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.

Costs, benefits and risks of IT in construction

Construction organisations were found to be reluctant to invest in IT due to the lack of a technique that accurately assesses the costs, benefits and risks. More importantly the associated indirect costs that are often overlooked can constitute up to 80% of costs related to investing in IT.

Costs of Silver Gulls Larus novaehollandiae in an urban environment

Silver Gull economic impacts were evaluated during 1998 to 2003 in the Greater Melbourne area. Roof nesting and roosting created substantial problems. Annual cost for cleaning, maintenance, damage, repairs and mitigation was $3,570,000. Roof corrosion was $0.9 million. Reducing anthropogenic food availability is the key to reducing problems.

Height and construction costs of residential high-rise buildings in Shanghai

A widely recognized theme of construction economics suggests that the cost of construction per square meter increases as building height rises. However, over a number of years, research conducted regarding the height and cost issue has established a classic relationship between the two factors which can be represented by a U-shaped curve. This paper describes the study of the height-cost relationship of high-rise residential buildings in Shanghai in terms of the total construction cost and elemental costs while considering the context and commonality of buildings. This research was developed as an extension of the previous work, which examined data for buildings in Hong Kong. Initial findings indicate that the curves illustrating the relationships between height and cost of residential buildings in Shanghai and Hong Kong exhibit different profiles. The dissimilarities indicate that different sets of criteria should be applied in the judgment of height that affects cost in different locations. In terms of elemental costs, the findings suggest that there are differences in the way these costs react to changes in the building height.

Dynamically opted protection envelope (DOPE) - A cost-effective strategy of insuring an investment portfolio

Popular ways of hedging downside risk of a stock portfolio is by means of a constant proportion portfolio insurance (CPPI) strategy or by means of an options-based portfolio insurance strategy (OBPI). However both have drawbacks in terms of practical applicability given transaction costs. Moreover they are not useful in times of very low liquidity e.g. in a market crash. Here we shall first review the common portfolio insurance techniques and then posit an alternative approach using a zero-coupon bond to extract downside coverage to the extent desired by an investor. While the posited strategy will not guarantee full downside protection for the entire investment horizon, it is unaffected by transaction costs resulting from need to periodically reallocate funds and is a lot easier to implement practically compared to options-based strategies. Unlike CPPI and OBPI, it will work in a crash situation too.

The economic burden of ill health due to diet, physical inactivity, smoking, alcohol and obesity in the UK : an update to 2006-07 NHS costs

Background: Estimates of the economic cost of risk factors for chronic disease to the NHS provide evidence for prioritization of resources for prevention and public health. Previous comparable estimates of the economic costs of poor diet, physical inactivity, smoking, alcohol and overweight/obesity were based on economic data from 1992–93.

Methods: Diseases associated with poor diet, physical inactivity, smoking, alcohol and overweight/obesity were identified. Risk factor-specific population attributable fractions for these diseases were applied to disease-specific estimates of the economic cost to the NHS in the UK in 2006–07.

Results: In 2006–07, poor diet-related ill health cost the NHS in the UK £5.8 billion. The cost of physical inactivity was £0.9 billion. Smoking cost was £3.3 billion, alcohol cost £3.3 billion, overweight and obesity cost £5.1 billion.

Conclusion: The estimates of the economic cost of risk factors for chronic disease presented here are based on recent financial data and are directly comparable. They suggest that poor diet is a behavioural risk factor that has the highest impact on the budget of the NHS, followed by alcohol consumption, smoking and physical inactivity.