principal findings: Using Statistical Process Control (SPC) charts, special cause variation was identified in total utilisation rate of private dental services in the intervention group post implementation. No such variation was present in the control group. On average in the three years after implementation of the program the utilisation rate of dental services by regional and rural residents of New South Wales who where members of HCF grew by 12.6%, over eight times the growth rate of 1.5% observed in the control group (HCF members who were Sydney residents). The differences were even more pronounced in the areas of service that were the focus of the program: diagnostic and preventive services. Conclusion: The implementation of a benefit design change, a participating provider scheme, that involved the removal of CO-payments on a defined range of preventive and diagnostic dental services combined with the establishment and promotion of a network of dentists, appears to have had a marked impact on HCF members' utilisation of dental services in regional and rural New South Wales, Australia.

The impact of perceived stage of cancer on carers’ anxiety and depression during the patients’ final year of life

Objective: This paper explores the effects of perceived stage of cancer (PSOC) on carers' anxiety and depression during the patients' final year. Methods: A consecutive sample of patients and carers (N=98) were surveyed at regular intervals regarding PSOC, and anxiety and depression using the Hospital Anxiety and Depression Scale. Means were compared by gender using the Mann-Whitney U-test. The chi-square was used to analyse categorical data. Agreement between carers' and patients' PSOC was estimated using kappa statistics. Correlations between carers' PSOC and their anxiety and depression were calculated using the Spearman's rank correlation. Results: Over time, an increasing proportion of carers reported that the cancer was advanced, culminating at 43% near death. Agreement regarding PSOC was fair (kappa=0.29-0.34) until near death (kappa=0.21). Carers' anxiety increased over the year; depression increased in the final 6 months. Females were more anxious (p=0.049, 6 months; p=0.009, 3 months) than males, and more depressed until 1 month to death. The proportion of carers reporting moderate-severe anxiety almost doubled over the year to 27%, with more females in this category at 6 months (p=0.05). Carers with moderate-severe depression increased from 6 to 15% over the year. Increased PSOC was weakly correlated with increased anxiety and depression. Conclusions: Carers' anxiety exceeded depression in severity during advanced cancer. Females generally experienced greater anxiety and depression. Carers were more realistic than patients regarding the ultimate outcome, which was reflected in their declining mental health, particularly near the end.

The Impact of Experiential Learning in Enhancing Palliative Care Knowledge and Skills among Nurses

Nurses working in community settings are increasingly required to care for people with chronic, life limiting conditions. Innovative educational programs are required to ensure nurses are equipped to deal with this challenging area of practice. The Program of Experience in the Palliative Approach (PEPA) started in 2003 as an initiative of the Australian Government, Department of Health and Ageing. The overall aim of PEPA is to improve the quality, availability and access to palliative care for people who are dying, and their families, by improving the skills and expertise of health practitioners, and enhancing collaboration between primary and specialist palliative care services. PEPA provides nurses with an opportunity to develop knowledge and skills in the palliative approach to care through funded clinical workforce placements or workshops.

Children's self-talk and academic self-concepts: The impact of teachers' statements

Data were collected from 269 Australian primary school children in grades 3 to 7. Self-report questionnaires measuring students' perceptions of the frequency of positive and negative statements directed to them by their teacher, their positive and negative self-talk; and their reading, mathematics and learning self-concepts were administered. Positive statements made by teachers were found to be directly related to positive self-talk and to maths and learning self-concepts. Teachers' positive statements were also indirectly related to reading self-concept through positive self-talk. Negative statements made by teachers were not predictive of self-talk or self-concepts for the total sample but were predictive of maths self-concept for girls and negative self-talk for boys. Implications for teachers and educational psychologists are discussed.

Driving and licensing experiences of learner drivers in two Australian states prior to major changes in the licensing laws

The learner licence is an important component of the graduated driver licensing system. This research describes the driving and licensing experiences of learner drivers in Queensland and New South Wales licensed prior to the changes made to the system in mid-2007. The sample consisted of 392 participants who completed a telephone interview just after they obtained their provisional licence. The results suggest that learner drivers in the two states had many similar experiences when they were obtaining a learner licence. However, once a learner licence was obtained, there were differences in the amount of practice, the supervisor learners practised with, the type of vehicle they used and the amount of unlicensed driving. This paper provides important baseline descriptive data that can be used to measure the impact of the changes that were introduced to the learner licence phase in mid-2007 in both of these states.

The impact of pain on the quality of life of people with multiple sclerosis: A community survey

The purpose of this study was to examine the impact of pain on functioning across multiple quality of life (QOL) domains among individuals with multiple sclerosis (MS). A total of 219 people were recruited from a regional MS society membership database to serve as the community-based study sample. All participants completed a questionnaire containing items about their demographic and clinical characteristics, validated measures of QOL and MS-related disability, and a question on whether or not they had experienced clinically significant pain in the preceding 2 weeks. Respondents who reported pain then completed an in-person structured pain interview assessing pain characteristics (intensity, quality, location, extent, and duration). Comparisons between participants with and without MS-related pain demonstrated that pain prevalence and intensity were strongly correlated with QOL: physical health, psychological health, level of independence, and global QOL were more likely to be impaired among people with MS when pain was present, and the extent of impairment was associated with the intensity of pain. Moreover, these relationships remained significant even after statistically controlling for multiple demographic and clinical covariates associated with self-reported QOL. These findings suggest that for people with MS, pain is an important source of distress and disability beyond that caused by neurologic impairments.

The impact of internal and external market orientations on firm performance.

The role of internal marketing in developing organisational competencies is identified as a key area for continued research (Rafiq and Ahmed, 2003). One competence of particular interest to marketers is market orientation. This paper examines the impact of internal marketing, operationalised as a set of internal market orientated behaviours (IMO) on market orientation (MO), and consequently organisational performance, and provides the first quantitative evidence to support the long held assumption that internal marketing has an impact on marketing success. Data from UK retail managers were analysed using structural equations modelling employing LISREL software. These data indicate significant relationships between internal market orientation, employee motivation and external marketing success (market orientation, financial performance and customer satisfaction). Our results also support previous findings indicating a positive impact of external market orientation on customer satisfaction and financial performance. For marketing practitioners, the role of internal market orientation is developing marketing strategies is discussed.

What is that place? Observations of the impact of environment colour through photographic analysis

Isolating the impact of a colour, or a combination of colours, is extremely difficult to achieve because it is difficult to remove other environmental elements such as sound, odours, light, and occasion from the experience of being in a place. In order to ascertain the impact of colour on how we interpret the world in day to day situations, the current study records participant responses to achromatic scenes of the built environment prior to viewing the same scene in colour. A number of environments were photographed in colour or copied from design books; and copies of the images saved as both colour and black/grey/white. An overview of the study will be introduced by firstly providing examples of studies which have linked colour to meaning and emotions. For example, yellow is said to be connected to happiness1 ; or red evokes feelings of anger2 or passion. A link between colour and the way we understand and/or feel is established however, there is a further need for knowledge of colour in context. In response to this need, the current achromatic/chromatic environmental study will be described and discussed in light of the findings. Finally, suggestions for future research are posed. Based on previous research the authors hypothesised that a shift in environmental perception by participants would occur. It was found that the impact of colour includes a shift in perception of aspects such as its atmosphere and youthfulness. Through studio-class discussions it was also noted that the predicted age of the place, the function, and in association, the potential users when colour was added (or deleted) were often challenged. It is posited that the ability of a designer (for example, interior designer, architect, or landscape architect) to design for a particular target group—user and/or clients will be enhanced through more targeted studies relating colour in situ. The importance of noting the perceptual shift for the participants in our study, who were young designers, is the realisation that colour potentially holds the power to impact on the identity of an architectural form, an interior space, and/or particular elements such as doorways, furniture settings, and the like.

The impact of susceptibility to informational influence on the effectiveness of consumer testimonials

In this article we examine how a consumer's susceptibility to informative influence (SII) affects the effectiveness of consumer testimonials in print advertising. More specifically, we show that consumers that are high in SII and that seek consumption-relevant information from other people are more influenced by the strength of the testimonial information than the strength of the attribute information. Conversely, consumers low in SII place greater emphasis on the strength of the attribute information when forming their evaluations. Our results show that consumer psychological traits can have an important impact on the acceptance of testimonial advertising. Theoretical and managerial implications of our findings are discussed.

Assessing the impact of streetscape on residential property in lower to middle socio-economic areas

A number of factors have been shown to influence residential property prices in various locations. Studies have identified the importance of location in relation to services, transport and proximity to negative factors such as power lines and cell phone towers. Often the socio-economic status of a residential precinct can determine the overall quality and nature of the streetscapes in that area, with higher value suburbs or locations offering a better visual appearance compared to areas where these factors are not present. However, does the same value for a good streetscape apply in lower socio-economic areas or a buyers more motivated by less aesthetic factors such as size of the house, construction materials or land size. This paper analyses specific streets in a lower to middle socio-economic suburb of Christchurch New Zealand to determine if the location of a house in a street with good streetscape appeal has greater value, investment performance and saleability compared to adjoining streets with less aesthetic appeal.

The impact of property title type on residential property returns

Residential property in New Zealand comprises both freestanding residential properties and medium to high density residential properties. Medium to high density residential property comprises the typical units, townhouses and semi-detached houses common in most residential property markets. However, in many of the larger cities of New Zealand the free standing residential property market has evolved into two separate markets being freehold residential property and cross lease residential property. Cross leases have developed as a form of infill housing to reduce the urban sprawl in major canters, while reducing the time and cost for residential property developers. A cross lease is created when an existing freestanding residential property subdivides a portion of the existing land for the erection of another house on the original title, basically dividing one larger residential section into two smaller residential blocks. This paper will analyse house prices in Christchurch over the period 1992 to 2006 to determine if the various housing markets have shown similar capital returns or if there is a specific preference for a particular residential property title.

The impact of natural disasters on residential property markets

Over the past ten years various residential property markets throughout Australia in general and NSW in particular have been subject to substantial natural disasters. These occurrences have included floods, bushfires and hailstorms. In extreme cases the actual rectification costs have been up to AUD$1.5 billion, which occurred with the severe hailstorm in Sydney in April 1999 and cyclone Tracey in Darwin in 1974. Natural disasters such as severe storms and hailstorms have tended to be very indiscriminate in relation to frequency and the actual location of damage, whereas the nature of bushfire and flooding tends to be more defined. Although these extreme natural disasters tend to be infrequent, occurrences of floods and bushfires in residential property areas are more frequent, particularly as urban sprawl encroaches closer to national Parks, State recreation Parks and State forests. Considerable work has been carried out on flood effects on property markets by Bell (1999), Donnelly (1988), McClusky and Rausser (2001), Skrantz and Strickland (1987) in the US, and Chou and Shih (2001) in Taiwan. Fibbens (1994), Lambley and Cordery (1991) and Eves (1999, 2001, 2002) have carried out studies in relation to the effect of flooding on residential property values in the Sydney region, including the tracking of flood prone property values over time. However, no similar rigorous research has been carried out in relation to the impact of bushfires on residential property markets in the Sydney region.