Supporting Medicare health, equity and efficiency in Australia: policies undermining bulk billing need to be scrapped

Forget semantics; Federal health policies that undermine bulk billing and encourage \u27user-pays\u27 charging of patients for primary care move Australia towards a US-style health care system. They are expected to cost the health system more, not A$12 billion less, and undermine Medicare\u27s bottom-line universal access equity, efficiency and health outcome objectives

Hospital performance including quality: creating economic incentives consistent with evidence-based medicine

This thesis addresses questions of how to incorporate quality of care, represented by disutility-bearing effects such as mortality, morbidity and re-admission, in measuring relative performance of public hospitals. Currently, case-mix funding and performance, measured with costs per case-mix adjusted separation, hold hospitals accountable for costs, but not effects, of care, creating economic incentives for quality of care minimising cost per admission. To allow an appropriate trade-off between the value and cost of quality of care a correspondence is demonstrated between maximising net benefit and minimising costs plus decision makers’ value of disutility events, where effects of care can be represented by disutility events and hospitals face a common comparator. Applying this correspondence to performance measurement, frontier methods specifying disutility events as inputs are illustrated to have distinct advantages over output specifications, allowing estimation of: 1. economic efficiency conditional on the value of avoiding disutility events. 2. technical, scale and congestion sources of net benefit efficiency; 3. best practice peers over potential decision makers’ value of quality; and 4. industry shadow price of avoiding disutility events. The accountability this performance measurement framework provides for effects and cost of quality of care are also illustrated as the basis for moving from case-mix funding towards a funding mechanism based on maximising net benefit. Links to evidence-based medicine in health technology assessment are emphasised in illustrating application of the correspondence to comparison of multiple strategies in the cost-disutility plane, where radial properties as shown to provide distinct advantages over comparison in the cost-effectiveness plane. The identified performance measurement and funding framework allows policy makers to create economic incentives consistent with evidence-based medicine in practice, while avoiding incentives for cream-skimming and cost-shifting. The linear nature of the net benefit correspondence theorem allows simple inclusion of multiple effects of quality, whether expressed as not meeting a standard, functional limitation or disutility directly. In applying the net benefit correspondence theorem to hospitals a clinical activity level is suggested, to allow correspondence conditions to be robustly satisfied in identification of effects with decision analytic methods, adjustment for within DRG risk factors and data linkage to effects beyond separation

Globally optimal trial design and risk sharing arrangements are key to avoiding opportunity costs of delay and enabling equitable, feasible and effective global vaccine research and implementation in current or future pandemics

Global vaccination in the face of pandemics such as COVID-19 and new variants is a race against time. Avoiding the opportunity costs of delay and the associated health, social, and downstream economic impacts is a challenge and an imperative. Failures to address the global challenges posed by COVID-19 have become increasingly evident as waves of vaccine-evading mutations have emerged, facilitated by unequal vaccination coverage and diminishing immunity against new variants worldwide. To address these challenges, societal decision-makers (governments) and industry manufacturer interests must be better aligned for rapid, globally optimal trial design, ideally with research coverage, implementation, and accessibility of effective vaccines across joint research, implementation, and distribution cycles to address pandemic evolution in real time. Value of information (VoI) methods for optimal global trial design and risk-sharing arrangements align the research, distribution, and implementation interests and efforts globally to meet head-on the imperative of avoiding opportunity costs of delay and enabling consistent global solutions with maximizing local and global net benefits. They uniquely enable feasible early adoption of the most promising strategies in real time while the best globally translatable evidence is collected and interests are aligned for global distribution and implementation. Furthermore, these methods are generally shown to be imperative for feasible, fast, and optimal solutions across joint research, reimbursement, and regulatory processes for current and future pandemics and other global existential threats. Establishing pathways for globally optimal trial designs, risk-sharing agreements, and efficient translation to practice is urgent on many fronts

Measuring impacts of value to patients is crucial when evaluating palliative care

The inclusion of preparation for death and managing affairs in the end-of-life instrument designed by Borreani et al.1 to elicit preferences about dying is commendable. Of note, few quality-of-life (QOL) measurement tools contain or adequately assess this patient-valued domain. Given the importance that patients place on these issues, it is possible that evaluations of palliative health care interventions, including comparative effectiveness and cost-effectiveness analyses, could easily misinterpret the net benefit of such interventions without inclusion of this domain as an outcome measure. Better assessment methods that incorporate preparation for death and managing affairs are needed

Gravity wave activity in the lower atmosphere: Seasonal and latitudinal variations

A climatology of gravity wave activity in the lower atmosphere based on high-resolution radiosonde measurements provided by the Australian Bureau of Meteorology is presented. These data are ideal for investigating gravity wave activity and its variation with position and time. Observations from 18 meteorological stations within Australia and Antarctica, covering a latitude range of 12°S – 68°S and a longitude range of 78°E – 159°E, are discussed. Vertical wavenumber power spectra of normalized temperature fluctuations are calculated within both the troposphere and the lower stratosphere and are compared with the predictions of current gravity wave saturation theories. Estimates of important model parameters such as the total gravity wave energy per unit mass are also presented. The vertical wavenumber power spectra are found to remain approximately invariant with time and geographic location with only one significant exception. Spectral amplitudes observed within the lower stratosphere are found to be consistent with theoretical expectations but the amplitudes observed within the troposphere are consistently larger than expected, often by as much as a factor of about 3. Seasonal variations of stratospheric wave energy per unit mass are identified with maxima occurring during the low-latitude wet season and during the midlatitude winter. These variations do not exceed a factor of about 2. Similar variations are not found in the troposphere where temperature fluctuations are likely to be contaminated by convection and inversions. The largest values of wave energy density are typically found near the tropopause.Simon J. Allen and Robert A. Vincen

Westmead hospital team midwifery project evaluation, CHERE Project Report No 4

midwifery, evaluation, Australia

HWA Expanded Scopes of Practice program evaluation: Extending the Role of Paramedics sub-project: final report

The Extending the Role of Paramedics (ERP) sub-project built on a model developed by the South Australian Ambulance Service (SAAS) which aims to provide a service that is complementary to primary health care, thus reducing emergency department presentations. The core of the model is training Extended Care Paramedics (ECPs) to treat patients in their usual place of residence, with referral to other health professionals if appropriate. ECPs manage patients with a diverse, and often ill-defined, range of signs and symptoms. Although these patients are deemed \u27low acuity\u27, these cases can be complex and require the ECP to apply advanced clinical reasoning. In many cases, the patient may have multiple chronic conditions and present as generally unwell. The published evidence to date generally supports an expansion of the role of paramedics to include the assessment and management of patients with minor illnesses and injuries to avoid transport to hospital. However, the evidence is primarily from overseas, particularly the United Kingdom, and more research is required to establish the effectiveness and safety of the model

Combining realism with rigour: evaluation of a national kitchen garden program in Australian primary schools

Overview - Background on Program - Overview of evaluation framework & methods - Findings: Outcomes - Findings: Program learning - Health Promoting Schools - Question

HWA Expanded Scopes of Practice program evaluation: Advanced Practice in Endoscopy Nursing sub-project: final report

The Advanced Practice in Endoscopy Nursing (APEN) sub-project was undertaken in response to a national trend of increasing demand for endoscopy services, in part due to the implementation of the National Bowel Cancer Screening Program. The aim was to train nurses to perform endoscopic procedures previously only undertaken in Australia by doctors. Although new to Australia, nurse endoscopists are well established in the United Kingdom. Recently published evidence based on a systematic review of the literature indicates that nurses can achieve similar results for efficacy and safety to those achieved by doctors