Catastrophic insurance: Impact of the Australian Medicare Safety Net on fees, service use and out-of-pocket costs, CHERE Working Paper 2006/9

Objectives: The Medicare Safety Net Policy was introduced in March 2004 to provide financial relief for those Australians who face high out-of-pocket (OOP) costs for outpatient medical services. This study evaluates the extent to which out-of-pocket costs have fallen since the introduction of the Safety Net and examines the impact of the policy on the level of service use, the amount of benefits paid by government and fees charged by medical providers. Methods: Regression modelling of time series data was used to examine whether there have been significant changes in levels of service use, fees charged and benefits paid for services provided by specialists in the two-year period following the introduction of the Safety Net. Four speciality fields were examined in this analysis: general specialists? consultations, obstetrics, pathology and diagnostic imaging. Results: The analysis indicates that the introduction of the Safety Net coincided with a substantial rise in public funding for Medicare services and a much smaller reduction in OOP costs. The policy has coincided with a small but significant change in the number of pathology and diagnostic imaging services used and in some specialty areas a substantial increase in the fees charged by providers. The net impact shows that for specialists? consultations every dollar spent on the Medicare Safety Net, $0.68 went towards higher fees and$0.32 went towards reducing OOP costs. The corresponding figures for diagnostic imaging were $0.74 and$0.26 respectively. Conclusions: The Safety Net was heralded by the government as a fundamental reform in Australia?s Medicare program. Whilst the Safety Net was introduced to help reduce out-of-pocket medical costs, this analysis shows that in its first two years of operation, there has been significant leakage of public funding towards higher provider fees. More research is needed using longer term data to assess the impact of the policy on patient and provider behaviour more widely, including examining the policy?s impact on those who did qualify for Safety Net and those who did not, as well as more disaggregated analysis of different Medicare services.Out-of-pocket costs; moral hazard; catastrophic insurance; health care financing; Australia

Who?s getting caught? An analysis of the Australian Medicare Safety Net, CHERE Working Paper 2006/8

The Medicare Safety Net Policy was introduced in March 2004 to provide financial relief for those Australians who face high out-of-pocket costs incurred through out-of-hospital medical services. This study examines variation in Safety Net benefits by federal electorate and by type of medical service. The results indicate widespread variation in Safety Net benefits. There were significantly higher Safety Net benefits in electorates with relatively high median family income and lower health care needs. The study also shows that patients who use private obstetrician and assisted reproductive services are the greatest beneficiaries of the policy. Whilst the Safety Net was introduced to help reduce out-of-pocket medical costs, this analysis shows that it may be missing the intended policy target.Medicare, health care policy, out-of-pocket costs, co-payments,catastrophic insurance, Australia

Program evaluation: Bureau of Reclamation, Lower Colorado Region business lines and focus areas “Water Drop” project

This paper examines how familiar Bureau of Reclamation employees in the Lower Colorado Region are with the region’s goals and priorities and how well they understand their individual role in relationship to those goals and priorities. It also analyzes the effectiveness of the communication strategies in place to communicate the goals and priorities of the organization

The importance of active-learning, student support, and peer teaching networks: A case study from the world’s longest COVID-19 lockdown in Melbourne, Australia

In the Australian state of Victoria, the city of Melbourne endured the world’s longest number of lockdown days, with severe government health orders and travel restrictions in place for extended periods of 2020 and 2021. In common with others, we found the provision of field teaching in introductory geology, structural geology, and volcanology, and the online replacement of practical instruction in petrology and petrography to be the greatest pedagogical challenges. We developed and used a range of different virtual field excursions that, given time and travel constraints imposed on us, were necessarily “low-tech” and non-immersive. Despite this, our students largely engaged enthusiastically with the virtual excursions, met many preexisting learning goals, and gained additional skills, particularly in regional-scale geological synthesis. In teaching petrology and petrography online, curated resources improved student understanding of some fundamental concepts, and it was advantageous that students were all assessed using identical imagery, rather than one sample from a non-identical class-set. On the other hand, we found we were less able to train students in the advanced skills of thin section interpretation. Assessment changes associated with online teaching have resulted in a permanent shift from low-level recall-style assessments to instead emphasizing higher-level synthesis and “geological thinking” skills. Our efforts throughout the pandemic demonstrated the value of instructor-student engagement and yielded teaching resources that have subsequently enhanced our face-to-face teaching and increased flexibility for students. Moreover, the COVID-19 pandemic has highlighted the importance of collaborative teaching practice and we have increasingly seen the benefits of local and national-scale teaching networks for peer support and for resource sharing

Kinetic and NMR studies of some nitrogen heterocycles

The work carried out in this thesis involves the investigation of some reactions of heterocyclic compounds by a wide range of spectroscopic and kinetic techniques. Chapter 1 describes several methods, including stopped-flow spectrophotometry, high pressure kinetics and MNDO calculations, which are used to analyse the mechanism of the reaction of imidazole with diazonium ions. Chapter 2 describes the use of the temperature-jump technique to follow the extremely fast protonation of pyrroles. Diazonium ions are further investigated in Chapter 3 which examines the structure of p-nitrobenzenediazonium tetrafluoroborate by X-ray crystallography. The nature of other benzenediazonium ions and some of their complexes is also investigated by solid state ¹⁵N nmr spectroscopy. Chapter 4 switches the emphasis to nmr spectroscopy. The reactive intermediates of reactions of benzil with nitrogen heterocycles are investigated using ¹³c nmr spectroscopy in a kinetic application. Chapters 5 and 6 continue the use of nmr spectroscopy in the structural assignment of bilirubin and the determination of the nature of bilirubin inclusion complexes. Chapter 6 also examines by spectrophotometry the reaction used in the clinical analysis of bilirubin and the effect on this reaction of binding agents such as albumin and α-cyclodextrin

Biochemical aspects of exercise in the horse

The present study was undertaken to obtain information on some of the biochemical changes which take place in the horse during exercise and training. Of particular interest were changes in the serum levels of certain enzymes, the tissue (or tissues) of origin of these enzymes and the manner in which exercise resulted in their release into the circulation. In conjunction with these studies, the effects of exercise on various blood metabolites were investigated to determine the relative importance of carbohydrate and lipid in the energy metabolism of the exercising horse. Since the optimal conditions for assaying enzyme activity vary with the source of the enzyme, the optimal assay conditions for horse serum GOT, LDH, ALD and CK were first determined. Using this information, the effects of controlled exercise on serum concentrations of these enzymes were studied. Serum levels of LDH, ALD and CK were found to Increase following exercise and the magnitude of these increases could be correlated with the duration of the exercise and the state of training of the animal. By comparing tissue LDH and CK isoenzyme patterns with serum isoenzyme patterns before and after exercise, the tissue of origin of these enzyme increases was found to be skeletal muscle (with some possible contribution from liver). An alteration in muscle cell membrane permeability which allows leakage of intracellular enzymes into the circulation was postulated. Monitoring of blood levels of glucose, lactate, pyruvate, free fatty acids and glycerol before, during and after exercise indicated that both carbohydrate and lipid catabolism were increased in the horse during exercise of varying degrees. Galloping (at 11.0-13.3 metres/sec) was found to involve anaerobic metabolism to a large extent while cantering (at 5.2-6.7 metres/sec) could be maintained by aerobic metabolism alone. Training was found to increase the animal's capacity for aerobic metabolism. Since the nature of the stimulus which causes changes in cell membrane permeability is still obscure, the possible involvement of catecholamines secreted during exercise was investigated. Although administration of adrenaline to resting horses resulted in increased serum enzyme levels, several features of this response were incompatible with the hypothesis that catecholamine secretion might be the only stimulus for enzyme release during exercise. Tissue hypoxia and lactate accumulation were discounted as possible stimuli since enzyme leakage occurred in the absence of detectable oxygen deficiency as indicated by lactate production. Several other aspects of the membrane permeability change were discussed

A Model for the Propagation of Sound in Granular Materials

This paper presents a simple ball-and-spring model for the propagation of small amplitude vibrations in a granular material. In this model, the positional disorder in the sample is ignored and the particles are placed on the vertices of a square lattice. The inter-particle forces are modeled as linear springs, with the only disorder in the system coming from a random distribution of spring constants. Despite its apparent simplicity, this model is able to reproduce the complex frequency response seen in measurements of sound propagation in a granular system. In order to understand this behavior, the role of the resonance modes of the system is investigated. Finally, this simple model is generalized to include relaxation behavior in the force network -- a behavior which is also seen in real granular materials. This model gives quantitative agreement with experimental observations of relaxation.Comment: 21 pages, requires Harvard macros (9/91), 12 postscript figures not included, HLRZ preprint 6/93, (replacement has proper references included