Nurses' retention and hospital characteristics in New South Wales, CHERE Discussion Paper No 52

Nursing shortages are commonly observed features of hospital systems in Australia, Europe and the United States. To date there has been very little research on the effects of hospital characteristics on the retention of the nursing staff. In this paper we match individual data on registered nurses (RNs) working in the public sector in NSW in 1996 to the hospital in which they work. We analyze the annual retention probability for these RNs using the nurses? personal characteristics as well as the characteristics of the hospitals. It is found that the type of hospital per se does not help explain the retention probability of the nurses employed in the premise but the hospital characteristics do. Hospital characteristics include measures of size, complexity, intensity, expenditures and staffing levels. The results suggest that the effects of these variables are complex. For example, complexity of the work as measured by admissions from emergency increase retention while high cost procedures and large ANDRG weights reduce retention. Higher levels of expenditures (at constant staffing levels) increase retention except for expenditures on visiting medical officers which reduce retention. The effects on the expected retention probability are very large and significant. One implication of our findings is that simply increasing staffing levels is unlikely to achieve much impact on nurses? retention levels unless problem areas of the job are also addressed.Medical workforce

Healthy, wealthy and insured? The role of self-assessed health in the demand for private health insurance, CHERE Working Paper 2006/2

Both adverse selection and moral hazard models predict a positive relationship between risk and insurance; yet the most common finding in empirical studies of insurance is that of a negative correlation. In this paper we investigate the relationship between ex ante risk and private health insurance using data from the 2001 Australian National Health Survey (NHS). The Australian health system provides a setting where the relationship between risk and insurance is more transparent than many other institutional frameworks; private health insurance is not tied to employment; community rating limits the actions of insurers; and private coverage is high for a country providing free public hospital treatment. We find a strong positive association between self-assessed health and private health cover. We use the detailed information available in the NHS to investigate whether we can identify factors responsible for the negative correlation between risk (lower SAHS) and insurance cover. However this relationship persists despite the inclusion of a large set of controls for personal and socio-economic characteristics, risk-related behaviours, objective health measures and an index of mental health. The opposite effect of self-assessed health and long-term conditions on coverage suggests that SAHS is capturing factors such as personality or risk preferences.Private health insurance, self-assessed health, Australia

Evaluating the success of seed sowing in a New England grassland

Grassland habitat is declining in the northeastern United States, leading to a decline in associated native species. Consequently, there is considerable interest by land managers in conserving and restoring grassland habitats in the Northeast. However, unlike the Great Plains and Europe, quantitative monitoring of restoration sites is uncommon, making it difficult to improve new restoration projects. Here we evaluate a grassland restoration in Waterford, Connecticut to determine if mechanical clearing of woody vegetation combined with sowing 23 native grasses and forbs led to successful establishment of these species. We also compared cover, diversity, and colonization by exotic and woody species in planted and unplanted areas over time. In the third and fifth growing seasons after planting in 2006, we sampled the vegetation in the planted site, an unplanted zone within the planted grassland, and an adjacent unplanted grassland. Twenty of the 23 sown species established by 2010, and sown species dominated the planted area (70% of total cover). Despite the successful establishment of most sown species, species richness and diversity were no higher in the sown grassland than in adjacent unseeded areas. However, the sown grassland contained lower cover of non-native and invasive species. Big bluestem (Andropogon gerardii Vitman) established aggressively, potentially reducing both exotic colonization and native diversity. This study shows that sowing native grassland species can lead to the successful development of native-dominated grasslands. Results can inform future grassland restoration efforts in the Northeast and show that seeding with aggressive grass species may greatly impact restored plant communities

Out-of-pocket health expenditures in Australia: A semi-parametric analysis, CHERE Working Paper 2006/15

Out-of-pocket health expenditures in Australia are high in international comparisons and have been growing at a faster rate than most other health costs in recent years. This raises concerns about the extent to which out-of-pocket costs have constrained access to health services for low income households. Using data from the ABS Household Expenditure Survey 2003-04, we model the relationships between health expenditure shares and equivalised total expenditure for categories of out-of-pocket health expenditures and analyse the extent of protection given by concession cards. To allow for flexibility in the relationship we adopt a semi-parametric estimation technique following Yatchew (1997). We find mixed evidence for the protection health concession cards give against high out-of-pocket health expenditures. Despite higher levels of subsidy, households with concession cards have higher total health expenditure shares than other households. Surprisingly, the major drivers of the difference are not categories of expenditure where cards offer little or no protection, such as dental services and non-prescription medicines, but prescriptions costs, where concession cards guarantee a subsidy, and specialist consultations, where bulk billing rates would be expected to be higher for cardholders. This is the first detailed distributional analysis of household health expenditures in Australia.Out-of-pocket costs, international comparisons, Australia

Advantageous selection in private health insurance: The case of Australia

When consumers have private information about risk of suffering a loss, or equivalently, if insurers are prohibited from using observable information on risk in underwriting, theoretical models of insurance predict adverse selection. Yet the most common finding in empirical studies is that of no positive correlation between risk and insurance coverage. This is found for different types of insurance (e.g. car, health, life) and in different countries (e.g. France, US, UK, Israel) suggesting a fundamental relationship involving private information and consumer preferences. In this paper, we investigate the nature of risk selection in the Australian market for private health insurance in which community rated private health insurance complements a universal public health care system. We use National Health Survey data on hospital utilisation and individual characteristics to construct an empirical analogue for the risk variable in the Rothschild and Stiglitz model. Estimating the relationship between insurance and risk semi-parametrically, we find robust evidence of favourable selection. To explore the extent to which underlying risk preferences rather than risk drives the decision to purchase health insurance, we use Household Expenditure Survey data to model decisions to purchase a range of insurance products (health, life, accident, home, car) and to engage in risky behaviours (smoking and various forms of gambling). Correlations between residuals in the model suggest that advantageous selection is driven by risk aversion, which theoretical models do not typically capture.health insurance, adverse selection, Australia

A Survey of the Ohio Administrative Procedures Act

The recent expansion of the use of administrative agencies to facilitate the functioning of the various levels of governmental operations has created a correspondingly complex morass of procedural law. Administrative procedure being the creation of administrative law, a definition of the latter is necessary for an understanding of the former. This area of law has been demarcated by the provisions of statutes conferring rule making and adjudicatory powers upon organizations in government outside the judicial branch and orders entered by these agencies pursuant to such powers. \u27 It should be noted, however, that this definition, like other brief definitions of broad areas of law, is not totally complete or absolutely accurate. It will be satisfactory for the purpose of forming a basis of understanding for the purpose of this discussion

A baseline appraisal of water-dependant ecosystem services, the roles they play within desakota livelihood systems and their potential sensitivity to climate change

This report forms part of a larger research programme on 'Reinterpreting the Urban-Rural Continuum', which conceptualises and investigates current knowledge and research gaps concerning 'the role that ecosystems services play in the livelihoods of the poor in regions undergoing rapid change'. The report aims to conduct a baseline appraisal of water-dependant ecosystem services, the roles they play within desakota livelihood systems and their potential sensitivity to climate change. The appraisal is conducted at three spatial scales: global, regional (four consortia areas), and meso scale (case studies within the four regions). At all three scales of analysis water resources form the interweaving theme because water provides a vital provisioning service for people, supports all other ecosystem processes and because water resources are forecast to be severely affected under climate change scenarios. This report, combined with an Endnote library of over 1100 scientific papers, provides an annotated bibliography of water-dependant ecosystem services, the roles they play within desakota livelihood systems and their potential sensitivity to climate change. After an introductory, section, Section 2 of the report defines water-related ecosystem services and how these are affected by human activities. Current knowledge and research gaps are then explored in relation to global scale climate and related hydrological changes (e.g. floods, droughts, flow regimes) (section 3). The report then discusses the impacts of climate changes on the ESPA regions, emphasising potential responses of biomes to the combined effects of climate change and human activities (particularly land use and management), and how these effects coupled with water store and flow regime manipulation by humans may affect the functioning of catchments and their ecosystem services (section 4). Finally, at the meso-scale, case studies are presented from within the ESPA regions to illustrate the close coupling of human activities and catchment performance in the context of environmental change (section 5). At the end of each section, research needs are identified and justified. These research needs are then amalgamated in section 6