Generic drugs: international trends and policy developments in Australia

Public and private third-party payers in many countries encourage or mandate the use of generic drugs. This article examines the development of generics policy in Australia, against the background of a description of international trends in this area, and related experiences of reference pricing programs. The Australian generics market remains underdeveloped due to a historical legacy of small Pharmaceutical Benefits Scheme price differentials between originator brands and generics. It is argued that policy measures open to the Australian government can be conceived as clustering around two different approaches: incremental changes within the existing regulatory framework, or a shift towards a high volume/low price role of generics which would speed up the delivery of substantial cost savings, and could provide enhanced scope for the financing of new, patented drugs.

Reconsidering the scope of the equitable mortgage arising from deposit of title documents

This article examines the underlying fairness of applying equitable security presumptions to the deposit of title documents belonging to third parties. It argues that within such transactions, the focus of the equitable jurisdiction must be upon the intention of the owner of the title documents rather than presumptions arising from the fact of the deposit. It suggests that there is no logic in applying equitable presumptions, founded on the principles of part performance, to infer a security intention in transactions involving third party title documents. The fact that the parties to a loan advance may have intended to create a mortgage between themselves does not mean that the third party owner of the title documents also intended to create a mortgage. In third party transactions, the objectives of the equity jurisdiction are best achieved through a comprehensive assessment of the intention of all parties and the abolition of presumptions based upon the bare fact of title deposit.

The need to vent and dissatisfactory self-service technology encounters

Reports of customer dissatisfaction with self-service technologies (SSTs) are becoming increasingly common. The SST context is characterised by customer participation in service production and delivery, independently of service personnel. With no opportunity for humanto- human interaction, feelings of customer irritation and frustration can have a tendency to build-up in dissatisfactory SST encounters. If SSTs do not perform as promised, customers can become angry and frustrated, and do not have the security or reassurance of human service personnel. With this in mind, it is argued that customers’ “need to vent” will be an important predictor of customers’ complaint behaviours (CCBs), i.e., voice, negative word of mouth, negative “word of mouse”, third party action, false loyalty and exit, in dissatisfactory SST encounters. The “need to vent” is defined as the need, when one has a problem, to seek relief by expressing one’s problem / “getting it off one’s chest”. This construct has been subject to little conceptual or empirical scrutiny, and to the researchers’ knowledge, has not been previously operationalised or measured. This paper begins to address this gap by presenting a conceptual model and hypotheses depicting the relationships between the need to vent and CCBs in the context of SSTs.

Consumer complaint behaviour in sport consumption: a theoretical model

In this study, traditional consumer complaint behaviours (CCBs) are re-examined in an experiential context; specifically, the consumption of live sport. It is proposed that these behaviours are not motivated by the “traditional” antecedents, and further, that they are not enacted with the purpose of reducing dissonance. Instead, it would appear that traditional CCBs, such as private responses, direct voicing and third party action take on a more functional role in the sport consumption experience. The possibility exists that for some spectators, these CCBs, which have been traditionally classified as negative, actually contribute to overall enjoyment of, and satisfaction with, a sport consumption experience. A review of literature in the area is presented, and a theoretical model of CCB in the experiential context is offered.

Green decisions : demographics and consumer understanding of environmental labels

This research examined the demographic profiles of Australian green consumers in relation to their satisfaction of environmental labelling. It examined consumers’ understanding of labelling and empirically investigated the association of demographic profile of consumers with their attitudes towards such labels. The results indicated that some of the demographic variables were significant, which is largely consistent with earlier findings by other researchers in this area. Label dissatisfaction was higher in the older and middle age respondents. However, some respondents disagreed that labels were accurate while commenting that labels were easy to understand. The key issue arising from the findings is that in order to provide perception of accuracy in labels, it is an option to use Type I or Type III labelling on products. These labels are, arguably, more credible because they are endorsed by third party labelling experts. This would come at a cost and for green products that use third party labelling, they will also have to bear in mind to keep the prices competitive.

A conceptual model for security outsourcing

This research analyses the current literature on IT security outsourcing and the organisational attitudes towards this approach to determine the applicability of outsourcing IT security in a commercial environment. A conceptual model is developed as the main goal of research which provides guidance in the process of outsourcing IT security functions to a third-party security service provider. The research conducted has established a complete process for outsourcing IT security.

Colorectal cancer screening in Australia: an economic evaluation of a potential biennial screening program using faecal occult blood tests

Objective: To evaluate whether the introduction of a national, co-ordinated screening program using the faecal occult blood test represents 'value-for-money' from the perspective of the Australian Government as third-party funder.  Methods: The annual equivalent costs and consequences of a   biennial screening program in 'steady-state' operation were estimated for the Australian population using 1996 as the reference year. Disability-adjusted life years (DALYs) and the years of life lost (YLLs) averted, and the health service costs were modelled, based on the epidemiology and the costs of colorectal cancer in Australia together with the mortality reduction achieved in randomised controlled trials. Uncertainty in the model was examined using Monte Carlo simulation methods. Results: We estimate a minimum or 'base program' of screening those aged 55 to 69 years could avert 250 deaths per annum (95% uncertainty interval 99–400), at a gross cost of $A55 million (95% UI $A46 million to $A96 million) and a gross incremental cost-effectiveness ratio of $A17,000/DALY (95% UI $A13,000/DALY to $A52,000/DALY). Extending the program to include 70 to 74-year-olds is a more effective option (cheaper and higher health gain) than including the 50 to 54-year-olds. Conclusions: The findings of this study support the case for a national program directed at the 55 to 69-year-old age group with extension to 70 to 74-year-olds if there are sufficient resources. The pilot tests recently announced in Australia provide an important opportunity to consider the age range for screening and the sources of uncertainty, identified in the modelled evaluation, to assist decisions on implementing a full national program.

Cost-effectiveness analysis of screening for lung cancer with low dose spiral CT (computed tomography) in the Australian setting

Introduction:
Low dose spiral computed tomography (CT) is a sensitive screening tool for lung cancer that is currently being evaluated in both non-randomised studies and randomised controlled trials.
Methods:
We conducted a quantitative decision analysis using a Markov model to determine whether, in the Australian setting, offering spiral CT screening for lung cancer to high risk individuals would be cost-effective compared with current practice. This exploratory analysis was undertaken predominantly from the perspective of the government as third-party funder. In the base-case analysis, the costs and health outcomes (life-years saved and quality-adjusted life years) were calculated in a hypothetical cohort of 10,000 male current smokers for two alternatives: (1) screen for lung cancer with annual CT for 5 years starting at age 60 year and treat those diagnosed with cancer or (2) no screening and treat only those who present with symptomatic cancer.
Results:
For male smokers aged 60–64 years, with an annual incidence of lung cancer of 552 per 100,000, the incremental cost-effectiveness ratio was $57,325 per life-year saved and $105,090 per QALY saved. For females aged 60–64 years with the same annual incidence of lung cancer, the cost-effectiveness ratio was $51,001 per life-year saved and $88,583 per QALY saved. The model was used to examine the relationship between efficacy in terms of the expected reduction in lung cancer mortality at 7 years and cost-effectiveness. In the base-case analysis lung cancer mortality was reduced by 27% and all cause mortality by 2.1%. Changes in the estimated proportion of stage I cancers detected by screening had the greatest impact on the efficacy of the intervention and the cost-effectiveness. The results were also sensitive to assumptions about the test performance characteristics of CT scanning, the proportion of lung cancer cases overdiagnosed by screening, intervention rates for benign disease, the discount rate, the cost of CT, the quality of life in individuals with early stage screen-detected cancer and disutility associated with false positive diagnoses. Given current knowledge and practice, even under favourable assumptions, reductions in lung cancer mortality of less than 20% are unlikely to be cost-effective, using a value of $50,000 per life-year saved as the threshold to define a “cost-effective” intervention.
Conclusion:
The most feasible scenario under which CT screening for lung cancer could be cost-effective would be if very high-risk individuals are targeted and screening is either highly effective or CT screening costs fall substantially.

The hybrid stranger and intercultural hermeneutics

The category of the stranger has experienced a renaissance in contemporary social theory. Within this burgeoning literature, a new conceptualisation has emerged known as the 'in-between stranger' or the 'hybrid of modernity'. The formulation of this stranger has raised epistemological concerns. Not only can the hybrid expose the misunderstanding between Self and Other or between two life-worlds, it is able to transcend the self/other dichotomy. The unresolved hermeneutic problem -the meeting with strangers -results in uncertainty, in particular uncertainty about how to read and respond to unfamiliar social situations. What is interesting is not the fact that misunderstanding occurs between the host and the stranger, but that the stranger's physical nearness and social distance fosters an interpretative view of the world that is not accessible to either the host (Self) or parent group (Other). The position of hybrid strangers purportedly encourages a critical and 'objective' stance that transcends conventional and 'situated' knowledge. The discourse on 'the stranger', beginning with Simmel, has constructed the hybrid stranger as disinterested third party. This in-between, third position allows hybrid strangers to see things more clearly and/or differently than those occupying opposing positions or cultural perspectives. In this paper I critically examine the nature of this third type of consciousness and its association with the idea of the intercultural.

An overview of IT outsourcing in public secto agenices

For the past 15 years, governments in the developed, Western world have been contracting out, or outsourcing, services as a key part of public sector reforms. Outsourcing has been argued to lead to cost savings, improved discipline, better services, access to scarce skills, and the capacity for managers to focus more time on the core business of their organizations (Domberger, 1998). Government outsourcing initiatives have encompassed a range of services, but given the large sums of money invested in IT assets, the outsourcing of IT services (IT outsourcing, or ITO) has been a major initiative for many agencies. Lacity and Willcocks (1998, p. 3) defined ITO as "handing over to a third party [the] management of IS/IT assets, resources and/or activities for required results." For public-sector outsourcing, this handover is usually made by way of a competitive tender. Case studies have reported ITO successes and failures (e.g., Currie & Willcocks, 1998; Rouse & Corbitt, 2003; Willcocks & Currie, 1997; Willcocks & Lacity, 2001; Willcocks & Kern, 1998), but much of the evidence presented to public-sector decision makers to justify this reform is anecdotal and unsystematic, and when investigated in depth, does not necessarily support widespread conclusions.

Environmental marketing claims : consumer interpretation and policy implications

Environmental claims communicate the concept of green brands. The purpose of this paper is to examine if environmental claims yield satisfactory results. Secondly, what policy measures would best encourage the adoption of environmental claims by businesses? Finally, how should businesses address practical and theoretical implications?The results suggests that in order to avoid misleading consumers, policy makers need to evaluate the public’s understanding of the meaning of claims, disallow the use of nonstandard claims by businesses, establish an education program and mandate their usage. There is also an indication that the usage of recognisable third party environmental labelling may be a more reliable.

The availability of information in knowledge-based economies

The use of information is preceded by its availability. For post-industrial economies to exploit information to full potential it is important for knowledge to be free of vested-interest censorship and manipulation. History suggests that a range of vested-interests have manipulated explicit> information availability through various forms of sectarian, state and business manipulation of the systems of information storage and transfer. The OECD 1996 report "The Knowledge-Based Economy" recognized that the diffusion of knowledge was as significant as its creation, and that knowledge distribution networks were crucial to innovation, production processes and product development. The success of enterprises and national economies is considered reliant on the effectiveness of their ability to gather, distribute and utilize knowledge. The increasing need for ready access (of information that might become knowledge) in accordance with the OEDC definition is particularly relevant to this paper as it assumes infrastructures capable of providing that need. Wherever there are infrastructures there are opportunities to benefit from them, either for profit or power. This paper considers the implications of sectarian, state and business-model control over the selective content, storage and dissemination of information and knowledge, both from historical and current perspectives. The advent of new technologies and how they have enabled the flow of information adds new dimensions to knowledge control but the quality of knowledge is less certain and who controls or influences distribution of knowledge less transparent. It could be argued that at each step in the development of knowledge distribution networks, knowledge and its distribution, is not free of the possibility of third-party vested interest.

Confidentiality and disclosure : assessment and intervention issues

This portfolio addresses the moral, ethical and legal issues that impact upon decisions to maintain or disclose confidential communications. The tensions and moral dilemmas that are created when a conflict between these aspects arises are considered. Risk assessment procedures that inform decisions to maintain or disclose confidential information are discussed, as are issues related to the practical implementation of planned interventions. The topic is addressed by firstly reviewing professional codes of conduct and legal requirements to maintain confidentiality. The limits of confidentiality and privileged communication are then reviewed together with legal requirements of “duty to warn” or “duty of care”. These requirements are then related to risk assessment procedures and relevant interventions. Four case studies that illustrate the practical application of assessment techniques in the decision process and planned interventions are presented. They cover such diverse topics as disclosure and suicidal intent, threat of harm to a third party, risk of transmission of the AIDS virus and “duty to warn” and maintenance of a minor’s confidential communications. The ways in which these issues were addressed and the outcome is presented. NOTE: All names and details that have the potential to identify the people whose cases are presented here have been changed to protect their anonymity.

Why educators should bring an end to pedagogy

As Australia is moving towards a national curriculum there are also activities to nationalise teacher education. This involves various departments of state and federal governments, third-party bodies funded by government such as the Curriculum Corporation and Teaching Australia, and non-government organisations such as the Business Council of Australia. These agencies are producing models and principles which aim on establishing standards of best practice for how they want teachers to teach. Within all of this activity the term ‘pedagogy’ is often employed to represent aspects of these best practices. Examples include ‘productive pedagogies’, ‘new pedagogies’, ‘pedagogical content knowledge’ and ‘pedagogical strategies’. However these are all means only without any end purposes which identify them as being valuable for education. In this paper I will argue that in order to have educative value teachers themselves must exercise a degree of professional autonomy to bring their own end purposes to their choice of pedagogy.

Secure buyer - seller watermarking protocol

In the existing watermarking protocols, a trusted third party (TTP) is introduced to guarantee that a protocol is fair to both the seller and buyer in a digital content transaction. However, the TTP decreases the security and affects the protocol implementation. To address this issue, in this article a secure buyer–seller watermarking protocol without the assistance of a TTP is proposed in which there are only two participants, a seller and a buyer. Based on the idea of sharing a secret, a watermark embedded in digital content to trace piracy is composed of two pieces of secret information, one produced by the seller and one by the buyer. Since neither knows the exact watermark, the buyer cannot remove the watermark from watermarked digital content, and at the same time the seller cannot fabricate piracy to frame an innocent buyer. In other words, the proposed protocol can trace piracy and protect the customer’s rights. In addition, because no third party is introduced into the proposed protocol, the problem of a seller (or a buyer) colluding with a third party to cheat the buyer (or the seller), namely, the conspiracy problem, can be avoided.