15 research outputs found
Response to Setting the record straight on obstetric gaps
No full textWe write in reply to the letter ‘Setting the Record Straight on Obstetric Gaps’.2 We thank the author for his reply to our previously published short commentary ‘Changes in out‐of‐pocket charges associated with obstetric care provided under Medicare in Australia’ (ANZJOG 2018; 58; 362–365). Overwhelmingly what ‘Setting the Record Straight on Obstetric Gaps’ highlights is the lack of transparency regarding the setting of fees that are charged to women, and the influence of ministerial decisions and lobbying on the fees that are paid from the woman's purse at the end of a private specialist consultation.No Full Tex
CancerCostMOD
No full text<p>Australia's first model (called CancerCostMod) of out-of-pocket healthcare expenditure of patients with cancer using administrative data from Queensland Cancer Registry, for all individuals diagnosed with any cancer in Queensland between 1 July 2011 and 30 June 2012, linked to their Admitted Patient Data Collection, Emergency Department Information System, Medicare Benefits Schedule and Pharmaceutical Benefits Scheme records from 1 July 2011 to 30 June 2015.</p><p>The full methodology is available in the Open Access publication from the Related Publications link below.</p><p>This is an AIHW (Australian Institute of Health and Welfare) approved data linkage/integration project - details under 2017 tab and heading: <a href="https://www.aihw.gov.au/our-services/data-linkage/approved-aihw-linkage-projects">Quantifying cancer patient’s health service use and costs in Queensland (EO 2017/1/343)</a></p><p>Data cannnot be shared as it is accessed through the custodian's remote data access facility. Please email the primary contact below for more information.</p>
Cost-Effectiveness of Interventions Related to the Treatment of Women With Polycystic Ovary Syndrome: A Scoping Review
No full textEmily Joy Callander,1,2 Yanan Hu,1 Alayna Carrandi,2 Chau Thien Tay,2 Aya Mousa,2 Helena Teede2 1School of Public Health, University of Technology Sydney, Sydney, NSW, Australia; 2Monash Centre for Health Research and Implementation, Monash University, Melbourne, VIC, AustraliaCorrespondence: Emily Joy Callander, University of Technology Sydney, 15 Broadway, Ultimo, Sydney, NSW, 2007, Australia, Email [email protected]: Polycystic ovary syndrome (PCOS) affects up to one-in-five reproductive-aged women and its global healthcare-related economic burden is substantial. The aim of this review was to summarise evidence of the cost-effectiveness of interventions related to the treatment of women with PCOS.Evidence Acquisition: Six academic databases were systematically searched for relevant records. Cost data were extracted, and an interpretation statement was provided for each study based upon the cost difference or incremental cost-effectiveness ratio, and its statistical significance.Evidence Synthesis: The search yielded 10 relevant studies. Only one study was conducted in a low- and middle-income country (LMIC), China. Nine studies focused on infertility treatment, and one study related to pregnancy care. There remains uncertainty regarding cost-effectiveness of the following infertility treatments: In vitro fertilisation (IVF) cycles compared to ovulation induction (OI) cycles in women with clomiphene citrate (CC) resistant PCOS; and urinary follicle stimulating hormone compared to recombinant follicle stimulating hormone for OI. There are likely cost savings associated with laparoscopic ovarian drilling compared to OI with gonadotropins in women with CC-resistant PCOS, as well as with artificial cycle-frozen embryo transfer (AC-FET) without gonadotropin releasing hormone agonist (GnRH-a) pre-treatment compared to AC-FET with GnRH-a pre-treatment in women with PCOS. Treatment with metformin was lower cost and more effective compared to no treatment for achieving normal glucose regulation without developing gestational diabetes mellitus.Conclusion: The high proportion of fertility-related treatment studies reflects reproductive features often being the best-recognised feature of PCOS. However, limited evidence is available from LMICs. Further economic evidence is needed regarding PCOS treatments, particularly lifestyle interventions treating outcomes other than infertility.Keywords: cost-effectiveness analysis, health expenditure, polycystic ovary syndrome, infertility, pregnanc
Keep on keeping on:Predicting who will be able to work until they are 70 years old
No full textAim of this project: To determine who is likely to be able to keep working until the age 70 and who is not. Specific aims are: 1. To estimate the number of people aged 65-69 with work capacity; 2. To estimate the number of people aged 65-69 who are likely to be working; 3. To estimate the number of people aged 65-69 who are likely to be in full-time and part-time work; 4. To estimate the number of people aged 65-69 who are likely to be unable to work due to their own ill-health; 5. To determine the main long-term health conditions that have the greatest impact on the labour force participation of people aged 65-69. Data: The data sources for this research comprised of the Australian Bureau of Statistics’ (ABS) Surveys of Disability, Ageing and Carers (SDAC) 2009 and 2012. Our modelling is based on the population aged 45 to 64 years old. We re-weighted the SDACs 2009 and 2012 data to reflect the profile of the subsample aged 45-69 years in 2015 using a generalised regression reweighting algorithm programmed in a SAS (a statistical software package) macro called GREGWT, developed by the ABS. Population and labour force projections for 2015 from the Commonwealth Treasury that were used in the 2015 Intergenerational Report were used as benchmarks for re-weighting. Methods: We developed a logistic regression model, based on the population aged 45-64 years, for the odds of labour force participation and used the model to estimate the probability of labour force participation for each individual in the 65-69 age group. Whether an individual would be in the labour force or not was then simulated using Monte Carlo simulation by comparing the estimated probability with a series of uniformly distributed random numbers between 0 and 1. We used age, sex, highest level of education, presence of a long-term health condition, marital status, region of residence, and home ownership as explanatory variables in the logistic regression model. Results: It was estimated that in 2015, around 818,970 people aged 65-69 years were not in the labour force. Of these, 1.5% (12,000) were not in the labour force due to ill-health. If the retirement age was lifted to age 70, the number of people aged 65-69 years who are estimated to be out of the labour force would decrease to 627,700. However, the percentage of those who would leave the labour force due to their ill-health among those out of the labour force would increase to 15.6% (97,700). If the retirement age was lifted to age 70, about 45% of people aged 65-69 years would participate in the labour force, a 17 percentage point increase from the current 28% labour force participation rate of 65-69 years age group. Of the estimated 512,700 people aged 65- 69 years who are likely to be in the labour force under the changed scenario of the retirement age increasing to age 70, 98% are projected to keep working until the age of 70 Report for IRT Foundation-Prof Deborah Schofield, Dr Rupendra Shrestha, Dr Michelle Cunich, Dr Emily Callander. April 2016 Keep on keeping on: Predicting who will be able to work until they are 70 years old 3 (500,600 people: 312,600 in full-time and 188,000 in part-time work). Men, individuals with a university degree, and home owners are more likely to be in the labour force. The five main chronic conditions keeping most people out of the labour force in 2015 in the 65-69 years age group are: arthritis, back problems, diseases of the musculoskeletal system & connective tissue, diabetes and tumours/cancers. Arthritis and back problems alone are estimated to account for 40% of the total number of people aged 65-69 years who are out of the labour force due to their ill-health. Should the age of retirement increase to 70, around 97,700 Australians aged 65-69 years would be out of the labour force due to their own ill-health or disability. Discussion and conclusions: The findings in this report are of national policy significance because they address one of the key concerns of those affected by increases to the age eligibility for the Age Pension: “Will I be able to keep working until I’m 70?” It provides evidence about the capacity of people aged 65-69 years to work, which was previously unavailable. This information can be used to develop policy which is consistent with the identifiable work capacity of individuals, rather than their “assumed work capacity” based on increased longevity
Antenatal magnesium sulfate to prevent cerebral palsy
No full textFirst published July 7, 2021.Magnesium sulfate given to women before birth at <30 weeks’ gestation reduces the risk of cerebral palsy in their children. Our study aimed to assess the impact of a local quality improvement programme, primarily using plan-do-study-act cycles, to increase the use of antenatal magnesium sulfate. After implementing our quality improvement programme, an average of 86% of babies delivered at <30 weeks’ gestation were exposed to antenatal magnesium sulfate compared with a historical baseline rate of 63%. Our study strengthens the case for embedding quality improvement programmes in maternal perinatal care to reduce the impact of cerebral palsy on families and society.Amy K Keir, Emily Shepherd, Sarah McIntyre, Alice Rumbold, Charlotte Groves, Caroline Crowther, Emily Joy Callande
Multi-dimensional poverty in Australia and the barriers ill health imposes on the employment of the disadvantaged
No full textA little over one million individuals in Australia between the ages of 24 and 64 years are in Freedom poverty – they have low family income, and have either poor health or an insufficient level of education. These individuals are some of the most disadvantaged in society due to their multiple capability restrictions. Current political rhetoric focused on reducing the number of individuals out of the labour force to improve their living standards may offer a means of improving the lives of these most disadvantaged individuals. Indeed, of those in Freedom poverty, 80% are not in employment. But these individuals also have poor health and/or a poor education and these capability limitations may act as barriers to their labour force participation. Indeed, 49% of individuals in freedom poverty who were out of the labour force cited ill health as the reason for this (39% cited their own ill health, and 10% cited another's ill health). Not only will these individual's ill health act as a barrier to their engaging in the labour force, but ill health will also contribute to reduced quality of life. Political promises to improve the lives of citizens should not focus narrowly upon increasing labour force participation rates, but should take a holistic view of the lives of individuals taking note in particular of how health may be restraining their quality of life
The midwifery model estimator - a business costing tool for scaling-up midwifery continuity of care in health and hospital services in Queensland, Australia
No full textBackground:
Expansion of cost-effective Midwifery Continuity of Care (MCoC) is a priority for women in Australia and a key feature of government policy. To scale-up MCoC hospitals and health services require costing and decision-making tools.
Objectives:
To showcase the Midwifery Model Estimator, a custom - built interactive costing tool. The Estimator was developed for Queensland Health as a component of the Midwifery Continuity of Care Costing Toolkit (2020).
The tool supports development of robust business cases for service re-design. This enables scale up of MCoC.
Methods:
The Estimator uses National Hospital Data Collection and Queensland - wide averages to estimate costs.
Included are costs associated with any in-patient health-service use in Queensland public hospitals (labour through to 1 year postpartum for mother and child). Relative risk calculation for each intervention and
resource use was calculated. Women who received MCoC were compared to all others.
Results:
Cost benefit relative to proportion of women receiving MCoC is achievable. Local data can be used to show potential cost saving through different scenarios of MCoC in hospitals of differing size / classification. Provider value for each intervention avoided and funder value associated with different activity was shown for:
caesarean section, induction, epidural, episiotomy, NICU and Special care nursery admission, and vaginal birth.
Conclusions:
This cost tool supports preparation of business cases for scaling up MCoC. Expanding MCoC addresses the triple aim of improving the experience of care, improving the health of populations, and reduces per capita costs of health care.
Key message:
The Midwifery Model Estimator supports scaling-up MCoC. The tool has broad application and can be used in other countries.
Keywords:
Midwife led care
Policy
Midwifery workforceFull Tex
Working beyond the traditional retirement age – The Influence of Health on Australia’s Older Workers
No full textThis article examines the relationship between health and workforce participation beyond the age of 65 years in Australia. This study found that people with a chronic health condition were less likely to be employed than those without a health condition (OR, 0.59; 95% CI [0.38, 0.92]). Among those with a chronic health condition, those in income quartile 2 (OR, 0.27; 95% CI [0.11, 0.67]) and 3 (OR, 0.38; 95% CI, [0.15–0.93]) were significantly less likely to be employed relative to those in income quartile 4. Older workers with a chronic health condition were less likely to work beyond the age of 65; however, among those with a chronic health condition, those with very high income and those with very low income were the most likely to keep workin
Safer Baby Bundle: study protocol for the economic evaluation of a quality improvement initiative to reduce stillbirths
No full textINTRODUCTION: Stillbirth continues to be a public health concern in high-income countries, and with mixed results from several stillbirth prevention interventions worldwide the need for an effective prevention method is ever present. The Safer Baby Bundle (SBB) proposes five evidence-based care packages shown to reduce stillbirth when implemented individually, and therefore are anticipated to produce significantly better outcomes if grouped together. This protocol describes the planned economic evaluation of the SBB quality improvement initiative in Australia. METHODS AND ANALYSIS: The implementation of the SBB will occur over three state-based health jurisdictions in Australia—New South Wales, Queensland and Victoria, from July 2019 onwards. The intervention is being applied at the state level, with sites opting to participate or not, and no individual woman recruitment. The economic evaluation will be based on a whole-of-population linked administrative dataset, which will include the data of all mothers, and their resultant children, who gave birth between 1 January 2016 and 31 December 2023 in these states, covering the preimplementation and postimplementation time period. The primary health outcome for this economic evaluation is late gestation stillbirths, with the secondary outcomes including but not limited to neonatal death, gestation at birth, mode of birth, admission to special care nursery and neonatal intensive care unit, and physical and mental health conditions for mother and child. Costs associated with all healthcare use from birth to 5 years post partum will be included for all women and children. A cost-effectiveness analysis will be undertaken using a difference-in-difference analysis approach to compare the primary outcome (late gestation stillbirth) and total costs for women before and after the implementation of the bundle. ETHICS AND DISSEMINATION: Ethics approval for the SBB project was provided by the Royal Brisbane & Women’s Hospital Human Research Ethics Committee (approval number: HREC/2019/QRBW/47709). Approval for the extraction of data to be used for the economic evaluation was granted by the New South Wales Population and Health Services Research Ethics Committee (approval number: 2020/ETH00684/2020.11), Australian Institute of Health and Welfare Human Research Ethics Committee (approval number: EO2020/4/1167), and Public Health Approval (approval number: PHA 20.00684) was also granted. Dissemination will occur via publication in peer reviewed journals, presentation at clinical and policy-focused conferences and meetings, and through the authors’ clinical and policy networks. This study will provide evidence around the cost effectiveness of a quality improvement initiative to prevent stillbirth, identifying the impact on health service use during pregnancy and long-term health service use of children
Change in Northumbria : was Aldfrith of Northumbria's reign a period of innovation or did it merely reflect the development of processes already underway in the late seventh century?
No full textThis thesis looks at a period of Northumbrian history when the king was a part Irish, Iona trained scholar. Some have suggested that Aldfrith was assisted to the kingship by the northern victors of the battle of Nechtansmere. It examines processes in the late seventh century to try to identify changes that might have happened during the reign of this king.
The study begins with a wide overview of previous research to establish a basis from which to look for processes and change and also examines the sources available to us, written and archaeological. It then looks at the kingdoms to the north and west and at Aldfrith and the period of his reign. The suggestion is made that Aldfrith acted, with the Church, to cult saints that were Northumbrian and Romanist, as opposed to other options that might have been available. It proposes that the Northumbrians rejected opportunities to develop links with the north and west that may have been open to them. The following chapters then examine processes underway in Northumbria in three general areas; in the use of power, in society, and in the economy.
It concludes that although many processes continued as before, these sped up and in certain areas such as the production of coins, and the consequential development of trade, it was a period of innovation. There is no evidence of a focus to the north and west during Aldfrith’s reign and this has implications for how Aldfrith got to the throne, suggesting that it was with the support of the Northumbrian elite and not through the military strength of the Dál Riata or the Picts. The evidence is that Northumbria increasingly looked south for its influences and is prepared to absorb and implement processes and approaches from southern England, Gaul and Rome
