Investigating genetic discrimination in Australia: Opportunities and challenges in the early stages

Genetic discrimination, defined as the differential treatment of individuals or their relatives on the basis of actual or presumed genetic differences, is an emerging issue of interest in academic, clinical, social and legal contexts. While its potential significance has been discussed widely, verified empirical data are scarce. Genetic discrimination is a complex phenomenon to describe and investigate, as evidenced by the recent Australian Law Reform Commission inquiry in Australia. The authors research project, which commenced in 2002, aims to document the multiple perspectives and experiences regarding genetic discrimination in Australia and inform future policy development and law reform. Data are being collected from consumers, employers, insurers and the legal system. Attempted verification of alleged accounts of genetic discrimination will be a novel feature of the research. This paper overviews the early stages of the research, including conceptual challenges and their methodological implications.

Residential mobility in the Seoul metropolitan region: Who, where and why?

This article presents data on residential mobility for the Seoul Metropolitan Region. It addresses two questions-why do households move and who moves and finds that like research undertaken in other cities that a wide range of factors impact on the residential mobility process. Key outcomes include the impact of housing dissatisfaction on residential mobility and the impact that life cycle, period of residence and housing and dwelling characteristics have on discerning between movers and non-movers.

Effectiveness of case management and post-acute services in older people after hospital discharge

Objective: To evaluate the benefits of coordinating community services through the Post-Acute Care (PAC) program in older patients after discharge from hospital. Design: Prospective multicentre, randomised controlled trial with six months of follow-up with blinded outcome measurement. Setting: Four university-affiliated metropolitan general hospitals in Victoria. Participants: All patients aged 65 years and over who were discharged between August 1998 and October 1999 and required community services after discharge. Interventions: Participants were randomly allocated to receive services of a Post-Acute Care (PAC) coordinator (intervention) versus usual discharge planning (control). Main outcome measures: Comparison of quality of life and carer stress at one-month post-discharge, mortality, hospital readmissions, use of community services and community and hospital costs over the six months post-discharge. Results: 654 patients were randomised, and 598 were included in the analysis (311 in the PAC group and 287 in the control group). There was no difference in mortality between the groups (both 6%), but significantly greater overall quality-of-life scores at one-month follow-up in the PAC group. There was no difference in unplanned readmissions, but PAC patients used significantly fewer hospital bed-days in the six months after discharge (mean, 3.0 days; 95% CI, 2.1-3.9) than control patients (5.2 days; 95% CI, 3.8-6.7). Total costs (including hospitalisation, community services and the intervention) were lower in the PAC than the control group (mean difference, $1545; 95% CI, $11-$3078). Conclusions: The PAC program is beneficial in the transition from hospital to the community in older patients.

Lifetime cover in private insurance markets

In the last few decades, private health insurance rates have declined in many countries. In countries and states with community rating, a major cause is adverse selection. In order to address age-based adverse selection, Australia has recently begun a novel approach which imposes stiff penalties for buying private insurance later in life, when expected costs are higher. In this paper, we analyze Australiarsquos Lifetime Cover in the context of a modified version of the Rothschild-Stiglitz insurance model (Rothschild and Stiglitz, 1976). We allow empirically-based probabilities to increase by age for low-risk types. The model highlights the shortcomings of the Australian plan. Based on empirically-based probabilities of illness, we predict that Lifetime Cover will not arrest adverse selection. The model has many policy implications for government regulation encouraging long-term health coverage.

Access to parental leave in Australia: evidence from Negotiating the Life Course

Although unpaid parental leave has been available to most Australian employees for more than a decade, and public sector legislation and company policies provide at least some employees with an entitlement to paid parental leave, there is as yet little information available on accessibility, take-up rates or the extent to which current leave provisions meet the needs of parents. In this paper, data from the Negotiating the Life Course survey are used to examine the first of these issues: accessibility. Variations in perceptions of access to paid and unpaid parental leave are examined in bivariate and multivariate analyses, which emphasise marked divisions in the Australian labour market between permanent and casual status. The data also suggest that access to unpaid parental leave is more variable than might be expected from a reading of formal legislative provisions, and raise questions over the accessibility of paid parental leave to those who need it most-employees with young children.

Vehicle routing and crew scheduling for metropolitan mail distribution at Australia Post

This paper presents a new multi-depot combined vehicle and crew scheduling algorithm, and uses it, in conjunction with a heuristic vehicle routing algorithm, to solve the intra-city mail distribution problem faced by Australia Post. First we describe the Australia Post mail distribution problem and outline the heuristic vehicle routing algorithm used to find vehicle routes. We present a new multi-depot combined vehicle and crew scheduling algorithm based on set covering with column generation. The paper concludes with a computational investigation examining the affect of different types of vehicle routing solutions on the vehicle and crew scheduling solution, comparing the different levels of integration possible with the new vehicle and crew scheduling algorithm and comparing the results of sequential versus simultaneous vehicle and crew scheduling, using real life data for Australia Post distribution networks.

Prevalence of Parkinson’s disease in metropolitan and rural Queensland: A general practice survey

The prevalence of idiopathic Parkinson’s disease (IPD) in Australia is unclear. We estimated the prevalence of IPD, and other forms of parkinsonism, through the study of typical caseloads in general practice. A random sample of general practitioners (GPs) throughout Queensland (401 responses from 528 validated practice addresses) was asked to estimate the numbers of patients with IPD and parkinsonism seen in the preceding year. The estimated prevalence of diagnosed IPD in Queensland was 146 per 100 000 (95% CI = 136–155). A further 51 per 100 000 in the population were suspected by doctors to have IPD without formal diagnosis, whereas another 51 per 100 000 people may have non-idiopathic parkinsonism. Idiopathic Parkinson’s disease was more common in rural than metropolitan areas. Although most GPs were confident in making diagnoses of IPD, the majority had little or no confidence in their ability to treat the disease, especially in its later stages. Support from neurologists was perceived by GPs to be very good in cities, but poor in remote areas.