Attaching unit costs to Australia's National Survey of Mental Health and Wellbeing

Background: In mental health, policy-makers and planners are increasingly being asked to set priorities. This means that health economists, health services researchers and clinical investigators are being called upon to work together to define and measure costs. Typically, these researchers take available service utilisation data and convert them to costs, using a range of assumptions. There are inefficiencies, as individual groups of researchers frequently repeat essentially similar exercises in achieving this end. There are clearly areas where shared or common investment in the development of statistical software syntax, analytical frameworks and other resources could maximise the use of data. Aims of the Study: This paper reports on an Australian project in which we calculated unit costs for mental health admissions and community encounters. In reporting on these calculations, our purpose is to make the data and the resources associated with them publicly available to researchers interested in conducting economic analyses, and allow them to copy, distribute and modify them, providing that all copies and modifications are available under the same terms and conditions (i.e., in accordance with the 'Copyleft' principle), Within this context, the objectives of the paper are to: (i) introduce the 'Copyleft' principle; (ii) provide an overview of the methodology we employed to derive the unit costs; (iii) present the unit costs themselves; and (iv) examine the total and mean costs for a range of single and comorbid conditions, as an example of the kind of question that the unit cost data can be used to address. Method: We took relevant data from the Australian National Survey of Mental Health and Wellbeing (NSMHWB), and developed a set of unit costs for inpatient and community encounters. We then examined total and mean costs for a range of single and comorbid conditions. Results: We present the unit costs for mental health admissions and mental health community contacts. Our example, which explored the association between comorbidity and total and mean costs, suggested that comorbidly occurring conditions cost more than conditions which occur on their own. Discussion: Our unit costs, and the materials associated with them, have been published in a freely available form governed by a provision termed 'Copyleft'. They provide a valuable resource for researchers wanting to explore economic questions in mental health. Implications for Health Policies: Our unit costs provide an important resource to inform economic debate in mental health in Australia, particularly in the area of priority-setting. In the past, such debate has largely, been based on opinion. Our unit costs provide the underpinning to strengthen the evidence-base of this debate. Implications for Further Research: We would encourage other Australian researchers to make use of our unit costs in order to foster comparability across studies. We would also encourage Australian and international researchers to adopt the 'Copyleft' principle in equivalent circumstances. Furthermore, we suggest that the provision of 'Copyleft'-contingent funding to support the development of enabling resources for researchers should be considered in the planning of future large-scale collaborative survey work, both in Australia and overseas.

Economic Incentives to Conserve Wildlife on Private Lands: Analysis and Policy

Some believe that provision of private property rights in wildlife on private land provides a powerful economic incentive for nature conservation because it enables property owners to market such wildlife or its attributes. If such marketing is profitable, private landholders will conserve the wildlife concerned and its required habitat. But land is not always most profitably used for exploitation of wildlife, and many economic values of wildlife (such as non-use economic values) cannot be marketed. The mobility of some wildlife adds to the limitations of the private-property approach. While some species may be conserved by this approach, it is suboptimal as a single policy approach to nature conservation. Nevertheless, it is being experimented with, in the Northern Territory of Australia where landholders had a possibility of harvesting on their properties a quota of eggs and chicks of red-tailed black cockatoos for commercial sale. This scheme was expected to provide an incentive to private landholders to retain hollow trees essential for the nesting of these birds but failed. This case and others are analysed. Despite private-property failures, the long-term survival of some wildlife species depends on their ability to use private lands without severe harassment, either for their migration or to supplement their available resources, for example, the Asian elephant. Nature conservation on private land is often a useful, if not essential, supplement to conservation on public lands. Community and public incentives for such conservation are outlined.

Hydrogen production and utilisation opportunities for Australia

Worldwide, research and policy momentum is increasing in the move towards a hydrogen economy. Australia is one of the highest per capita users of energy, but relies heavily on fossil fuels to fulfil its energy requirements-thus making it one of the highest per capita polluters. It is also a country rich in natural resources, giving it the full range of options for a hydrogen economy. With the first Australian Hydrogen Study being completed by the end of 2003, there has as yet been little analysis of the options available to this country specifically. This paper reviews the resources, production and utilisation technology available for a hydrogen economy in Australia, and discusses some of the advantages and disadvantages of the different options. It points out that coal, natural gas, biomass and water are the most promising hydrogen sources at this stage, while solid oxide and molten carbonate fuel cells may hold the advantage in terms of current expertise for utilising hydrogen rich gases for stationary power in Australia. (c) 2004 International Association for Hydrogen Energy. Published by Elsevier Ltd. All rights reserved.

Fixing the system? The experience of service users of the quasi-market in disability services in Australia

A qualitative study involving semi-structured interviews with 31 people with disabilities and 32 carers in the state of Queensland, Australia, found that their experience of supportive service delivery had not improved despite reforms of the service delivery system driven by a version of the quasi-market model. Instead of delivering increased consumer choice and improved efficiency in service delivery, service users experienced inadequate service supply, service cutbacks, and an increased emphasis on cost subsidisation and assessment processes. Additionally, few consumers felt that individualised funding arrangements had personally delivered the benefits which the quasi-market model and associated policy paradigm had indicated that they should receive. For many consumers, the notion of consumer 'choice' around service provision was fictitious and they felt that any efficiency gains were at the agency level, largely at the consumers' cost. It is concluded that there appears to be no particular benefit to service users of quasi-market reforms, particularly in policy contexts where service delivery systems are historically under-funded.

The economic costs of road traffic crashes: Australia, states and territories

In this paper, we obtain detailed data on road traffic crash (RTC) casualties, by severity, for each of the eight state and territory jurisdictions for Australia and use these to estimate and compare the economic impact of RTCs across these regions. We show that the annual cost of RTCs in Australia, in 2003, was approximately $17b, which is approximately 2.3% of the Gross Domestic Product (GDP). Importantly, though, there is remarkable intra-national variation in the incident rates of RTCs in Australia and costs range from approximately 0.62 to 3.63% of Gross State Product (GSP). The paper makes two fundamental contributions: (i) it provides a detailed breakdown of estimated RTC casualties, by state and territory regions in Australia, and (ii) it presents the first sub-national breakdown of RTC costs for Australia. We trust that these contributions will assist policy-makers to understand sub-national variations in the road toll better and will encourage further research on the causes of the marked differences between RTC outcomes across the states and territories of Australia. (c) 2006 Elsevier Ltd. All rights reserved.

Occupational therapists' decision making in three therapy settings in Australia

Can a work setting with its organizational, cultural, and practical considerations influence the way occupational therapists make decisions regarding client interventions? There is currently a paucity of evidence available to answer this question. This study aimed to investigate the influence of work setting on therapists’ clinical reasoning in the management of clients with cerebral palsy and upper limb hypertonicity. Specifically the study aimed to examine therapists’ objective and stated policies, and their intervention decisions using Social Judgement Theory methodology. Participants were eighteen occupational therapists with more than five years experience with clients with cerebral palsy who were asked to make intervention decisions for clients represented by 90 case vignettes. They worked in three settings, hospitals (5), schools (6), and community (6). The results indicated that therapy settings did influence therapists’ decisions about intervention choices but not their objective and subjective policy decisions.

Career counselling in Australia

Historically, perhaps because of its matching process traditions, career counselling has tended to be viewed more simplistically than other fields of counselling. However, in the latter part of the 20th century the career development industry witnessed rapid growth and seems set for a promising future. Such growth has corresponded with irreversible change in the world of work, the emergence of lifelong learning as integral to people's careers, and broader and more holistic definitions of career and career development that have gained widespread acceptance. With the increased influence of constructivism, career counselling has emerged from its vocational guidance origins as a profession in its own right. Increasingly, policymakers are recognizing the importance of career guidance and counselling in assisting to achieve policy goals related to lifelong learning, employment, and social equity. Thus, closer links have been created between policymakers and practitioner associations such as the Australian Association of Career Counsellors (AACC). Such intense focus on career guidance and counselling has also resulted in closer scrutiny of its professional standards and qualifications. Consequently, at the same time as there being increased demand for and interest in career counselling, practitioner associations are faced with issues related to redefining their roles with members, the community, and policymakers. This article will describe the changed context of career counselling, current issues such as standards and accreditation, and redefinition of the profession. The AACC's response to these challenges will be the focus of this article.

Palliative care training: a survey of physicians in Australia and Europe

The purpose of this paper is to present data about the level and background characteristics of physicians' training in palliative care in Australia (AU), Belgium (BE), Denmark (DK), Italy (IT), the Netherlands (NL), Sweden (SE) and Switzerland (CH) (n=16,486). The response rate to an anonymous questionnaire differed between countries (39%-68%). In most countries approximately half of all responding physicians had any formal training in palliative care (median: 3-10 days). Exceptions were NL (78%) and IT (35%). The most common type of training was a postgraduate course. Physicians in nursing home medicine (only in NL), geriatrics, oncology (not in NL), and general practice had the most training. In all seven countries, physicians with such training discussed options for palliative care and options to forgo life-sustaining treatment more often with their patients than did physicians without. Irrespective of earlier palliative care training, 87%-98% of the physicians wanted extended training.

Prevalence, severity, and heritability of Stephanofilaria lesions on cattle in central and southern Queensland, Australia

Observations of cattle in central and southern Queensland are collated to de. ne the prevalence and area of Stephanofilaria lesions associated with infestations of the buffalo fly, Haematobia irritans exigua. The observations were made on herds that were being used for other purposes. In a survey of similar to 1500 animals at Belmont in central Queensland in 1982, 98% of cows and 70% of calves had lesions. Most lesions were on the neck and dewlap and 10% were raw and weeping at the time of sampling. The total area of lesions per animal was strongly related to cattle breed and age. Old Bos taurus animals had the greatest area of lesions, whereas young Bos indicus had the least. Heritability estimates were low, averaging 0.01 for calves and 0.18 for cows. A smaller survey of cows and steers at Craighoyle in central Queensland in 1986 showed a higher numbers of lesions and positive correlations between the total lesion area and animal size. The lesion area increased with tick survival, suggesting that tick-resistant animals are also resistant to Stephanofilaria infection. Steers had smaller areas of lesions than cows, as found previously with cattle ticks. Long-term monitoring observations in central and southern Queensland between 1981 and 1986 showed that the total area of lesions was seasonal with a peak in late summer, consistent with the seasonal incidence of buffalo fly. Animals segregated into Low and High lesion herds maintained their differences over time. The lesions penetrated the dermis of the cattle hides and rendered the affected area unusable, but few lesions occurred on valuable parts of the hide so such economic effects are likely to be insignificant. One animal nearly died of a haemorrhage from a lesion on the dewlap and had to be treated. The results can inform policy on buffalo fly control, and biosecurity preparations in relation to the potential establishment of the OldWorld screw-worm fly, Chrysomyia bezziana, in Australia, which will be facilitated by the lesions. The results emphasise the significant animal welfare and biosecurity risks posed by the lesions in northern Australia.

Regional renaissance? New forms of governance in nonmetropolitan Australia

Since the Second World War, Australian governments have adopted various approaches to governing nonmetropolitan Australia. The authors profile three distinct approaches to governance characterised as (1) state-centred regionalism; (2) new localism; and (3) new forms of multifaceted regionalism. Although recent policy initiatives have been justified by the argument that the region is the most suitable scale for planning and development in nonmetropolitan Australia, in practice the institutional landscape is a hybrid of overlapping local, regional, and national scales of action. The authors compare this new, multifaceted, regionalism with the so-called 'new regionalism currently being promoted in Western Europe and North America. It is argued that new regionalism differs in quite important ways from the regionalism currently being fostered in Australia. In Australia, the centrality of sustainability principles, and the attempt to foster interdependence amongst stakeholders from the state, market, and civil society, have produced a layer of networked governance that is different from that overseas. It is argued that there is a triple bottom-line 'promise' in the Australian approach which differs from the Western Europe/North American model, and which has the potential to deliver enhanced economic, social, and environmental outcomes.

A victim of its own success: Internationalization, neoliberalism, and organizational involution at the Business Council of Australia

The focus of this article is on the Business Council of Australia (BCA), an association of the CEOs of the 100 or so largest companies operating in Australia. Since its inception the BCA has been an influential supporter of largely successful efforts to neoliberalize and internationalize the Australian economy. Running in parallel with these developments, however, the BCA has moved from being a "somewhat strong" to a relatively weak policy organization. This article argues these two trends are causally related. Neoliberal-inspired economic restructuring and economic internationalization have weakened the "logic of membership" and the "logic of influence" of the BCA, leading to a process of organizational involution. Furthermore, potential offsets to what I describe as the organizational predations of neoliberalism and internationalization - especially via a willingness or capacity to forge supportive or mutualistic relations with the state - have not been realized.

Graduate overeducation and its effects among recently arrived immigrants to Australia: A longitudinal survey

There is increasing importance attached to skill-based immigration in many countries including Australia. This paper investigates the incidences, determinants, and returns to graduate overeducation among tertiary qualified immigrants during the early phase of their settlement in Australia. We place particular emphasis on visa categories and region of origin. As expected, those on visas with higher skill requirements perform better in the labour market. The bulk of these are immigrants from English Speaking Backgrounds (ESB). Non-English Speaking Background (NESB) immigrants, on the other hand, have higher and persistent rates of overeducation. The wage returns to required and surplus education match the stylized facts of overeducation for ESB and Other NESB immigrants while Asian NESB immigrants receive no return to surplus education. Thus, the results suggest that NESB graduate immigrants are a heterogeneous group, with Asian graduate immigrants facing greater assimilation hurdles in the Australian labour market.

Cattle, crops and clearing: Regional drivers of landscape change in the Brigalow Belt, Queensland, Australia, 1840-2004

Landscape change occurs through the interaction of a multitude of natural and human driving forces at a range of organisational levels, with humans playing an increasingly dominant role in many regions of the world. Building on the current knowledge of the underlying drivers of landscape change, a conceptual framework of regional landscape change was developed which integrated population, economic and cultural values, policy and science/technology. Using the Southern Brigalow Belt biogeographic region of Queensland as a case study, the role of natural and human drivers in landscape change was investigated in four phases of settlement since 1840. The Brigalow Belt has experienced comparable rates of vegetation clearance over the past 50 years to areas of tropical deforestation. Economic factors were important during all phases of development, but the five regional drivers often acted in synergy. Environmental constraints played a significant role in slowing rates of change. Temporal trends of deforestation followed a sigmoidal curve, with initial slow change accelerating though the middle phases then slowing in recent times. Future landscape management needs to take account of the influence of all the components of the conceptual framework, at a range of organisational levels, if more ecologically sustainable outcomes are to be achieved. (c) 2006 Elsevier B.V. All rights reserved.