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

The use of breast screening services in NSW: Are we moving towards greater equity? [Draft - not for quotation or citation], CHERE Working Paper 2007/7

Introduction: Since 1991 State and Federal Governments, under the auspices of BreastScreen Australia, have been providing mammography services free at the point of delivery to women aged 40 and over. One of the stated aims of the program is to provide equitable access to all women in the target group. Methods: Data on self-reported utilisation of breast screening services came from the 1997/98 and 2002/04 NSW Health Surveys. Probit regression analysis was used to examine the relationship between income and breast screening behaviour of women in NSW aged 50 to 69. Results: The results for 2002 and 2004 show that income has a positive and significant impact on the likelihood that a woman chooses to screen for breast cancer at regular intervals. The role of income was consistent across most regions. Women born overseas have a lower likelihood of screening regularly. Results from the pooled dataset show that the income gradient appears to be steeper in 2002/04 compared to 1997/98. Conclusions: These results indicate that the current program has not ensured equitable take-up of mammography services and that further research and investment is needed to meet program objectives.breast screening, Australia

Breast screening in NSW, Australia: predictors of non-attendance and irregular attendance

BreastScreen Australia provides free mammography services to women in the target age group of 50 to 69 years. The program uses a variety of measures to recruit women to the service and, subsequently, encourage them to screen at two year intervals. One of the stated aims of the program is to provide equitable access to all women in the target age group. This paper analyses the extent to which systematic variation can be observed amongst women in terms of their screening behaviour, focusing on those who have never screened or are irregular screeners. Data on self reported utilisation of breast screening services was obtained from the 2002/04 NSW Health Surveys. A multinomial logit (MNL) model was used to examine the role of socioeconomic status, cultural background, education and region of residence on breast screening behaviour. The results show that lower income is associated with a woman never screening or screening irregularly. Region of residence is an important predictor of screening behaviour, although the degree of remoteness was not influential in determining participation. A higher number of hours worked was associated with women being more likely to screen irregularly. These results provide evidence of persistent and systematic variation in screening uptake and regular participation. The results also point towards targeted recruitment and retainment strategies that may provide the greatest potential benefits.breast screening, mammography, NSW, 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

Targeting services to reduce social inequalities in utilisation: an analysis of breast cancer screening in New South Wales

Many jurisdictions have used public funding of health care to reduce or remove price at the point of delivery of services. Whilst this reduces an important barrier to accessing care, it does nothing to discriminate between groups considered to have greater or fewer needs. In this paper, we consider whether active targeted recruitment, in addition to offering a 'free' service, is associated with a reduction in social inequalities in self-reported utilization of the breast screening services in NSW, Australia

Design considerations for piezocomposite materials for electrical stimulation in medical implants

This is an Accepted Manuscript of an article published by Taylor & Francis in Journal of Medical Engineering & Technology on 08 Jun 2022, available at: https://doi.org/10.1080/03091902.2022.2080881.Incidence of non-union following long bone fracture fixation and spinal fusion procedures is increasing, and very costly for patients and the medical system. Direct current (DC) electrical stimulation has shown success as an adjunct therapy to stimulate bone healing and increase surgery success rates, though drawbacks of current devices and implantable battery packs have limited widespread use. Energy harvesting utilising piezoelectric materials has been widely studied for powering devices without a battery, and a preclinical animal study has shown efficacy of a piezocomposite spinal fusion implant resulting in faster, more robust fusion. Most piezoelectric energy harvesters operate most effectively at high frequencies, limiting power generation from loads experienced by orthopaedic implants during human motion. This work characterises the efficient power generation capability of a novel composite piezoelectric material under simulated walking loads. Building on compliant layer adaptive composite stacks (CLACS), the power generation of mixed-mode CLACS (MMCLACS) is defined. Utilising poling direction to capitalise on in-plane strain generation due to compliant layer expansion, MMCLACS significantly increased power output compared to a standard piezo stack. The combination of radial and through-thickness poled piezoelectric elements within a stack to create MMCLACS significantly increases power generation under low-frequency dynamic loads. This technology can be adapted to a variety of architectures and assembled as a load-bearing energy harvester within current implants. MMCLACS integrated with implants would provide enough power to deliver bone healing electrical stimulation directly to the fusion site, decreasing non-union rates, and also could provide quantitative assessment of healing progression through load sensing

The killing fields of KZN: Local government elections, violence and democracy in 2016

Various government initiatives focus on the promotion of social cohesion for nation building. The impact of social cohesion on levels of violence is also the subject of research. This article argues that despite official rhetoric organs of state - are used  in KwaZulu-Natal to  serve party political interests by targeting cohesive groupings struggling for their constitutional rights. Violence is promoted and nation building retarded.  The main case study cited is that of violence-wracked Glebelands hostel in Durban. Since it is also argued that what is happening in Glebelands is not an isolated case reference is also made to the similar targeting of the shack dwellers’ movement Abahali baseMjondolo

Studies on the inhibition of bovine plasma amine oxidase by hydrazines

Several aspects of the potent inhibition of bovine plasma amine oxidase (PAO) by hydrazines were investigated by kinetic and preparative means. The inhibition was classified as pseudo-irreversible by the method of Ackerman and Potter (Proc. Soc. Exptl. Biol. Med. 72, 1 (1949), and was found to exhibit Zone B kinetic behavior (Straus and Goldstein, J. Gen. Physiol. 26, 559 (1943)). The constancy of the mole ratio of inhibitor to enzyme which produced 50% inhibition, (I/E)₅₀, for PAO preparations of different degrees of purity demonstrated the unique specificity of these inhibitors for PAO. Inhibitor potency as a function of structure was found to parallel the reactivity of these hydrazines towards carbonyls in model systems. The kinetically determined amount of (unsubstituted) hydrazine which produced 100% inhibition was found to correspond exactly with the reported pyridoxal phosphate (PLP) content of the enzyme. The isolation of a ¹⁴C-labelled EI complex confirmed this stoichiometry. These results, coupled with the spectral observations of Yamada and Yasunobu (J. Biol. Chem. 238, 2669 (1963)) led to the conclusion that the inhibition most likely proceeded from a nucleophilic attack of the hydrazine molecule on the carbonyl of the enzyme's PLP to form a stable azomethine via a transaldiminization reaction. The kinetic competition observed between hydrazines and substrate indicated that they react with PAO at the same site, PLP, thus confirming the proposal originated by Tabor, Tabor, and Rosenthal (J. Biol. Chem. 208, 645 (1954)) that PLP is involved in the active site. Inhibitor potency was found to decrease with increasing N-methyl substitution in a manner which could not be related exclusively to either steric or inductive effects of the substituents, but rather, depended on the presence or absence of a hydrogen alpha to the attacking nucleophilic -NH₂ on the hydrazine molecule. Thus, binding of hydrazines to the catalytic site of PAO may involve a three-point attachment. Therefore, the active site of PAO can be visualized to contain two subsites: one which binds the α-H of hydrazines or substrates by non-covalent forces, which functions to optimally orient the molecule for the chemical reaction at the enzyme's primary site, PLP. The titration of PAO by hydrazines was found to exhibit a biphasic response. Low inhibitor concentrations enhanced PAO activity, but high concentrations inhibited. This apparent homotropic cooperative effect suggested the presence of an allosteric site for the binding of these inhibitors. PAO was found to exhibit anomalous kinetic order with respect to substrate in the presence of hydrazines; v vs. (S) curves were sigmoidal. Normal Michaelis-Menten kinetics were followed in the absence of these inhibitors, indicating that the binding of a hydrazine molecule by the enzyme potentiated an effect which resulted in the binding of more than substrate molecule. High substrate inhibition of PAO was found to conform to the Haldane mechanism. The dissymmetry of v vs. log (S) plots indicated that at high substrate concentrations PAO binds more than two substrate molecules. Thus, PAO may contain an allosteric site for substrate as well as for hydrazines. A hypothetical model is presented which accounts for these experimental observations in terms of the nature and interaction of PAO's inhibitor and substrate binding sites. PAO was found to undergo a time- and concentration-dependent activation in dilute solution at room temperature, pH 7.0, in the presence or absence of hydrazines which could not be attributed to the presence of an endogenous activator or inhibitor (v vs. (E) plots were linear). Gel-filtration experiments revealed that the activation in the absence of hydrazines was not caused by a shift in the monomer- polymer equilibrium or the dissociation of PAO into subunits. Only one species was eluted from the column (which had a molecular weight corresponding to that of the monomer) whether the enzyme was activated or not. This peak was likewise independent of PAO concentration. These results led to the conclusion that the activation of the enzyme in the absence of inhibitor is most likely due to a conformational change. The activation of the inhibited enzyme was found to be greater than that of the "enzyme alone" control; in other words, the inhibition appeared to be reversed. This reversal of inhibition was found to follow first order (with respect to (EI) kinetics indicating that it was caused by the catalytic decomposition of the hydrazine inhibitors by the enzyme