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People with endometriosis use cannabis to manage their symptoms. This study aimed to identify costs, modes of administration, product composition, and self‐reported effectiveness for those accessing medicinal cannabis in Australia. There were 192 survey responses analysed. Most (63.5%) used a 'cannabis clinic' doctor, incurring an initial consultation cost of $100–$200+ (10.2% Medicare bulk‐billed) and median cannabinoid medicine costs of $300AUD per month. Cost was a major barrier to access, necessitating reducing dosage (76.1%) and/or consuming illicit cannabis (42.9%), despite a prescription. Most (77%) medical consumers used two or more cannabis products, with delta‐9‐tetrahydrocannabinol predominant oil and flower products most frequently prescribed. [ABSTRACT FROM AUTHOR]

Objective: Lifetime Health Cover (LHC) was introduced in mid-2000 to increase participation in private health insurance that includes hospital cover (PHI-HC) and improve the risk profile of PHI-HC participants. It initially achieved both objectives, but since 2001 the PHI-HC population has aged faster than the general population. The aim of this study was to determine if the excess ageing of the PHI-HC risk pool has been due to passive age-based adverse selection, an inherent risk of LHC. This study has potential implications for the retention of LHC. Methods: A descriptive population-level analysis of publicly available administrative datasets was performed. Data relating to PHI-HC were obtained from the Australian Prudential Regulatory Authority. National population data were obtained from the Australian Bureau of Statistics. Trends in demography, PHI-HC participation rates and LHC loading payments were analysed. Results: By 2021, age-based adverse selection had returned to the pre-LHC level. Based on the available data, this was due to passive age-based adverse selection not active age-based adverse selection. Specifically, it reflected the combination of an avoidable unintended consequence of the introduction of LHC (the over-representation, in 2001, of individuals aged 45–59) and one of LHC's intended effects (incentivisation of insured individuals to retain PHI-HC). Conclusions: This study supports the retention of LHC. Nonetheless, it highlights the risk of passive age-based adverse selection created by incentivising insured individuals to retain PHI-HC in the presence of distortions in the age distribution of the PHI-HC risk pool. Early targeted interventions are required when such distortions arise. What is known about the topic? Since the introduction of Lifetime Health Cover (LHC) in mid-2000, the participation rate for private health insurance that includes hospital cover (PHI-HC) has remained relatively stable, but the PHI-HC population has aged faster than the general population. What does this paper add? This paper makes a novel distinction between 'active' and 'passive' age-based adverse selection to explain LHC's role in the excess ageing of the PHI-HC risk pool. What are the implications for practitioners? Governments need to be vigilant for the emergence of distortions in the age distribution of the PHI-HC risk pool and respond with targeted interventions to normalise the age distribution, or risk problematic passive age-based adverse selection. [ABSTRACT FROM AUTHOR]

Introduction: This study examines the impact of funding provided to support the well‐being of rural health practitioners and their practice staff following the 2019–2022 bushfires. Objective: To assess the benefits and implications of grant funding for rural practices to aid recovery following bushfires in NSW, Australia. Design: An explanatory sequential mixed method design consisted of a survey and a thematic analysis of semi‐structured Interviews. Findings: Five key themes emerged from analysis: (1) the disasters altered the role of the practice and therapeutic relationships; (2) the funding had a positive impact on access to professional development; (3) the training had a positive impact on staff well‐being and resilience; (4) the professional development had a positive impact on rural practitioner's sense of capability; and (5) important elements of future grant opportunities. Discussion: The findings indicate the importance of recovering funding to facilitate access to professional development for rural health practioners during natural disasters which improved their mental health and wellbeing, capability and support to clients. Conclusion: Recovery funding facilitated improvement in workforce capability, professional resilience, mental health and well‐being in the face of natural disasters and emergencies. There was a link between training and maintaining the capability of rural health care practitioners and their practice staff. Capability was an important factor in the well‐being and resilience of the health workforce and their ability to support clients. [ABSTRACT FROM AUTHOR]

Objectives: With elimination of the financial burden of dental services, one can expect an increase in utilization of dental services. This study aimed to investigate the effective mechanisms of financial barriers to the utilization of dental services in an Australian adult population. Methods: South Australian survey data from the Dental Care and Oral Health Study (2015) were analysed. Following the flexible mediation approach, the direct effect of income and indirect effect of income through mediators (insurance, concession card and service sector) on the outcomes (visit avoidance and treatment prevention due to the cost) were calculated. Results: Findings showed that around half of the low‐income people and one‐third of the high‐income South Australians experienced a financial burden on receiving a dental visit or service. The indirect effect of income on both outcomes of financial burden was negligible, while the direct effect was significant. By changing the potential outcome distribution to their counterfactual exposure distribution and if the mediators are drawn from their counterfactual exposure (lower/higher income) distribution, the odds of visit avoidance and treatment prevention due to the cost were almost twice (Odds Ratio: 2.13, 95% CI 1.72–2.60) and 98% (Odds Ratio: 1.98, 95% CI 1.67–2.35) than in the lower‐income individuals, respectively. Conclusions: It can be concluded that the level of household income, directly and regardless of insurance status, concession card ownership and whether the service sector was public or private, affected the financial burden on utilization of dental services. [ABSTRACT FROM AUTHOR]

Controversy surrounding recommendations for supplemental screening (ultrasound and magnetic resonance screening) in women with dense breasts exists, as the long-term benefits from these additional modalities may not outweigh the harms. This study aimed to examine factors associated with supplemental screening intentions following a hypothetical breast density notification in a population of women who have not been routinely notified. Australian women of breast screening age participated in an online randomised experimental study where they were presented with one of two breast density notifications (with or without health literacy-sensitive information) and asked their screening intentions. After adjusting for covariates in multivariable analyses, women in both groups (n = 940) who indicated higher levels of breast cancer worry, had private health insurance, had a family history of breast cancer, and had a greater number of times previously attending mammography screening had higher intentions for supplemental screening. Understanding women's supplemental screening intentions following notification of dense breasts has important implications for health systems with breast screening considering the impacts of widespread notification. Personal, clinical and psychological factors should be considered when discussing both the benefits and harms of supplemental screening with women with dense breasts. [ABSTRACT FROM AUTHOR]

The expansion of genetic and genomic testing in clinical practice and research, and the growing market for direct-to-consumer genomic testing has led to increased awareness about the impact of this form of testing on insurance. Genetic or genomic information can be requested by providers of mutually rated insurance products, who may then use it when setting premiums or determining eligibility for cover under a particular product. Australian insurers are subject to relevant legislation and an industry led standard that was updated in 2019 to introduce a moratorium on the use of genetic test results in life insurance underwriting for policies

Background: Hysteroscopy is a safe procedure which allows both diagnosis and management of cervical and endometrial pathology. Improving Australian women's access to outpatient hysteroscopy would improve cost efficiency and allow women a quicker recovery, negating the need for a general anaesthetic. Increasing the Medicare renumeration for outpatient hysteroscopy could incentivise provision of outpatient hysteroscopy. Aim: We sought to review the trend and current uptake of outpatient diagnostic hysteroscopy in Medicare Benefits Scheme (MBS)‐funded clinics within Australia. Materials and Methods: A retrospective review of Australian MBS data from 1 January 1993 to 31 December 2020. Results: Over the past 27 years, 1 319 909 hysteroscopies have been claimed from Medicare in Australia, with 39 958 (3.1%) claimed as an outpatient diagnostic procedure. Australian outpatient diagnostic hysteroscopy MBS item number use peaked in 1994 (5871 cases) representing 18.2% of all hysteroscopies claimed through the MBS that year. Uptake of the outpatient hysteroscopy item number rapidly declined after 1994 and in 2010, it represented 0.8% of all hysteroscopies claimed (426 of 49 618) and has remained below <0.5% from 2010 to 2020. Conclusions: The lower Medicare rebate and lack of recognition of the importance of outpatient hysteroscopy has likely been a driving factor in continuing inpatient hysteroscopy. Incentivised government funding has been successfully utilised in the UK to improve outpatient hysteroscopy access. This MBS data suggests that Australia has not progressed in outpatient hysteroscopy access and support a change in the current funding model to assist in supporting the uptake of outpatient access. [ABSTRACT FROM AUTHOR]

To extend the authors' previous research by investigating the maintenance of work performance over time and the long-term experience of employment following traumatic brain injury (TBI). Semi-structured interviews were conducted with a sample of 72 individuals with predominantly severe TBI, up to 10-years post-injury. Thematic analysis of transcribed interviews was conducted. Four key themes were identified: brain injury influences on work performance and long-term employment; factors optimising long-term employment; and need for compromise and acceptance, which all impacted the final theme, quality of life outcome. While TBI-related difficulties such as fatigue, cognitive, and emotional difficulties still impacted work many years post-injury, work modifications and employer and vocational rehabilitation (VR) support were important factors optimising long-term employment. The timing of return to work (RTW) was also an important and potentially modifiable factor influencing work performance, which appeared to have long-term effects on the maintenance of employment. Support for acceptance of altered career goals is needed. Findings support the need for early VR to facilitate employer contact, to maximise adjustment and preparation time before RTW, to educate both employees and employers and to implement work modifications to support continuing employment after TBI. The maintenance of employment following TBI is of critical importance for financial independence, psychological and social well-being, and improved quality of life. Injury-related difficulties still impact work performance many years after injury requiring individuals with TBI to continue working in modified roles and for reduced hours over the long-term. Ongoing VR and employer support is needed to facilitate long-term work modifications and compensatory strategies to support work performance. Early VR involvement to facilitate employer contact and maximise adjustment and preparation time before returning to work is necessary to avoid the negative and potentially dire consequences of returning too early. Psychological support to facilitate acceptance of role changes and career compromises is also important. [ABSTRACT FROM AUTHOR]

Objective: This study set out to present data on out-of-pocket payments for Medicare mental health services provided by general practitioners (GP), psychiatrists, clinical psychologists and other psychologists, to explore how much is spent on out-of-pocket payments for mental health; if any trends could be seen; and what variations exist across regions. Methods: We performed secondary analysis of publicly available data on Medicare-subsidised GP, allied health and specialist health care across Australia. We merged and interrogated data covering the period 2013–19 and 2019–21 to create a data set covering eight full years of Medicare mental health services, arranged by profession and by region. Results: Out-of-pocket payments for mental health care in Australia have been rising consistently over the period 2013–21, at a considerably faster rate than overall expenditure on mental health care. There is wide variation in out-of-pocket payments depending on where you live. Conclusions: The impact of out-of-pocket payments on community access to mental health care is growing. This has implications, especially in poorer communities, for access to care. This should be an important consideration taken as the Australian Government considers next steps in national mental health reform, including the Better Access Program, currently under evaluation. What is known about the topic? A$35 m is spent on Medicare mental health services every week but there has been little research on the out-of-pocket payments charged to Australians. What does this paper add? Looking at Medicare data from 2013 to 2021, this paper answers three main questions: how much are out-of-pocket payments for mental health in Australia; what trends can be seen; and what variations exist? What are the implications for practitioners? Medicare's Better Access Program is under current review and this research can help practitioners, funders and policy-makers understand the significant investment made in mental health services. [ABSTRACT FROM AUTHOR]

The Indonesian nation is located along equator, a a very strategic potential that crosses between two ocean big, that is Ocean Indian and Ocean Pacific, and between two continent that is Asia and Australia continents. Beside that the Indonesian people have riches diverse nature variety, both on land as well as at sea. Study this aim for get description how Overview Juridical Implementation of Marine Cargo Insurance in the Agreement Freight Sea at PT. Insurance Sinar Mas for interpreted to in a the description presented in form of words. Study this aim for get description how Overview Juridical Implementation of Marine Cargo Insurance in the Agreement Freight Sea at PT. Insurance Sinar Mas for interpreted to in a the description presented in form of words. because of that, research this use approach qualitative descriptive. Condition coverage in Marine Cargo Insurance guaranteed by PT. Insurance Sinar Mas serves 3 (three) conditions coverage. Election condition by the insured influence quantity premium must paid as well as breadth guarantee the danger posed by the insurer. So that the consequences is condition of the policy purchased in accordance the dangers that can guaranteed that 's what can submitted accompanied completeness document claim. [ABSTRACT FROM AUTHOR]

Climate change is impacting the frequency and severity of physical risks such as wildfire, flood, cyclone and extreme precipitation. This is changing both the costs and benefits of home insurance purchase for households—leading to uncertainty about future insurance uptake rates under climate change. We use disaggregated data for Australia on the likelihood of climate hazards, and household panel data, to model the relationship between insurance uptake and exposure to climate physical risks. This model is then used to project insurance purchase out to 2100 under three climate scenarios. We find that exposure to climate risks does influence the likelihood of purchasing insurance. While for most hazards higher risk reduces the likelihood of purchase, there are exceptions, and the relationship is often complex. Projections from our model indicate that insurance coverage is likely to decline relatively modestly, by around one percentage point across Australia from 2000 to 2100 as a result of climate change. However, we find there is significant variation across regions. [ABSTRACT FROM AUTHOR]

Conditions and warranties, which are generally referred to as policy terms in insurance contracts, are crucial in the determination of the rights and obligations of the contracting parties. The article examines the enforcement of policy terms in insurance contracts at common law and the legislative measures that have been deployed in some common law countries, including Nigeria, the United Kingdom and Australia, to ensure fairness as well as to balance the inequality in the bargaining power of the contracting parties. In as much as the principle of freedom of contract will generally be honoured by the court, the paper argues that through legislative intervention in policy terms in these countries, the principle is being discountenanced with, in appropriate cases, in order to effectuate the just and reasonable expectation of the insured. It concludes by proffering suggestions to identified lacunae in the Nigerian Insurance law. [ABSTRACT FROM AUTHOR]

Across the world, cities are growing, blurring lines between urban and rural. In Australia, peri-urban areas are undergoing demographic shifts and extensive development. In the literature, these shifts are characterised by differences in the risk perceptions and hazard experiences between established and incoming residents. In this paper, we illustrate how some of these differences are perceived by focusing on house and contents insurance in the bushfire-prone City of Whittlesea on the fringes of Greater Melbourne. This location captures the complex relationship between growing population and high bushfire risk, and is the site of the country's deadliest bushfire event, Black Saturday, in 2009. Through in-depth interviews, we observe that residents perceive insurance as playing a role in peri-urban change. Specifically, underinsurance is understood to be a challenge faced by many impacted by the Black Saturday fires, and contributes to feelings of uncertainty regarding the capacities of changing communities to work together to prepare for and recover from future fires. Our focus on insurance is informed by the need to better understand the social qualities of this dimension of disaster preparedness and recovery, and how perceptions of insurance amid peri-urban change may help produce social patterns and trends. [ABSTRACT FROM AUTHOR]

Aged care coverage in Australia is universal but fragmented and has been challenged by government policy to deregulate aged care and open it up to market forces. A recent inquiry into aged care (Royal Commission into Aged Care Quality and Safety) documented the outcome of this policy—substandard care at most levels. The provision of services to older Aboriginal and Torres Strait Islander peoples, who have high prevalence of frailty and cognitive impairment, was also identified as inadequate. The effects of yet to be implemented changes in policy and funding in response to this report remain to be seen. Despite this policy backdrop, geriatricians have contributed to a steady growth in medical services and interventions focussed on specific geriatric issues such as dementia, falls, polypharmacy and orthogeriatrics. These are often driven by, or in collaboration with researchers, and aim to generate research data as well as provide patient care. The numbers of academic geriatricians and other aged care health professionals is increasing, and the training of specialist geriatricians now includes a significant research component. [ABSTRACT FROM AUTHOR]

The National Disability Insurance Scheme is the new consumer-controlled funding system for people with disability in Australia, and is expected to enhance participation outcomes of people with disability. This research explored participation opportunities for people with disability during the formative period of transition to the scheme, through stakeholder accounts of changes in allied health service contexts. Qualitative data were generated during interviews, workshops and meetings with industry, policy, practice and education stakeholders involved in scheme services. Inductive coding explored key themes within the data. The International Classification of Functioning model was then applied as a deductive coding framework to illuminate how the scheme was perceived to be impacting participation opportunities for recipients of scheme funding. Using the International Classification of Functioning helped us illuminate whether changes resulting from scheme transition posed participation opportunities or barriers for scheme recipients. Research participants often framed these changes negatively, even when examples suggested that changes had removed participation barriers for scheme recipients. Some participants viewed changes as obstructing equitable and quality professional practice. We explore potential opportunities to resolve tensions that also optimise the participation outcomes of individuals who receive services through individualised funding. The introduction of individualised funding has removed barriers to participation for many National Disability Insurance Scheme recipients. Efforts must be made to build the trust of stakeholders involved in National Disability Insurance Scheme service provision regarding how fee-for-service funding can lead to good participation outcomes for scheme recipients. Transparency around the shared processes of clinical governance and equitable service access operating in Australia's individualized disability funding scheme are suggested to build trust. A visible commitment to maintaining a broad range of services is also indicated to build trust for stakeholders involved in the scheme. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to explore policy paths towards private health insurance (PHI) reform that might reduce out-of-pocket costs, restore public confidence and allow insurers to finance value-based care. Methods: This study used thematic analysis of semi-structured interviews with informed opinion holders, including a politician, three former senior public servants and an industry lobbyist. Critical analysis of peer reviewed and grey literature was also conducted. Results: PHI regulation is contributing to unexpected out-of-pocket expenses and low-value care. Modification of existing tax incentives would be incapable of significantly increasing PHI coverage. Regulatory reform could restore confidence among policy holders by promoting value-based care, wherein health outcomes are measured and incentivised with remuneration. Conclusions: Targeted relaxation of out-of-hospital restrictions should be explored to promote value-based competition and facilitate bundled payments for chronic disease management and community services. To address out-of-pocket diagnostic and procedural costs, insurers should have more responsibility for private specialist's fees, including by financing the entire provider's bill through insurance and redirecting the Medicare Benefits Schedule fee to the insurer. What is known about the topic?: Healthcare expenditure and out-of-pocket costs have grown rapidly, while confidence and depth of coverage in private health insurance has declined, as has the fiscal appetite for expanding public financing for health care. What does this paper add?: This paper outlines the regulatory and policy factors that are contributing to low-value care and unmet expectations from insurance policy holders. It also maps the strategic terrain of the non-government health sector and considers feasible policy options for reforming the PHI industry that do not increase drawings on the public purse. What are the implications for practitioners?: An appreciation of the ongoing challenges to financing value-based care provision will inform key stakeholders, including policymakers and health service providers, as reforms are debated and implemented. [ABSTRACT FROM AUTHOR]

Home and contents insurance is framed as key to Australia's national strategy for disaster resilience. Despite the perceived importance of financial indemnity, ambiguity characterises the ways in which it facilitates both short‐ and long‐term everyday household recovery when disaster strikes. Addressing such ambiguity, this article explores how insurance impacts upon households' capacities to rebuild and recover after disastrous bushfire. In‐depth interviews conducted with residents in the Blue Mountains of New South Wales four years after they were affected by the October 2013 bushfires show that insurance was fundamental to recovery. Swift claims handling and payouts allowed participants to access rental accommodation, material necessities, and sufficient finances to repair, rebuild, and refurnish their houses—essentials in restoring everyday routines and a sense of normalcy. Yet, many people were underinsured and used alternative strategies to stretch "adequate" insurance coverage, which had practical and emotional implications. Importantly, while insurance reduced post‐disaster stress and trauma, the length and depth of recovery were more closely determined by the impacts of personal and situational circumstances than by insurance. On that basis, analysis points to the conclusion that while insurance is a crucial tool for disaster resilience, greater levels of psychosocial support are needed to improve households' short‐ and longer‐term recovery. [ABSTRACT FROM AUTHOR]

In many countries, health technology assessment (HTA) organizations determine the economic value of new drugs and make recommendations regarding appropriate pricing and coverage in national health systems. In the US, recent policy proposals aimed at reducing drug costs would link drug prices to six countries: Australia, Canada, France, Germany, Japan, and the UK. We reviewed these countries' methods of HTA and guidance on price and coverage recommendations, analyzing methods and guidance documents for differences in (1) the methodologies HTA organizations use to conduct their evaluations and (2) considerations they use when making recommendations. We found important differences in the methods, interpretations of HTA findings, and condition-specific carve-outs that HTA organizations use to conduct evaluations and make recommendations. These variations have ethical implications because they influence the recommendations of HTA organizations, which affect access to the drug through national insurance and price negotiations with manufacturers. The differences in HTA approaches result from the distinct political, social, and cultural contexts of each organization and its value judgments. New cost-containment policies in the US should consider the ethical implications of the HTA reviews that they are considering relying on to negotiate drug prices and what values should be included in US pricing policy. [ABSTRACT FROM AUTHOR]

Home and contents insurance is integral to household and community resilience against disasters. Yet many households are underinsured. While causes for underinsurance have been widely researched, changes to Australian building regulations in the last decade has established a new source of insurance miscalculations. Bushfire Attack Level (BAL) ratings can inflate rebuilding costs by 20% or more, yet BAL ratings remain obfuscated to homeowners and are notoriously confusing to navigate. After the October 2013 bushfires in New South Wales, the Blue Mountains Local Recovery Steering Group found that 'information on the BAL process, the guidelines, the expected costs, the consulting experts and a property's bushfire-prone status is literally all over the place'. This paper aims to provide clarity on the subject, tracing the precise socio-technical means through which disaster risk is perceived and assessed. The paper conceptualises insurance and risk ratings as calculative devices that provide both a technical solution to reduce financial losses and a philosophical tool for risk rationalisation. It then builds on interviews conducted with residents in the Blue Mountains affected by the 2013 bushfires, to ascertain how such calculative devices practically affect communities at risk. The paper concludes by outlining potential solutions to a confusing and costly problem in Australia, highlighting critical public awareness issues surround BAL ratings, which have profound insurance and wellbeing implications for people rebuilding and recovering from bushfire. [ABSTRACT FROM AUTHOR]

The article discusses Australia an agricultural nation diverse climates which translates into significant sources of risk for agricultural production and subsequent farm revenues contributing to an increase in the vulnerability of crops. Topics include crop insurance products, including classical claim-based and index-based insurance, that allow exposed individuals to pool resources to spread risk; and the impact of multiple synoptic-scale climate mode indices on crop yield.

Australian health policy has prioritized efforts to close the ten-year life expectancy gap between indigenous and nonindigenous Australians, a disparity largely driven by cardiovascular disease and diabetes. Because out-of-pocket spending poses a barrier to accessing medications for chronic conditions, in 2010 the Australian government reduced or eliminated medication copayments for indigenous people with chronic disease or risk factors for chronic disease. In this quasiexperimental study we found that the copayment reductions were associated with a 39 percent relative increase in the use of medications and a 61 percent reduction in out-of-pocket spending. Among indigenous Australians who qualified for the largest copayment reductions, overall use of medications increased by 156 percent--including increases of 26-109 percent in the use of lipid-lowering, hypertension, and diabetes medications. These findings suggest that Australia's novel strategy of targeted copayment reductions improved access to prescription medications among indigenous Australians, a population with a high burden of chronic conditions and marked social disadvantage. [ABSTRACT FROM AUTHOR]

An editorial is presented on World Health Assembly Resolution. Emergency Care (EC) systems are poorly developed in a majority of low- and middle-income countries (LMICs), and there is a significant unmet need for acute care. To facilitate global EC capacity development, the World Health Organization (WHO) has devised a framework to describe the essential functions of EC systems.

Background: Current evidence suggests that preimplantation genetic testing for aneuploidy (PGT‐A) used during assisted reproductive technology improves per‐cycle live‐birth rates but cumulative live‐birth rate (CLBR) was similar to a strategy of morphological assessment (MA) of embryos. No study has assessed the cost‐effectiveness of repeated cycles with PGT‐A using longitudinal patient‐level data. Aim: To assess the cost‐effectiveness of repeated cycles with PGT‐A compared to MA of embryos in older women. Materials and Methods: Micro‐costing methods were used to value direct resource consumption of 2093 assisted reproductive technology‐naïve women aged ≥37 years undergoing up to three 'complete assisted reproductive technology cycles' (fresh plus cryopreserved embryos) with either PGT‐A or MA in an Australian clinic between 2011 and 2014. Incremental cost‐effective ratios were calculated from healthcare and patient perspectives with uncertainty assessed using non‐parametric bootstrap methods. Cost‐effectiveness acceptability curves were constructed to evaluate the probability of PGT‐A being cost‐effective over a range of willingness‐to‐pay thresholds. Results: The CLBR and mean healthcare costs per patient were 30.90% and $22 962 for the PGT‐A group, and 26.77% and $21 801 for the MA group, yielding an incremental cost‐effective ratio of $28 103 for an additional live birth with PGT‐A. At a willingness‐to‐pay threshold of $50 000 and above, there is more than an 80% probability of PGT‐A being cost‐effective from the healthcare perspective and a 50% likelihood from a patient perspective. Conclusion: This is the first study to use real‐world patient‐level data to assess the cost‐effectiveness of PGT‐A in older women from the healthcare and patient perspectives. The findings contribute to the ongoing debate on the role of PGT‐A in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Little is known about the sociodemographic and clinical characteristics of adverse drug events (ADEs) in patients with neurodevelopmental disorders (NDD). Objective: The objective of this study was to describe and compare the demographic details of people with and without NDD hospitalised due to ADEs. Methods: The all‐inclusive New South Wales Admitted Patient Data Collection from 2001 to 2014 was employed to identify ADE‐related hospitalisations in patients with NDD using the International Classification of Diseases 10th revision Australian modification codes. We derived case sets specific to different clinical groups and patient characteristics and compared proportional differences between patients with and without intellectual disability using chi squared tests. Results: A total of 2173 patients with NDD were admitted for acute care of ADEs, accounting for 0.7% of all ADE‐related hospitalisations. Hospitalised ADEs among patients with NDD increased by twofold over the 14‐year study period. Psychotropic medications and opioid analgesic medications were leading causes of ADE‐related hospitalisations in patients with NDD. Compared with their counterparts, patients with NDD were younger, experienced more socio‐economic disadvantage and less private insurance coverage, suffered with less severe but different co‐morbid clinical conditions and incurred more challenges in the acute hospital care setting. Conclusion: Although the pattern of ADE‐related hospitalisations in patients with NDD differed from that in patients without NDD, there is a lack of targeted healthcare programmes to meet their special needs. This study suggests the need for countermeasures in primary healthcare settings to reduce the burden of ADEs in this vulnerable group. [ABSTRACT FROM AUTHOR]

Background: Disease management programmes may improve quality of care, improve health outcomes and potentially reduce total healthcare costs. To date, only one very large population-based study has been undertaken and indicated reductions in hospital admissions > 10%.Objective: We sought to confirm the effectiveness of population-based disease management programmes. The objective of this study was to evaluate the relative impact on healthcare utilisation and cost of participants the Costs to Australian Private Insurance - Coaching Health (CAPICHe) trial.Design: Parallel-group randomised controlled trial, intention-to-treat analysis SETTING: Australian population PARTICIPANTS: Forty-four thousand four hundred eighteen individuals (18-90 years of age) with private health insurance and diagnosis of heart failure, chronic obstructive pulmonary disease (COPD), coronary artery disease (CAD), diabetes, or low back pain, with predicted high cost claims for the following 12 months.Intervention: Health coaching for disease management from Bupa Health Dialog, vs Usual Care.Main Outcome Measures: Total cost of claims per member to the private health insurer 1 year post-randomisation for hospital admissions, including same-day, medical and prostheses hospital claims, excluding any maternity costs. Analysis was based on the intent-to-treat population.Results: Estimated total cost 1 year post-randomisation was not significantly different (means: intervention group A$4934; 95% CI A$4823-A$5045 vs control group A$4868; 95% CI A$4680-A$5058; p = 0.524). However, the intervention group had significantly lower same-day admission costs (A$468; 95% CI A$454-A$482 vs A$508; 95% CI A$484-A$533; p = 0.002) and fewer same-day admissions per 1000 person-years (intervention group, 530; 95% CI 508-552 vs control group, 614; 95% CI 571-657; p = 0.002). Subgroup analyses indicated that the intervention group had significantly fewer admissions for patients with COPD and fewer same-day admissions for patients with diabetes.Conclusions: Chronic disease health coaching was not effective to reduce the total cost after 12 months of follow-up for higher risk individuals with a chronic condition. Statistically significant changes were found with fewer same-day admissions; however, these did not translate into cost savings from a private health insurance perspective. [ABSTRACT FROM AUTHOR]

Objective: Provincial and territorial governments are considering how best to improve access to psychotherapy from the current patchwork of programmes. To achieve the best value for money, new funding needs to reach a wider population rather than simply replacing services funded through insurance benefits. We considered lessons for Canada from the relative uptake of private insurance and public funding for allied health psychotherapy in Australia.Method: We analysed published administrative claims data from 2003-2004 to 2014-2015 on Australian privately insured psychologist services, publicly insured psychotherapy under the 'Better Access' initiative, and public grant funding for psychotherapy through the 'Access to Allied Psychological Services' programme. Utilisation was compared to the prevalence of mental disorders and treatment rates in the 2007 National Survey of Mental Health and Wellbeing.Results: The introduction of public funding for psychotherapy led to a 52.1% reduction in private insurance claims. Costs per session were more than double under private insurance and likely contributed to individuals with private coverage choosing to instead access public programmes. However, despite substantial community unmet need, we estimate just 0.4% of the population made private insurance claims in the 2006-2007 period. By contrast, from its introduction, growth in the utilisation of Better Access quickly dwarfed other programmes and led to significantly increased community access to treatment.Conclusions: Although insurance in Canada is sponsored by employers, psychology claims also appear surprisingly low, and unmet need similarly high. Careful consideration will be needed in designing publicly funded psychotherapy programmes to prepare for the high demand while minimizing reductions in private insurance claims. [ABSTRACT FROM AUTHOR]

The expansion of genetic and genomic testing in clinical practice and research and the growing market for at home personal genome testing has led to increased awareness about the impact of this form of testing on insurance. Genetic or genomic information can be requested by providers of mutually rated insurance products, who may then use it when setting premiums or determining eligibility for cover under a particular product. Australian insurers are subject to relevant legislation and an industry standard that was updated in late 2016. In 2018, the Human Genetics Society of Australasia updated its position statement on genetic testing and life insurance to account for these changes and to increase the scope of the statement to include a wider scope of insurance products that are not rated according to community risk, such as life, critical care, and income protection products. Recommendations include that providers of professional education involving genetics should include ethical, legal, and social aspects of insurance discrimination in their curricula; that the Australian government take a more active role in regulating use of genetic information in personal insurance, including enacting a moratorium on use of genetic test results; that information obtained in the course of a research project be excluded; and that there is improved engagement between the insurance industry, regulators, and the genetics profession. [ABSTRACT FROM AUTHOR]

The article offers health fund news briefs in Australia as of December 2018. Australian Traditional Medicine Society (ATMS) membership does not equate with provider status with all health funds, as it is subject to eligibility requirements. A Certificate IV or higher from a registered training organisation is required for remedial and Chinese massage therapists who graduated after March 2002. Special provider numbers are required for Bowen Therapy, Kinesiology, and Reflexology providers.

In undertaking what we believe is the first national-scale study of its kind, we provide methodologically transparent, statistically robust insights into associations and potential unfolding effects of house and contents under-insurance. We identify new dimensions in the complex relationship between householders and insurance, including the salience of interpersonal – and likely institutional – trust. Under-insurance is (re)produced along socio-economic and geographical lines, with those of lower socio-economic status or living in cities more likely to be under-insured. Should a disaster strike, such communities are likely to suffer further disadvantage, especially if governments continue to shift the responsibility for risk onto households. Our findings support the observation that insurance can contribute to increasing socio-economic urban polarisation in light of natural disasters. We conclude by considering how under-insurance may contribute to growing urban social stratification, as well as how it may produce situated ethical and political responses that exceed neoliberal aspirations. [ABSTRACT FROM AUTHOR]

People with intellectual disability and complex support needs challenge human rights in the current disability policy and practice framework in Australia. With the implementation of the National Disability Insurance Scheme (NDIS) in Australia, it is pivotal to understand how human rights can offer a framework for understanding these challenges. There are complex issues and challenges in operationalising support for the human rights of people with intellectual disability. Their experience is characterised by overlapping and compounding forms of discrimination, abuse and vulnerability in their social and systemic interactions. This article uses qualitative content analysis to describe and articulate disadvantages and challenges of this group, and maps this onto the United Nations Convention on the Rights of Persons with Disabilities and current policies and practices in Australia. The article concludes that utilising human rights instruments helps to recognise the multiple disadvantages faced by people with intellectual disability and complex support needs and focus on the specific areas that need to be addressed in policy and practice. [ABSTRACT FROM AUTHOR]

The article presents the discussion on environmental sustainability being a key issue associated with pharmaceutical use in Australia. Topics include pharmaceutical pollution being well-established threat to ecosystems with harmful effects on animal and plant life, and human health; and minimising the effects of pharmaceuticals on the environment by optimising prescription practices and educating patients.

The article reports on the health insurance provider eligibility of Australian Traditional Medicine Society (ATMS) members. Topics discussed include the changes in the private health insurance coverage of natural therapies as of April 2019, the submission of the ATMS Health Fund Application and Declaration Form, and the eligibility requirements of insurers such as the Australian Health Management (AHM), Australian Regional Health Group (ARHG), and Doctors Health Fund (DHF).

The article offers natural medicine news briefs as of December 2021. The Australian government excludes certain natural therapies from private health insurance under implemented reforms. Also cited are the accreditation of Australian Traditional Medicine Society (ATMS) members as authorized providers, and the terms and conditions of provider status for individual health funds.

Purpose: Fertility preservation discussions with pediatric and adolescent cancer patients can be difficult for clinicians. This study describes the acceptability of a fertility clinician decision support system (CDSS). Methods: A cross-sectional study of clinicians at The Royal Children's Hospital, Melbourne. Participants were trained on CDSS purpose, contents, and use. A survey captured the perceived benefits and weaknesses of the CDSS. Results: Thirty-nine clinicians participated. Over 90% felt the CDSS aims and format were clear, and understood the components. Over 80% felt it would enable adherence to clinical pathways, policy, and standards of care. Conclusions: The CDSS provided significant perceived benefits to oncofertility care. [ABSTRACT FROM AUTHOR]

Utilising a large comparative survey across 11 countries, it is shown that country effects condition the individual uptake of income protection insurance and that shared attributes, including labour market status, are important factors in determining the take-up of income protection insurance, whatever the respondents' country of residence. We observed differences in the respondents' coping strategies, including self-reliance, and were able to distinguish between migrant workers and those who work in their country of origin, along with the "special" case of the Australian respondents. These findings have implications for the ongoing debate on the labour market effects of globalisation and the significance of national institutions and regulatory practices. [ABSTRACT FROM AUTHOR]

Objective Although Australia's service and policy context differs from that of the US, studies have highlighted potential for individual placement and support (IPS) to support competitive employment outcomes for people with severe and persistent mental illness. The aim of the present study was to explore why the model is not yet widely available.Methods A document analysis was conducted to discern reasons for challenges in implementation of IPS practice principles within the Australian service context.Results The document analysis illustrated that although policy acknowledges the importance of increasing employment rates for people with severe and persistent mental illness, consistent measures, change indicators, direction and time frames are lacking in policy and strategy documentation. Further, IPS principles are not consistently evident in guiding operational documentation that government-funded Disability Employment Services (DES) programs are mandated to adhere to.Conclusions For IPS to be readily implemented, it is necessary for government to offer support to agencies to partner and formal endorsement of the model as a preferred approach in tendering processes. Obligations and processes must be reviewed to ensure that model fidelity is achievable within the Australian Commonwealth policy and service context for programs to achieve competitive employment rates comparable to the most successful international programs. [ABSTRACT FROM AUTHOR]

Lung cancer screening with low dose computed tomography (LDCT) is recommended in the USA and Canada for high-risk smokers but not in Australia. We administered a cross-sectional survey to Western Australian general practitioners (GP). The majority (64/93, 69%) reported requesting a screening chest X-ray (42/93, 45%) and/or LDCT (38/93, 41%) in the past year. LDCT screening was more common if the GP had received education from radiology practices (odds ratio (OR) 2.81, P = 0.03) or if they believed screening is funded by the Medical Benefits Scheme (OR 3.57, P = 0.02). Lung cancer screening with LDCT is occurring outside a coordinated programme, contrary to Australian guidelines. [ABSTRACT FROM AUTHOR]

High-income countries are grappling with the challenge of caring for aging populations, many of whose members have chronic illnesses and declining capacity to manage activities of daily living. The 2017 Commonwealth Fund International Health Policy Survey of Older Adults in eleven countries showed that US seniors were sicker than their counterparts in other countries and, despite universal coverage under Medicare, faced more financial barriers to health care. The survey's findings also highlight economic hardship and mental health problems that may affect older adults' health, use of care, and outcomes. They show that in some countries, one in five elderly people have unmet needs for social care services--a gap that can undermine health. New to the survey is a focus on the "high-need" elderly (those with multiple chronic conditions or functional limitations), who reported high rates of emergency department use and care coordination failures. Across all eleven countries, many high-need elderly people expressed dissatisfaction with the quality of health care they had received. [ABSTRACT FROM AUTHOR]

Objectives There are few studies of dental service expenditure in Australia. Although dental insurance status is strongly associated with a higher probability of dental visiting, some studies indicate that there is little variation in expenditure by insurance status among those who attend for care. Our objective was to assess the overall impact of insurance on expenditures by modelling the association between insurance and expenditure accounting for variation in the probability of incurring expenses, that is dental visiting. Methods A sample of 3000 adults (aged 30-61 years) was randomly selected from the Australian electoral roll. Dental service expenditures were collected prospectively over 2 years by client-held log books. Questionnaires collecting participant characteristics were administered at baseline, 12 months and 24 months. Unadjusted and adjusted ratios of expenditure were estimated using marginalized two-part log-skew-normal models. Such models accommodate highly skewed data and estimate effects of covariates on the overall marginal mean while accounting for the probability of incurring expenses. Results Baseline response was 39%; of these, 40% ( n = 438) were retained over the 2-year period. Only participants providing complete data were included in the analysis ( n = 378). Of these, 68.5% were insured, and 70.9% accessed dental services of which nearly all (97.7%) incurred individual dental expenses. The mean dental service expenditure for the total sample (those who did and did not attend) for dental care was AUS$788. Model-adjusted ratios of mean expenditures were higher for the insured (1.61; 95% CI 1.18, 2.20), females (1.38; 95% CI 1.06, 1.81), major city residents (1.43; 95% CI 1.10, 1.84) and those who brushed their teeth twice or more a day (1.50; 95% CI 1.15, 1.96) than their respective counterparts. Conclusion Accounting for the probability of incurring dental expenses, and other explanatory factors, insured working-aged adults had (on average) approximately 60% higher individual dental service expenditures than uninsured adults. The analytical approach adopted in this study is useful for estimating effects on dental expenditure when a variable is associated with both the probability of visiting for care, and with the types of services received. [ABSTRACT FROM AUTHOR]

The article discusses health fund updates of interest to the members of the Australian Traditional Medicine Society (ATMS) as of September 1, 2019. Topics covered include reforms made by the Australian government for private health insurance which caused 16 natural therapies to no longer be eligible for health fund rebates, additional eligibility requirements to be recognized as a provider by health funds, and the terms and conditions of provider status.

The article presents health fund news of interest to members of the Australian Traditional Medicine Society (ATMS). Topics covered include requirements for recognition of ATMS members as a provider by health funds, website where ATMS members can check their eligibility for Australian Health Management (AHM) and health funds that comprise the Australian Regional Health Group (ARHG).

While deaths are thought to be rare in community Australian sport, there is no systematic reporting so the frequency and leading causes of death is unknown. The aim of this study was to describe the frequency and cause of deaths associated with community-level Australian Football (AF), based on insurance-claims records. Retrospective review of prospectively collected insurance-claims for death in relation to community-level AF activities Australia-wide from 2004 to 2013. Eligible participants were aged 15+ years, involved in an Australian football club as players, coaches, umpires or supporting roles. Details were extracted for: year of death, level of play, age, sex, anatomical location of injury, and a descriptive narrative of the event. Descriptive data are presented for frequency of cases by subgroups. From 26,749 insurance-claims relating to AF, 31 cases were in relation to a death. All fatalities were in males. The initial event occurred during on-field activities of players (football matches or training) in 16 cases. The remainder occurred to people outside of on-field football activity (n = 8), or non-players (n = 7). Road trauma (n = 8) and cardiac conditions (n = 7) were the leading identifiable causes, with unconfirmed and other causes (including collapsed or not yet determined) comprising 16 cases. Although rare, fatalities do occur in community AF to both players and people in supporting roles, averaging 3 per year in this setting alone. A systematic, comprehensive approach to data collection is urgently required to better understand the risk and causes of death in participants of AF and other sports. [ABSTRACT FROM AUTHOR]

Background: Motor vehicle related moderate-severe orthopaedic trauma has a major impact on the burden of injury. In Australia, all states and territories provide access to financial compensation following injury in a motor vehicle crash. The aim of this study was to investigate the influence of seeking financial compensation (i.e., making a claim) on injury recovery following motor vehicle related moderate-severe orthopaedic trauma.Methods: Patients admitted with upper/lower extremity fractures after a motor vehicle crash were recruited from two trauma hospitals. Baseline data were collected in person by written questionnaire within two weeks of injury. Follow up data were collected by a mailed written questionnaire at six, 12 and 24 months. Additional (demographic/injury-related) information was collected from hospital databases, all other measures were self-reported. Outcomes were: Short Form-36 Version 2.0 (SF36v2), Physical/Mental Component Scores (PCS/MCS); Post Traumatic Stress Disorder (PTSD) Checklist Civilian Version (PCL-C); and Global Rating of Change (GRC) scale. Analysis involved descriptive statistics and linear mixed models to examine the effect of compensation status on injury recovery over time.Results: There were 452 study participants. Baseline characteristics showed: mean age 40 years (17.1 Standard Deviation [SD]); 75 % male; 74 % worked pre-injury; 67 % in excellent-very good pre-injury health; 56 % sustained serious injuries, Injury Severity Score (ISS) 9-15; 61 % had a low-middle range household income. Overall, after controlling for possible confounders, the compensable group had poorer recovery compared to the non-compensable group for PCS (-2.97 Mean Difference (MD), 95 % CI -4.73, -1.22); MCS (-3.44 MD, 95 % CI -5.62, -1.26); PCL-C (3.42MD, 95 % CI 0.87, 5.99); and GRC (-0.66MD, 95 % CI -1.15, -0.17). Injury recovery over time for all participants showed: PCS improved from 6-12 and 12-24 months; MCS and GRC improved from 6-12 months; and PCL-C did not significantly improve from 6-12 and 12-24 months. Injury recovery over time continued for compensable and non-compensable groups but compensable participants had poorer scores at each time period, especially MCS and PCL-C.Conclusions: Making a claim was associated with poor injury recovery following motor vehicle related orthopaedic trauma, mainly for mental health. Irrespective of claim status, the majority had poor injury recovery, especially for mental health. [ABSTRACT FROM AUTHOR]

Objective To examine how the rates of the use of particular face-to-face primary mental health care services changed in the first 4 years (2006-2010) of the Better Access initiative in both urban and rural regions of South Australia. Design Time-series analysis of the number of psychology session, psychiatry assessment and general practitioner care plan services recorded in Medicare Australia data. Setting South Australia. Pre-existing data set of South Australian residents who accessed Medicare between 2006 and 2010 Main objective measure Number of services per 100 000 population (service rate). Results Psychology session service rates increased in all regions, but continued to follow a 'location gradient', being higher in areas closer to Adelaide and lower in areas more distant from Adelaide. Psychiatry assessment service rates increased in Adelaide but did not change in other regions. Rates in remote areas were subject to substantial variation over time. General practitioner care plan service rates increased in Adelaide and in the Riverland, but declined in the Murray Mallee region. Conclusions Overall, service rates increased in Adelaide and nearby regions, but the results for rural and remote regions were mixed. Possible explanations for the geographical variability include population characteristics (such as socio-economic status), methods of service delivery (visiting practitioners, telepsych), the relative proportion of total health services provided by general practitioners versus other practitioners, or real variations in the need for primary mental health services. [ABSTRACT FROM AUTHOR]

For decades, public satisfaction with the health care system has been lower in the United States than in other high-income countries. To better understand the distinctive nature of US health system satisfaction, we compared the determinants of satisfaction with the health system in the United States to those in seventeen other high-income countries by applying regression decomposition methods to survey data collected in the period 2011-13. We found that concerns related to "accessing most-preferred care" (the extent to which people feel that they can access their top preferences at a time of need) were more important to satisfaction in the United States than in other high-income countries, while the reverse was true for satisfaction with recent interactions with the health system. Differences among US socioeconomic groups in survey responses regarding access to most-preferred care suggest that wide variation in insurance coverage and generosity may play a role in these differences. While reductions in the uninsured population and the movement toward minimum health plan standards could help address some concerns about access to preferred care, our results raise the possibility of public backlash as market forces push plans toward more restricted access and higher cost sharing. [ABSTRACT FROM AUTHOR]

The article presents guidelines concerning the health funds received by different professional organizations in Australia in 2016. Topics covered include the release of the funds to adhere to the Private Health Insurance Accreditation Rules 2011 and the importance of the funds to promote traditional medicine in the country. Also mentioned are requirements for the funds such as providing complete clinic address details and have private practices.

Disability reform in Australia centres on a National Disability Insurance Scheme (NDIS), which aims to provide lifelong, individualised support based on the principle of 'reasonable and necessary' care. As a universal rights-based scheme it represents a historical shift in allocation principles in Australia's disability policy. Nonetheless, attention will be on determining who receives what care given the diversity of personal and family contexts. The aim of this paper is to discuss the operational complexities of a principle of reasonable and necessary care with reference to the findings of a three-year study on the experiences and perspectives of disability care of 25 adults with acquired disability, their 22 nominated family members and 18 service providers. Evidence from this study suggests enacting the principle of reasonable and necessary care and support will be problematic, in particular as it relates to personalising the level and scope of services, balancing formal and informal care, and principles of equity. The paper contributes to the literature about allocation principles in social policy and the challenges of implementation. Further, it provides an empirically informed discussion of some of the specific policy implementation challenges concerning the NDIS. [ABSTRACT FROM AUTHOR]

Abstract: Emergency medicine was once exclusively provided in public hospitals in Australia, but now over half a million consultations per annum are in private (7% total emergency consultations). Private EDs have excess capacity and are staffed by senior doctors (majority FACEM) with open access to investigations and broad specialist inpatient services. Public EDs struggle with rising attendances and overcapacity. Private hospitals have high levels of patient satisfaction and aim to optimise service provision. A major barrier to private ED attendances is out‐of‐pocket costs. Insurers deem private EDs outpatient services and therefore do not contribute any funding to these attendances. Additionally state governments provide no funding while Medicare items cover only 10–15% of costs. Out‐of‐pocket consultation costs to patients vary nationally ($110–$480) but never cover the full cost of providing services. Patients may also pay out‐of‐pocket costs for investigations. Private EDs can provide many benefits to patients and the community. Patients can see senior doctors immediately (at less cost per patient than public EDs). Demand can be directed away from resource‐poor public EDs. Private EDs could also provide extra surge capacity during disasters. There is a need for further strong advocacy for private emergency medicine at many levels, particularly regarding the lack of funding. Stakeholder relationships should be strengthened. Research and education about decision‐making in the choice between public and private ED attendance should be encouraged, particularly regarding paramedic advice to patients. Finally, patients who have purchased private insurance should be able to utilise it during evaluation of an acute illness. [ABSTRACT FROM AUTHOR]