Quality-based benefit design in health insurance : the impact of a product benefit design change on the utilisation of oral health services by members of a private health insurance fund in regional and rural New South Wales, Australia

Objective: To examine the impact on dental utilisation following the introduction of a participating provider scheme (Regional and Rural Oral Health Program {RROHP)). In this model dentists receive higher third party payments from a private health insurance fund for delivering an agreed range of preventive and diagnostic benefits at no out-ofpocket cost to insured patients. Data source/Study setting: Hospitals Contribution Fund of Australia (HCF) dental claims for all members resident in New South Wales over the six financial years from l99811999 to 200312004. Study design: This cohort study involves before and after analyses of dental claims experience over a six year period for approximately 81,000 individuals in the intervention group (HCF members resident in regional and rural New South Wales, Australia) and 267,000 in the control group (HCF members resident in the Sydney area). Only claims for individuals who were members of HCF at 31 December 1997 were included. The analysis groups claims into the three years prior to the establishment of the RROHP and the three years subsequent to implementation. Data collection/Extraction methods: The analysis is based on all claims submitted by users of services for visits between 1 July 1988 and 30 June 2004. In these data approximately 1,000,000 services were provided to the intervention group and approximately 4,900,000 in the control group. Principal findings: Using Statistical Process Control (SPC) charts, special cause variation was identified in total utilisation rate of private dental services in the intervention group post implementation. No such variation was present in the control group. On average in the three years after implementation of the program the utilisation rate of dental services by regional and rural residents of New South Wales who where members of HCF grew by 12.6%, over eight times the growth rate of 1.5% observed in the control group (HCF members who were Sydney residents). The differences were even more pronounced in the areas of service that were the focus of the program: diagnostic and preventive services. Conclusion: The implementation of a benefit design change, a participating provider scheme, that involved the removal of CO-payments on a defined range of preventive and diagnostic dental services combined with the establishment and promotion of a network of dentists, appears to have had a marked impact on HCF members' utilisation of dental services in regional and rural New South Wales, Australia.

Measuring the quality of teaching in elementary school classrooms

This paper reviews the means by which teacher quality has been measured. It considers data sources such as students, peers, experts, and examines the psychometrics and scaleproperties of teacher quality assessment instruments with respect to reliability and validity. A list of items for possible inclusion in an elementary student focussed instrument is considered, together with the potential use of such an instrument in measuring teacher quality.

Final report : task 2 : design guidelines for delivering high quality indoor environments

This report is for one of the four Tasks of the CRC project ‘Regenerating Construction to Enhance Sustainability’. The report specifically addresses Task 2 ‘Design guidelines for delivering high quality indoor environments’.

Static load modelling and voltage stability indices

This paper analyzes the performance of some of the widely used voltage stability indices, namely, singular value, eigenvalue, and loading margin with different static load models. Well-known ZIP model is used to represent loads having components with different power to voltage sensitivities. Studies are carried out on a 10-bus power system and the New England 39-bus power system models. The effects of variation of load model on the performance of the voltage stability indices are discussed. The choice of voltage stability index in the context of load modelling is also suggested in this paper.

Power quality enhanced operation and control of a microgrid based custom power park

This paper describes the operation of a microgrid that contains a custom power park (CPP). The park may contain an unbalanced and/or nonlinear load and the microgrid may contain many dis-tributed generators (DGs). One of the DGs in the microgrid is used as a compensator to achieve load compensation. A new method is proposed for current reference generation for load compensation, which takes into account the real and reactive power to be supplied by the DG connected to the compensator. The real and reactive power from the DGs and the utility source is tightly regulated assuming that dedicated communication channels are available. Therefore this scheme is most suitable in cases where the loads in CPP and DGs are physically located close to each other. The proposal is validated through extensive simulation studies using EMTDC/PSCAD software package (version 4.2).

Estimating indoor air quality using integrated 3D CAD building models

The indoor air quality (IAQ) in buildings is currently assessed by measurement of pollutants during building operation for comparison with air quality standards. Current practice at the design stage tries to minimise potential indoor air quality impacts of new building materials and contents by selecting low-emission materials. However low-emission materials are not always available, and even when used the aggregated pollutant concentrations from such materials are generally overlooked. This paper presents an innovative tool for estimating indoor air pollutant concentrations at the design stage, based on emissions over time from large area building materials, furniture and office equipment. The estimator considers volatile organic compounds, formaldehyde and airborne particles from indoor materials and office equipment and the contribution of outdoor urban air pollutants affected by urban location and ventilation system filtration. The estimated pollutants are for a single, fully mixed and ventilated zone in an office building with acceptable levels derived from Australian and international health-based standards. The model acquires its dimensional data for the indoor spaces from a 3D CAD model via IFC files and the emission data from a building products/contents emissions database. This paper describes the underlying approach to estimating indoor air quality and discusses the benefits of such an approach for designers and the occupants of buildings.

High quality indoor environments for office buildings

The quality of office indoor environments is considered to consist of those factors that impact the occupants according to their health and well-being and (by consequence) their productivity. Indoor Environment Quality (IEQ) can be characterized by four indicators: • Indoor air quality indicators • Thermal comfort indicators • Lighting indicators • Noise indicators. Within each indicator, there are specific metrics that can be utilized in determining an acceptable quality of an indoor environment based on existing knowledge and best practice. Examples of these metrics are: indoor air levels of pollutants or odorants; operative temperature and its control; radiant asymmetry; task lighting; glare; ambient noise. The way in which these metrics impact occupants is not fully understood, especially when multiple metrics may interact in their impacts. It can be estimated that the potential cost of lost productivity from poor IEQ may be much in excess of other operating costs of a building. However, the relative productivity impacts of each of the four indicators is largely unknown. The CRC Project ‘Regenerating Construction to Enhance Sustainability’ has a focus on IEQ impacts before and after building refurbishment. This paper provides an overview of IEQ impacts and criteria and the implementation of a CRC project that is currently researching these factors during the refurbishment of a Melbourne office building. IEQ measurements and their impacts will be reported in a future paper

High quality indoor environments for sustainable office buildings

The quality of office indoor environments is considered to consist of those factors that impact occupants according to their health and well-being and (by consequence) their productivity. Indoor Environment Quality (IEQ) can be characterized by four indicators: • Indoor air quality indicators • Thermal comfort indicators • Lighting indicators • Noise indicators. Within each indicator, there are specific metrics that can be utilized in determining an acceptable quality of an indoor environment based on existing knowledge and best practice. Examples of these metrics are: indoor air levels of pollutants or odorants; operative temperature and its control; radiant asymmetry; task lighting; glare; ambient noise. The way in which these metrics impact occupants is not fully understood, especially when multiple metrics may interact in their impacts. While the potential cost of lost productivity from poor IEQ has been estimated to exceed building operation costs, the level of impact and the relative significance of the above four indicators are largely unknown. However, they are key factors in the sustainable operation or refurbishment of office buildings. This paper presents a methodology for assessing indoor environment quality (IEQ) in office buildings, and indicators with related metrics for high performance and occupant comfort. These are intended for integration into the specification of sustainable office buildings as key factors to ensure a high degree of occupant habitability, without this being impaired by other sustainability factors. The assessment methodology was applied in a case study on IEQ in Australia’s first ‘six star’ sustainable office building, Council House 2 (CH2), located in the centre of Melbourne. The CH2 building was designed and built with specific focus on sustainability and the provision of a high quality indoor environment for occupants. Actual IEQ performance was assessed in this study by field assessment after construction and occupancy. For comparison, the methodology was applied to a 30 year old conventional building adjacent to CH2 which housed the same or similar occupants and activities. The impact of IEQ on occupant productivity will be reported in a separate future paper

Memoirs of a trainer : The search for a balance between quality and best practice

The field of research training (for students and supervisors) is becoming more heavily regulated by the Federal Government. At the same time, quality improvement imperatives are requiring staff across the University to have better access to information and knowledge about a wider range of activities each year. Within the Creative Industries Faculty at the Queensland University of Technology (QUT), the training provided to academic and research staff is organised differently and individually. This session will involve discussion of the dichotomies found in this differentiated approach to staff training, and begin a search for best practice through interaction and input from the audience.

The impact of pain on the quality of life of people with multiple sclerosis: A community survey

The purpose of this study was to examine the impact of pain on functioning across multiple quality of life (QOL) domains among individuals with multiple sclerosis (MS). A total of 219 people were recruited from a regional MS society membership database to serve as the community-based study sample. All participants completed a questionnaire containing items about their demographic and clinical characteristics, validated measures of QOL and MS-related disability, and a question on whether or not they had experienced clinically significant pain in the preceding 2 weeks. Respondents who reported pain then completed an in-person structured pain interview assessing pain characteristics (intensity, quality, location, extent, and duration). Comparisons between participants with and without MS-related pain demonstrated that pain prevalence and intensity were strongly correlated with QOL: physical health, psychological health, level of independence, and global QOL were more likely to be impaired among people with MS when pain was present, and the extent of impairment was associated with the intensity of pain. Moreover, these relationships remained significant even after statistically controlling for multiple demographic and clinical covariates associated with self-reported QOL. These findings suggest that for people with MS, pain is an important source of distress and disability beyond that caused by neurologic impairments.

Measuring and supporting quality of life

It is widely acknowledged that “quality of life” (QoL) is an imprecise concept, which is difficult to define (Arnold, 1991; Ball et al., 2000; Bury & Holme, 1993; Byrne & MacLean, 1997; Guse & Masesar, 1999; McDowell & Newell, 1996). McDowell and Newell (1996) described the term as “intuitively familiar” (p.382), suggesting that everyone believes that they know what it means; while, in reality its meaning differs from person to person. Recent years, have seen steadily increasing interest in the study and measurement of QoL related to human services, which reflects greater importance being attached to accountability in its widest sense. Anecdotally, many care staff will indicate that ensuring good QoL for their clients is important to them, but how can we ascertain whether we are achieving positive QoL outcomes, and given the complexities of the concept and its measurement, how can we best incorporate QoL assessment into everyday practice? This chapter will explore the issues of QoL definition and measurement, particularly as they pertain to aged care. It will consider many measurement tool options, and provide advice on how to choose an appropriate instrument for your circumstances. Issues of quality of care and their relationship to QoL will also be considered, and the chapter will conclude with a discussion on the integration of QoL assessment into practice. Because residential aged care constitutes a living environment as well as a care environment, QoL is considered particularly pertinent in this context, and as such, it will provide much of the focus for the chapter

The relationship between clinical outcomes and quality of life for residents of aged care facilities

Objectives It is widely assumed improving care in residential facilities will improve quality of life (QoL), but little research has explored this relationship. The Clinical Care Indicators (CCI) Tool was developed to fill an existing gap in quality assessment within Australian residential aged care facilities and it was used to explore potential links between clinical outcomes and QoL. Design and Setting Clinical outcome and QoL data were collected within four residential facilities from the same aged care provider. Subjects Subjects were 82 residents of four facilities. Outcome Measures Clinical outcomes were measured using the CCI Tool and QoL data was obtained using the Australian WHOQOL‑100. Results Independent t‑test analyses were calculated to compare individual CCIs with each domain of the WHOQOL‑100, while Pearson’s product moment coefficients (r) were calculated between the total number of problem indicators and QoL scores. Significant results suggested poorer clinical outcomes adversely affected QoL. Social and spiritual QoL were particularly affected by clinical outcomes and poorer status in hydration, falls and depression were most strongly associated with lower QoL scores. Poorer clinical status as a whole was also significantly correlated with poorer QoL. Conclusions Hydration, falls and depression were most often associated with poorer resident QoL and as such appear to be key areas for clinical management in residential aged care. However, poor clinical outcomes overall also adversely affected QoL, which suggests maintaining optimum clinical status through high quality nursing care, would not only be important for resident health but also for enhancing general life quality.

Service quality in Hong Kong : wet markets vs super markets

Purpose – The purpose of this paper is to determine consumer perceptions of service quality in wet markets and supermarkets in Hong Kong. Design/methodology/approach – A questionnaire was developed and distributed via a convenience sample to consumers in shopping malls in Causeway Bay, Mong Kok and Tsuen Wan. Findings – The study finds that supermarkets outperformed wet markets across all aspects of service quality as measured by SERVQUAL-P. Research limitations/implications – Implications suggest that wet market vendors are not providing the level of service quality demanded by their customers. In particular, findings suggest that wet market vendors need to improve the visual attractiveness of their stalls, work on making them look more professional and start using more modern equipment. Practical implications – Wet market vendors in conjunction with government representatives need to develop standards of service quality for wet markets across Hong Kong. This is imperative if the wet market model is to survive in what is a highly competitive food retailing industry. Without action, it appears that the supermarketization of the Hong Kong food retailing industry will continue unabated. Originality/value – This paper adds to a small but growing research stream examining service quality in the food retailing industry in Hong Kong. It provides empirical results that guide suggested actions for change.

Conclusion explicitness in advertising: The moderating role of need for cognition (NFC) and argument quality (AQ) on persuasion

Previous research into the use of explicit and implicit conclusions in advertising has yet to demonstrate consistent effects for both brand attitudes and purchase intentions. While research has examined the role of involvement, this study contributes by examining the trait called need for cognition (NFC), which addresses a person’s propensity to engage in effortful thinking. In addition, this study introduces argument quality (AQ) as another potential moderator of conclusion explicitness effects. In a 2 × 2 experiment of 261 subjects, conclusion explicitness (explicit conclusion, implicit conclusion) and AQ (strong, weak) are manipulated, with NFC (high NFC, low NFC) as a third measured variable. Results indicate more favorable evaluations for implicit conclusions over explicit conclusions for high-NFC individuals. Further, implicit conclusions result in more favorable brand attitudes and purchase intentions when linked with strong AQ for high-NFC individuals. The findings confirm that conclusion explicitness does not differentially affect the evaluations of low-NFC subjects. Results suggest that NFC may represent an important moderating variable for future conclusion explicitness research.