Epidemiological analysis of electroconvulsive therapy in Victoria, Australia

Objective: To determine the population-based utilization rate of electroconvulsive therapy (ECT) in Victoria between 1998-1999, to examine the characteristics of the ECT treated group, and to identify patient factors independently associated with differential rates of ECT treatment. Method: Electroconvulsive therapy is reported under statute in Victoria, Australia. Crude, age-adjusted and age-sex specific utilization rates were calculated using this statutory data for the 1998-1999 financial year and estimated mid-year populations from the Australian Bureau of Statistics. Descriptive characteristics of those treated with ECT were derived from the statutory data. Patient factors associated with an increased likelihood of ECT in the public sector were explored with logistic regression analysis, using non-ECT treated mental health patients from the Victorian Psychiatric Case Register as the reference population. Results: The crude treated-person and age-adjusted rates for the State (both public and private sectors) were 39.9 and 44.0 persons per 100 000 resident population per annum, respectively. The crude and age-adjusted administration rates were 330.3 and 362.6 ECT administrations per 100 000 resident population per annum, respectively. Age-sex specific rates varied by age and sex, with rates generally increasing with age and female sex. Overall, 62.8% of the treated group were women, 32.9% aged over 64, and 75.2% had depression. Diagnosis, age and sex each independently predicted ECT in the public sector, with diagnosis the most important factor, followed by age then sex. Conclusions: Despite decades of use, the appropriate rate of ECT utilization is still unclear. Further research should be directed at exploring the factors, including provider variables, determining ECT treatment.

The changing public-private infrastructure mix: Economy-wide implications

This article provides an economy-wide perspective on the changing role of the public sector in developing economic and social infrastructure in Australia. It analyses the scale and macroeconomic significance of the key economic and social infrastructure sectors - communication services, electricity, gas and water supply, transport, education, health and community services, government administration and defence. It then canvasses the major policy issues that have arisen in the progression from public to private infrastructure provision and considers why concerns about the trend fall in traditional public works spending may be misplaced in light of recent economic and institutional changes.

Managing woodlands for income maximisation in western Queensland, Australia: clearing for grazing versus timber production

Queensland, Australia, has a proud pastoral history; however, the private and social benefits of continued woodland clearing for pasture development are unlikely to be as pronounced as they had been in the past. The environmental benefits of tree retention in and regions of the State are now better appreciated and market opportunities have arisen for the unique timbers of western Queensland. A financial model is developed to facilitate a comparison of the private profitability of small-scale timber production from remnant Acacia woodlands against clearing for pasture development in the Mulga Lands and Desert Uplands bioregions of western Queensland. Four small-scale timber production scenarios, which differ in target markets and the extent of processing (value-adding), are explored within the model. Each scenario is examined for the cases where property rights to the timber are vested with the timber processor, and where royalties are payable. For both cases of resource ownership, at least one scenario generates positive returns from timber production, and exceeds the net farm income per hectare for an average grazing property in the study regions over the period 1989-1990 to 2000-2001. The net present value per hectare of selectively harvesting and processing high-value clearwood from remnant western Queensland woodlands is found to be greater than clearing for grazing. (C) 2003 Elsevier B.V. All rights reserved.

The Evolving Nature of Small-Scale Forestry in Australia

Two forms of small-scale forestry are developing in Australia, each with different impacts on rural communities. One is based on growing short-rotation Eucalyptus globulus (blue gum) for pulp and the other on production of higher-value products from longer-rotation native hard-woods. Several impediments exist to further development of small-scale forestry, including the lack of a small-scale forestry culture, concerns over harvest rights, lack of market development, the long wait for returns, and satisfaction with current land uses. Nevertheless, the rapid increase in farm woodlot establishment in the past five years has paralleled the strong increase in the private industrial plantation estate. As markets develop and hindrances are overcome, landholders not previously interested in small-scale forestry may consider ita worthwhile land use.

Beauty and the market: Actress postcards and their senders in early twentieth century Australia

A hundred years ago the international craze for picture postcards distributed millions of images of popular stage actresses around the world. The cards were bought, sent, and collected by many whose contact with live theatre was sometimes minimal. Veronica Kelly's study of some of these cards sent in Australia indicates the increasing reach of theatrical images and celebrity brought about by the distribution mechanisms of industrial mass modernity. The specific social purposes and contexts of the senders are revealed by cross-reading the images themselves with the private messages on the backs, suggesting that, once outside the industrial framing of theatre or the dramatic one of specific roles, the actress operated as a multiply signifying icon within mass culture – with the desires and consumer power of women major factors in the consumption of the glamour actress card. A study of the typical visual rhetoric of these postcards indicates the authorized modes of femininity being constructed by the major postcard publishers whose products were distributed to theatre fans and non-theatregoers alike through the post. Veronica Kelly is working on a project dealing with commercial managements and stars in early twentieth-century Australian theatre. She teaches in the School of English, Media Studies, and Art History at the University of Queensland, is co-editor of Australasian Drama Studies, and author of databases and articles dealing with colonial and contemporary Australian theatre history and dramatic criticism. Her books include The Theatre of Louis Nowra (1998) and the collection Our Australian Theatre in the 1990s (1998).

Adult mental health needs and expenditure in Australia

Background Relatively little international work has examined whether mental health resource allocation matches need. This study aimed to determine whether adult mental health resources in Australia are being distributed equitably. Method Individual measures of need were extrapolated to Australian Areas, and Area-based proxies of need were considered. Particular attention was paid to the prevalence of mental health problems, since this is arguably the most objective measure of need. The extent to which these measures predicted public sector, private sector and total adult mental health expenditure at an Area level was examined. Results In the public sector, 41.6% of expenditure variation was explained by the prevalence of affective disorders, personality disorders, cognitive impairment and psychosis, as well as the Area's level of economic resources and State/Territory effects. In the private sector, 72.4% of expenditure variation was explained by service use and State/Territory effects (with an alternative model incorporating service use and State/Territory supply of private psychiatrists explaining 69.4% of expenditure variation). A relatively high proportion (58.7%) of total expenditure variation could be explained by service utilisation and State/Territory effects. Conclusions For services to be delivered equitably, the majority of variation in expenditure would have to be accounted for by appropriate measures of need. The best model for public sector expenditure included an appropriate measure of need but had relatively poor explanatory power. The models for private sector and total expenditure had greater explanatory power, but relied on less appropriate measures of need. It is concluded that mental health services in Australia are not yet being delivered equitably.

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.

Economic Incentives to Conserve Wildlife on Private Lands: Analysis and Policy

Some believe that provision of private property rights in wildlife on private land provides a powerful economic incentive for nature conservation because it enables property owners to market such wildlife or its attributes. If such marketing is profitable, private landholders will conserve the wildlife concerned and its required habitat. But land is not always most profitably used for exploitation of wildlife, and many economic values of wildlife (such as non-use economic values) cannot be marketed. The mobility of some wildlife adds to the limitations of the private-property approach. While some species may be conserved by this approach, it is suboptimal as a single policy approach to nature conservation. Nevertheless, it is being experimented with, in the Northern Territory of Australia where landholders had a possibility of harvesting on their properties a quota of eggs and chicks of red-tailed black cockatoos for commercial sale. This scheme was expected to provide an incentive to private landholders to retain hollow trees essential for the nesting of these birds but failed. This case and others are analysed. Despite private-property failures, the long-term survival of some wildlife species depends on their ability to use private lands without severe harassment, either for their migration or to supplement their available resources, for example, the Asian elephant. Nature conservation on private land is often a useful, if not essential, supplement to conservation on public lands. Community and public incentives for such conservation are outlined.

Lifetime Subsidies in Australian Private Health Insurance Markets with Community Rating

This paper considers the problem of inducing low-risk individuals of all ages to buy private health insurance in Australia. Our proposed subsidy scheme improves upon the age-based penalty scheme under the current "Australian Lifetime Cover" (LTC) scheme. We generate an alternative subsidy profile that obviates adverse selection in private health insurance markets with mandated, age-based, community rating. Our proposal is novel in that we generate subsidies that are both risk- and age-specific, based upon actual risk probabilities. The approach we take may prove useful in other jurisdictions where the extant law mandates community rating in private health insurance markets. Furthermore, our approach is useful in jurisdictions that seek to maintain private insurance to complement existing universal public systems.

Never-married childless women in Australia: Health and social circumstances in older age

A growing proportion of women reach older age without having married or having children. Assumptions that these older women are lonely, impoverished, and high users of social and health services are based on little evidence. This paper uses data from the Older cohort of the Australian Longitudinal Study on Women's Health to describe self-reported demographics, physical and emotional health, and use of services among 10,108 women aged 73-78, of whom 2.7% are never-married and childless. The most striking characteristic of this group is their high levels of education, which are associated with fewer reported financial difficulties and higher rates of private health insurance. There are few differences in self-reported physical or emotional health or use of health services between these and other groups of older women. Compared with older married women with children, they make higher use of formal services such as home maintenance and meal services, and are also more likely to provide volunteer services and belong to social groups. Overall, there is no evidence to suggest that these women are a problem group. Rather, it seems that their life experiences and opportunities prepare them for a successful and productive older age. (c) 2005 Elsevier Ltd. All rights reserved.

Some economic dimensions of the mental health jigsaw in Australia

The purpose of this paper is to demonstrate that, although there are some unique features associated with mental illness, such special features do not preclude economic analysis. As a mechanism for understanding how individual economic studies fit into the mental health sector, a conceptual framework of the components of mental health service provision is outlined. Emphasis is placed on, not simply institutional and market resources, but also on the services provided by relatives, self-help groups, etc. Australian data on parts of the mental health sector are employed to illustrate that some (and different) economic analyses can be undertaken in mental health. First, time-series data on public psychiatric hospitals are employed to demonstrate trends associated with deinstitutionalisation. Other data (for Queensland alone) indicate that there are state-based differences in the provision of such services. Second, attention is then directed to the analysis of time-series data on private fee-for-service psychiatric services. Various concepts and measures from industrial economics are applied to analyse the relative size of this service industry, the pricing behaviour of the profession, the service-mix of "the psychiatry firms" operating in Australia.

Gender, computing and the organisation of working time: public/private comparisons in the Australian context

Professional computing employment in Australia, as in most advanced economies, is highly sex segregated, reflecting well-rehearsed ideas about the masculinity of technology and computing culture. In this paper we are concerned with the processes of work organisation that sustain and reproduce this gendered occupational distribution, focusing in particular on differences and similarities in working-time arrangements between public and private sectors in the Australian context. While information technology companies are often highly competitive workplaces with individualised working arrangements, computing professionals work in a wide range of organisations with different regulatory histories and practices. Our goal is to investigate the implications of these variations for gender equity outcomes, using the public/private divide as indicative of different regulatory frameworks. We draw on Australian census data and a series of organisational case studies to compare working-time arrangements in professional computing employment across sectors, and to examine the various ways employees adapt and respond. Our analysis identifies a stronger ‘long hours culture’ in the private sector, but also underlines the rarity of part-time work in both sectors, and suggests that men and women tend to respond in different ways to these constraints. Although the findings highlight the importance of regulatory frameworks, the organisation of working time across sectors appears to be sustaining rather than challenging gender inequalities in computing employment.