Do public investments crowd out private investments? Fresh evidence from Fiji

In this paper, we investigate whether government investment crowds out or crowds in private investment for Fiji over the period 1950–2001. We begin by searching endogenously for break points in the data series using the Zivot and Andrews [J. Business Economic Stat. 10 (1992) 251–270] test. Upon finding that 1975 is the statistically significant break date, we divide the sample into two. Using the error correction mechanism test, we find that government and private investments are cointegrated over the period 1950–1975, but not for the period 1976–2001. We also find that in the former period government investment has crowded in private investment, while in the latter period the relationship between government and private investments has been statistically weak.

Improving collaboration between private psychiatrists, the public mental health sector and general practitioners : evaluation of the Partnership Project

Objectives: We describe the evaluation of the Partnership Project, which was designed to improve linkages between public and private sector mental health services. We consider the Project's key elements: a Linkage Unit, designed to improve collaborative arrangements for consumers and promote systems-level and cultural change; and the expansion of private psychiatrists' roles to include supervision and training, case conferencing and secondary consultation. The evaluation aimed to describe the impacts and outcomes of these elements.

Method: The evaluation used de-identified data from the Linkage Unit database, the Project's billing system, and the Health Insurance Commission (HIC). It drew on consultations with key stakeholders (semistructured interviews with 36 key informants, and information from a forum attended by over 40 carers and a meeting of five public sector and three private sector psychiatrists) and a series of case studies.

Results: The Linkage Unit facilitated 224 episodes of collaborative care, many of which had positive outcomes for providers, consumers and carers. It had a significant impact at a systems level, raising consciousness about collaboration and influencing procedural changes. Thirty-two private psychiatrists consented to undertaking expanded roles, and the Project was billed $78 032 accordingly. Supervision and training were most common, involving 16 psychiatrists and accounting for approximately 80% of the total hours and cost. Commonwealth expenditure on private psychiatrists' participation in the expanded roles was not associated with a reduction in benefits paid by the HIC. Key informants were generally positive about the expanded roles.

Conclusions: The Project represented a considered, innovative approach to dealing with poor collaboration between the public mental health sector, private psychiatrists and GPs. The Linkage Unit achieved significant systems-level and cultural change, which has the potential to be sustained. Expanded roles for private psychiatrists, particularly supervision and training, may improve collaboration, and warrant further exploration in terms of costs and benefits.

Public and private psychiatry : can they work together and is it worth the effort?

OBJECTIVE: Partnerships in mental health care, particularly between public and private psychiatric services, are being increasingly recognized as important for optimizing patient management and the efficient organization of services. However, public sector mental health services and private psychiatrists do not always work well together and there seem to be a number of barriers to effective collaboration. This study set out to investigate the extent of collaborative 'shared care' arrangements between a public mental health service and private psychiatrists practising nearby. It also examined possible barriers to collaboration and some possible solutions to the identified problems.

METHOD: A questionnaire examining the above factors was sent to all public sector mental health clinicians and all private psychiatrists in the area.

RESULTS: One hundred and five of the 154 (68.2%) public sector clinicians and 103 of the 194 (53.1%) private psychiatrists returned surveys. The main barriers to successful collaboration identified by members of both sectors were: 'Difficulty communicating' endorsed by 71.4% of public clinicians and 72% of private psychiatrists, 'Confusion of roles and responsibilities' endorsed by 62.9% and 66%, respectively, and 'Different treatment approach' by 47.6% and 45.6%, respectively. Over 60% of private psychiatrists identified problems with access to the public system as a barrier to successful shared care arrangements. It also emerged, as hypothesized, that the public and private systems tend to manage different patient populations and that public clinicians in particular are not fully aware of the private psychiatrists' range of expertise. This would result in fewer referrals for shared care across the sectors.

CONCLUSIONS: A number of barriers to public sector clinicians and private psychiatrists collaborating in shared care arrangements were identified. The two groups surveyed identified similar barriers. Some of these can potentially be addressed by changes to service systems. Others require cultural shifts in both sectors. Improved communications including more opportunities for formal and informal meetings between people working in the two sectors would be likely to improve the understanding of the complementary sector's perspective and practice. Further changes would be expected to require careful work between the sectors on training, employment and practice protocols and initiatives, to allow better use of the existing services and resources.

From the private to the public : a pilgrimage of symbols and metaphors

The marks and imagery that visual artists use to form images often consist of, or incorporate, elements of a visual symbolic language. When the artist's personal set of symbols aligns with that of the society in which the artist works it would be anticipated that the works produced could be readily interpreted and appreciated by that audience or society.

Narrative analysis of female student 'resistance' in a Japanese private university

The thesis points to the emergence of a series of distinctive tensions which were informed by the author's position as a Western male researcher living in Japan, and the changing perceptions of what occured as notions of 'empowerment' and 'voice' touched the 'grounded' data. It argues that the generative narrative(s) constitutes a form of ongoing 'conversation' which succeed in producing an unstructured reading or pedagogy. Although the research does not achieve tangible liberatory outcomes, the generative narrative(s) provides the lens through which to view the student 'resistance' and, as such, permits the examination of an instance of student 'resistance' in Japan.

Intention to claim a Medicare rebate among women receiving private Victorian pregnancy termination service

Objectives: To determine the proportion of women who have pregnancy terminations as private patients in Victoria who do not intend to claim a procedure fee rebate from Medicare, to compare characteristics of women who intend to submit a Medicare claim with those who do not and to compare the findings to the results from a similar study conducted in NSW in 1992.

Design, setting and participants: This was a cross-sectional observational study over a 12-week period. Women having a pregnancy termination service in eight large Victorian private clinics were invited to complete a brief written questionnaire.

Outcome measurer: The proportion of women who did not have a Medicare card or who had a Medicare card but did not intend to use it to claim from Medicare.

Results: Of the 1,329 women who responded, 13.1% either did not have a Medicare card or did not intend to use their card to claim a Medicare rebate. A further 20.7% of respondents were not sure about whether they would submit a claim. Women who intended to claim a Medicare rebate were different from women who did not according to age, language spoken at home, residency, citizenship and distance travelled to the service. These results are very similar to the findings from the 1992 NSW study.

Conclusion: Between 13.1% and 33.8% of private Victorian pregnancy terminations were estimated to not be recorded at the Health Insurance Commission. Health Insurance Commission records of Medicare rebate claims for pregnancy terminations are an incomplete and somewhat biased record of the services that are provided and are likely to have been so for some time.

Travel undertaken by women accessing private Victorian pregnancy termination services

Objective: To investigate the extent and cost of travel undertaken by women accessing Victorian termination of pregnancy services.

Design, setting and participants: This was a multi-centre, cross-sectional observational study of women receiving privately funded pregnancy termination services, conducted between November 2002 and June 2003 at eight major pregnancy termination service providers in Victoria.

Main outcome measures: Distance travelled, money and time expended undertaking travel, and reasons women chose particular clinics.

Results: Of the 1,244 Australian resident respondents who resided in Victoria, 9.3% travelled more than 100 km to access services. Teenagers were 2.5 times more likely than other respondents to travel further than 100 kilometres (km) (18.2% compared with 7.8%, OR=2.5, 95% CI 1.5-4.2, p<0.001). Women originated from all Australian States and Territories except South Australia and 13.7% were from Statistical Divisions other than Melbourne. More than one-third of respondents (41.3%) chose their clinic because they were referred by a doctor or general practitioner.

Conclusion: Many pregnancy termination patients face substantial and immediate costs beyond the service fee, as well as the diffculties associated with poor continuity of care and signifcant time away from home. Patients and service providers should be consulted further to determine appropriate clinical services, support services and subsidy schemes for the sizeable proportion of patients who undertake long-distance travel to access pregnancy termination services.

Risk allocation in public-private partnership projects

Both the increasing private participation in public projects and the critical importance of appropriate risk allocation to the success of public-private partnership (PPP) projects justify specific research on the risk allocation practice in PPP projects, particularly whether the practice is value-for-money driven. In this paper, the risk allocation in construction projects is examined firstly. The risks associated with PPP projects and the concept of optimal risk allocation are then reviewed. More importantly, the risk allocation practice in PPP projects is examined, particularly in the Australian context. Important issues, such as the current practice, the governments' accountability, and achieving efficient allocation, are discussed. The discussion presented in this paper is expected to justify and elicit further research on how to achieve efficient risk allocation in PPP projects