Patient-initiated switching between private and public inpatient hospitalisation in Western Australia 1980 – 2001: An analysis using linked data

BACKGROUND: The aim of the study was to identify any distinct behavioural patterns in switching between public and privately insured payment classifications between successive episodes of inpatient care within Western Australia between 1980 and 2001 using a novel 'couplet' method of analysing longitudinal data. METHODS: The WA Data Linkage System was used to extract all hospital morbidity records from 1980 to 2001. For each individual, episodes of hospitalisation were paired into couplets, which were classified according to the sequential combination of public and privately insured episodes. Behavioural patterns were analysed using the mean intra-couplet interval and proportion of discordant couplets in each year. RESULTS: Discordant couplets were consistently associated with the longest intra-couplet intervals (ratio to the average annual mean interval being 1.35), while the shortest intra-couplet intervals were associated with public concordant couplets (0.5). Overall, privately insured patients were more likely to switch payment classification at their next admission compared with public patients (the average rate of loss across all age groups being 0.55% and 2.16% respectively). The rate of loss from the privately insured payment classification was inversely associated with time between episodes (2.49% for intervals of 0 to 13 years and 0.83% for intervals of 14 to 21 years). In all age groups, the average rate of loss from the privately insured payment classification was greater between 1981 and 1990 compared with that between 1991 and 2001 (3.45% and 3.10% per year respectively). CONCLUSION: A small but statistically significant reduction in rate of switching away from PHI over the latter period of observation indicated that health care policies encouraging uptake of PHI implemented in the 1990s by the federal government had some of their intended impact on behaviour

Development of a health care policy characterisation model based on use of private health insurance

OBJECTIVE: The aim of this study was to develop a policy characterisation process based on measuring shifts in use of private health insurance (PHI) immediately following implementation of changes in federal health care policy. METHOD: Population-based hospital morbidity data from 1980 to 2001 were used to produce trend lines in the annual proportions of public, privately insured and privately uninsured hospital separations in age-stratified subgroups. A policy characterisation model was developed using visual and statistical assessment of the trend lines associated with changes in federal health care policy. RESULTS: Of eight changes in federal health care policy, two (introduction of Medicare and Lifetime Health Cover) were directly associated with major changes in the trend lines; however, minor changes in trends were associated with several of the other federal policies. Three types of policy effects were characterised by our model: direction change, magnitude change and inhibition. Results from our model suggest that a policy of Lifetime Health Cover, with a sanction for late adoption of PHI, was immediately successful in changing the private: public mix. The desired effect of the 30% rebate was immediate only in the oldest age group (70+ years), however, introduction of the lifetime health cover and limitations in the model restricted the ability to determine whether or if the rebate had a delayed effect at younger ages. CONCLUSION: An outcome-based policy characterisation model is useful in evaluating immediate effects of changes in health care policy

Matching small β\beta functions using centroid jitter and two beam position monitors

Matching to small beta functions is required to preserve emittance in plasma accelerators. The plasma wake provides strong focusing fields, which typically require beta functions on the mm-scale, comparable to those found in the final focusing of a linear collider. Such beams can be time consuming to experimentally produce and diagnose. We present a simple, fast, and noninvasive method to measure Twiss parameters in a linac using two beam position monitors only, relying on the similarity of the beam phase space and the jitter phase space. By benchmarking against conventional quadrupole scans, the viability of this technique was experimentally demonstrated at the FLASHForward plasma-accelerator facility.Comment: 8 pages, 7 figure

Possible protective effect of green tea intake on risk of adult leukaemia

In a case–control study of 107 adults with leukaemia and 110 orthopaedic controls in China, a reduced risk was found with longer duration, higher quantity, and frequency of green tea intake

Adverse obstetric and perinatal outcomes following treatment of adolescent and young adult cancer: A population-based cohort study

Objective - To investigate obstetric and perinatal outcomes among female survivors of adolescent and young adult (AYA) cancers and their offspring. Methods - Using multivariate analysis of statewide linked data, outcomes of all first completed pregnancies (n = 1894) in female survivors of AYA cancer diagnosed in Western Australia during the period 1982–2007 were compared with those among females with no cancer history. Comparison pregnancies were matched by maternal age-group, parity and year of delivery. Results - Compared with the non-cancer group, female survivors of AYA cancer had an increased risk of threatened abortion (adjusted relative risk 2.09, 95% confidence interval 1.51–2.74), gestational diabetes (2.65, 2.08–3.57), pre-eclampsia (1.32, 1.04–1.87), post-partum hemorrhage (2.83, 1.92–4.67), cesarean delivery (2.62, 2.22–3.04), and maternal postpartum hospitalization>5 days (3.01, 1.72–5.58), but no excess risk of threatened preterm delivery, antepartum hemorrhage, premature rupture of membranes, failure of labor to progress or retained placenta. Their offspring had an increased risk of premature birth (<37 weeks: 1.68, 1.21–2.08), low birth weight (<2500 g: 1.51, 1.23–2.12), fetal growth restriction (3.27, 2.45–4.56), and neonatal distress indicated by low Apgar score (<7) at 1 minute (2.83, 2.28–3.56), need for resuscitation (1.66, 1.27–2.19) or special care nursery admission (1.44, 1.13–1.78). Congenital abnormalities and perinatal deaths (intrauterine or ≤7 days of birth) were not increased among offspring of survivors. Conclusion - Female survivors of AYA cancer have moderate excess risks of adverse obstetric and perinatal outcomes arising from subsequent pregnancies that may require additional surveillance or intervention

Pay progression in routinised service sector work: navigating the internal labour market in a fast food multinational company

The United Kingdom's widespread use of low‐skill, low‐paid employment has been well documented. It has been argued internal labour markets (ILMs) benefit such workers, affording them with opportunities for progression. Relatively little is known, however, about the impact of ILMs on entry level workers undertaking routinised service sector work. Drawing on qualitative data, this article explores the prospects on offer in a market leading, fast food multinational company. Potential enabling features include on‐the‐job training, a transparent and integrated pay structure and a professed culture of progression. Occupational movements to positions above the low‐pay threshold are, however, relatively rare. We conjecture this contradiction is the result of the business context in which the firm operates. The findings suggest that in sectors where price leadership strategies dominate, escape from low pay is likely to be exceptional, even within large organisations featuring some of the classic characteristics of ‘pure’ or strong ILMs

Differential aging of median and ulnar sensory nerve parameters

Introduction: Nerve conduction velocity slows and amplitude declines with aging. Methods: Median and ulnar sensory nerves were tested at the annual meetings of the American Dental Association. Seven hundred four subjects had at least two observations. The rate of change in the nerve parameters was estimated while controlling for gender, age, change in hand temperature, baseline body mass index (BMI), and change in BMI. Results: Amplitudes of the median sensory nerve action potentials decreased by 0.58 μV per year, whereas conduction velocity decreased at a rate of 0.41 m/s per year. Corresponding values for the ulnar nerve were 0.89 μV and 0.29 m/s per year. The rates of change in amplitudes did not differ, but the median nerve demonstrated a more rapid loss of conduction velocity. Conclusions: The rate of change for the median conduction velocity was higher than previously reported. The rate of change of median conduction velocity was significantly greater than for the ulnar nerve. Muscle Nerve 45: 60–64, 2012Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/89485/1/22233_ftp.pd

Staying the Course: Facility and Profession Retention Among Nursing Assistants in Nursing Homes

High turnover rates among nursing assistants (NAs) in nursing homes have costly implications for facility operation and quality, while low rates of NA profession retention can deplete the stock of experienced staff. This study assesses the extent to which the same factors are associated with NAs' intent to leave a particular job versus the NA profession