Private Health Insurance Status and Utilisation of Dental Services in Australia

This article focuses on the relationship between private insurance status and dental service utilisation in Australia using data between 1995 and 2001. This article employs joint maximum likelihood to estimate models of time since last dental visit treating private ancillary health insurance (PAHI) as endogenous. The sensitivity of results to the choice between two different but related types of instrumental variables is examined. We find robust evidence in both 1995 and 2001 that individuals with a PAHI policy make significantly more frequent dental consultations relative to those without such coverage. A comparison of the 1995 and 2001 results, however, suggests that there has been an increasing role of PAHI in terms of the frequency of dental consultations over time. This seems intuitive given the trends in the price of unsubsidised private dental consultations. In terms of policy, our results suggest that while government measures to increase private health insurance coverage in Australia have been successful to a significant degree, that success may have come at some cost in terms of socio-economic inequality as the privately insured are provided much better access to care and financial protection.

Insurance services in multi-agent systems

In a multi-agent environment, there is often the need for an agent to cooperate with others so as to ensure that a given task is achieved timely and cost-effectively. Present agent systems currently maximizes this through mechanisms such as trust and risk assessments. In this paper, we extend this mechanism by introducing the concept of insurance, in which the insurance agents act as a bridge between agents who require resources from others. Unlike traditional systems, agents purchase insurance so as to guarantee to have the requested resources during the task execution time and thus minimize the risk in task failure. The novelty of this proposal is that it ensures agents continuously to exchange resources and to seek maximum expected utility in a dynamic environment at the same time. Our experimental results confirm the feasibility of our approach.

Buying and selling with insurance in open multi-agent marketplace

In this paper, we incorporate the insurance concept in buying and selling model for agents to trade in the open multi-agent marketplace. During buying, agents purchase insurance as a method to search for potential sellers and select their partners based on the information provided by insurance agents. During selling, agents purchase insurance as a method to protect themselves against potential risk. The insurance concept greatly simplifies the trading procedure in the open marketplace. The novelty of this proposal is that it ensures a dynamic trading environment while agents continue to seek maximum utility and being fully protected by insurance. Our experimental results confirm the feasibility of our approach.

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.

Health consumer activism in Australia : the downside of state inclusion

Many community groups concerned with health issues - women's organisations, patient support groups and older citizens' organisations - were formed long before they were designated as 'consumer' groups. Members of health groups founded in the 1960s and 1970s understood themselves to be activists for social change, not 'consumers'. They challenged established models of health care and mobilised to redress inequities of access to care and inequalities of power between the medical profession and the 'lay' population. The major campaign in this period was to establish universal health insurance.

General practice : contribution to health and equity

The evidence that a primary health approach enhances health outcomes, increases system effectiveness and is cost effective gives a new impetus for general practice within the continuum of health services. At the same time, in Australia the establishment of the Divisions of General Practice and their continued support has led to a new found confidence in general practice.

A telephone support program to reduce costs and hospital admissions for patients at risk of readmissions: lessons from an evaluation of a complex health intervention

This study aimed to evaluate the effectiveness of a telephone health coaching and support service provided to members of an Australian private health insurance fund-Telephonic Complex Care Program (TCCP)-on hospital use and associated costs. A case-control pre-post study design was employed using propensity score matching. Private health insurance members (n=273) who participated in TCCP between April and December 2012 (cases) were matched (1:1) to members who had not previously been enrolled in the program or any other disease management programs offered by the insurer (n=232). Eligible members were community dwelling, aged ≥65 years, and had 2 or more hospital admissions in the 12 months prior to program enrollment. Preprogram variables that estimated the propensity score included: participant demographics, diagnoses, and hospital use in the 12 months prior to program enrollment. TCCP participants received one-to-one telephone support, personalized care plan, and referral to community-based services. Control participants continued to access usual health care services. Primary outcomes were number of hospital admission claims and total benefits paid for all health care utilizations in the 12 months following program enrollment. Secondary outcomes included change in total benefits paid, hospital benefits paid, ancillary benefits paid, and total hospital bed days over the 12 months post enrollment. Compared with matched controls, TCCP did not appear to reduce health care utilization or benefits paid in the 12 months following program enrollment. However, program characteristics and implementation may have impacted its effectiveness. In addition, challenges related to evaluating complex health interventions such as TCCP are discussed.

In the service of the society: the labour management practices of an Australian life Insurer to 1940

This article considers the labour management practices in use in the Australian life insurance industry during the inter-war period. Using the Australian Mutual Provident as a case study, it is argued that the specific human resource management practices evolved to deal with separate sets of problems arising from the functions of the life insurance business and the manner in which the principal/agent problem was manifested. The differing nature of work associated with the sales and management of life insurance fostered the development of primary and secondary labour markets in which the benefits flowing to one were superior to those accruing to the other.

Beyond the silo effect : the challenges of collaboration

Women entering the maternity arena in Australia and other Western regimes have suffered incidentally from what is known as the' silo effect'. This refers to a clash between the training regimes of the 'old' professionalism and the 'new' professionalism. Under the 'old' professionalism, hierarchies were erected between medicine and the so-called semi-professions such as nursing and social work (Tully and Mortlock 2004) resulting in what Degeling et al (1998; 2000) have documented as oppositional modes of decision-making, styles of working, roles and accountabilities. Within the last decade, a 'new professionalism' has emerged in many Western regimes, including Canada, NZ, the UK and The Netherlands. (Romanow Report 2002; Street, Gannon and Holt 1991; Victorian Department of Human Services, Australia 2004) depicted by a flatter more egalitarian structure of multidisciplinarity .. An example in Australia is the Future Directions in Maternity Care document released in mid 2004 by the Bracks Victorian Labor government. In Australia, the move towards the 'new professionalism' can be attributed to a confluence of macro economic factors including the swing away from hospital-based training and towards university-based training for nurses and midwives, the ripple effects of three decades of feminism, the professionalisation of midwifery, the attrition of midwives from the workforce, the rise of health consumerism from the late 1980s and the crippling costs of professional indemnity health insurance for obstetricians leading to a crisis in recruitment.

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.

Devaluation of a constitutional guarantee : the history of section 51(xxiiiA) of the Commonwealth Constitution

This article describes constitutional and socio-historical background to the referendum that led to the inserrion of s 51(xxiijA) into the Commonwealth Constitution. It traces judicial interpretations of the clause 'but not so as to authorise any fonn of civil conscription' through the major cases, including British Medical Association v Commonwealth, General Practitioners Society v Commonwealth, and Alexandra Private Geriatric Hospital Pty Ud v Commonwealth. The issue of the powers of the Commonwealth to regulate private medical practice without infringing the constitutional guarantee against civil conscription is analysed in the context of the development of National Health Care Schemes for financing medical benefits (Health Insurance Commission v Peverill). Constitutional aspects of the 1995 legislation enabling the introduction into Australia of purchaser-provider agreements ('managed care ') are also examined. Finally, the article questions the constitutionality of the Australian Competition and Consumer Commission s powers to regulate the essential elements of the patient-doctor relationship.

The 1947 bank nationalisation scheme : a prehistory of issues management?

Industry-wide crises emanating from legislative proposals are rare in Australia, and can be classed as once in a generation events, and so merit consideration and research. Currently, there is one such debate over the Mineral Resources Rent Tax, proposed by Prime Minister’s Julia Gillard’s government. Prior to this, the closest comparable event was the 1974 proposal for the establishment of a universal health insurance scheme. The 1947 proposal, by the Ben Chifley-led Labor Government, aimed to nationalise Australia’s banks, and it brought a crisis of massive proportions to Australia’s conservative financial service industry. Although the High Court of Australia finally found Chifley’s proposed legislation unconstitutional, the banks realised they must win in the court of public opinion, generate press coverage in favour of their position, and help defeat the Labor Government at the 1949 election. At the time, and for some decades to come, this was the most expensive and largest public relations campaign waged in Australia. After such a campaign there could be few Australians who could claim that they had not been exposed to the powers of public relations in a modern world. This paper looks at what can be learned from the banks’ collective response to the proposed nationalisation. It does so by applying contemporary issues management evaluation techniques.

Validation of de-identified record linkage to ascertain hospital admissions in a cohort study

Background Cohort studies can provide valuable evidence of cause and effect relationships but are subject to loss of participants over time, limiting the validity of findings. Computerised record linkage offers a passive and ongoing method of obtaining health outcomes from existing routinely collected data sources. However, the quality of record linkage is reliant upon the availability and accuracy of common identifying variables. We sought to develop and validate a method for linking a cohort study to a state-wide hospital admissions dataset with limited availability of unique identifying variables.

Methods A sample of 2000 participants from a cohort study (n = 41 514) was linked to a state-wide hospitalisations dataset in Victoria, Australia using the national health insurance (Medicare) number and demographic data as identifying variables. Availability of the health insurance number was limited in both datasets; therefore linkage was undertaken both with and without use of this number and agreement tested between both algorithms. Sensitivity was calculated for a sub-sample of 101 participants with a hospital admission confirmed by medical record review.

Results Of the 2000 study participants, 85% were found to have a record in the hospitalisations dataset when the national health insurance number and sex were used as linkage variables and 92% when demographic details only were used. When agreement between the two methods was tested the disagreement fraction was 9%, mainly due to "false positive" links when demographic details only were used. A final algorithm that used multiple combinations of identifying variables resulted in a match proportion of 87%. Sensitivity of this final linkage was 95%.

Conclusions High quality record linkage of cohort data with a hospitalisations dataset that has limited identifiers can be achieved using combinations of a national health insurance number and demographic data as identifying variables.

Frequency of excisions and yields of malignant skin tumors in a population-based screening intervention of 360 288 whole-body examinations

Objective To explore the frequency of excisions and yields of histopathologically confirmed skin cancer.

Design A population-based skin cancer screening intervention (the SCREEN project) in the German state of Schleswig-Holstein (July 1, 2003, to June 30, 2004).

Setting Physician offices. Participants could choose between nondermatologist physicians and dermatologists for their initial whole-body skin examination. All screening physicians received a mandatory 8-hour training course.

Participants Inhabitants of Schleswig-Holstein 20 years or older with statutory health insurance (N = 360 288).

Main Outcome Measures Frequency of excisions and yields of malignant skin tumors (malignant melanomas [MMs], basal cell carcinomas [BCCs], and squamous cell carcinomas [SCCs]), stratified by sex and age.

Results Overall, 15 983 excisions were performed (1 of 23 screenees). A total of 3103 malignant skin tumors were diagnosed in 2911 persons: 585 MMs, 1961 BCCs, 392 SCCs, and 165 other malignant skin tumors. Overall, 116 persons (3103 of 360 288) had to be screened to find 1 malignant tumor, with 1 of 620 for MM, 1 of 184 for BCC, and 1 of 920 for SCC. Twenty excisions were performed to find 1 melanoma in men 65 years and older, but more than 50 excisions were required to find 1 melanoma in men aged between 20 and 49 years.

Conclusions The results of SCREEN suggest a high yield of malignant skin tumors in a large-scale population-based screening project. We found that a high number of excisions was performed in the youngest screenees with an associated low yield, suggesting a need in screener training to emphasize a more conservative attitude toward excisions in young screenees.