117 results on '"Van Gool, K."'
Search Results
2. Adapting Portfolio Theory for the Evaluation of Multiple Investments in Health with a Multiplicative Extension for Treatment Synergies
- Author
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Bridges, J. F. P., Stewart, M., King, M. T., and van Gool, K.
- Published
- 2002
3. Towards actionable international comparisons of health system performance : expert revision of the OECD framework and quality indicators
- Author
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CARINCI, F., VAN GOOL, K., MAINZ, J., VEILLARD, J., PICHORA, E. C., JANUEL, J. M., ARISPE, I., KIM, S. M., and KLAZINGA, N. S.
- Published
- 2015
4. The link between out-of-pocket costs and inequality in specialist care in Australia
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Pulok, MH, van Gool, K, and Hall, J
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National Health Programs ,Australia ,Humans ,Public Health ,1110 Nursing, 1117 Public Health and Health Services, 1605 Policy and Administration ,Aged - Abstract
Objective Out-of-pocket (OOP) costs could act as a potential barrier to accessing specialist services, particularly among low-income patients. The aim of this study is to examine the link between OOP costs and socioeconomic inequality in specialist services in Australia. Methods This study is based on population-level data from the Medicare Benefits Schedule of Australia in 2014-15. Three outcomes of specialist care were used: all visits, visits without OOP costs (bulk-billed services), and visits with OOP costs. Logistic and zero-inflated negative binomial regression models were used to examine the association between outcome variables and area-level socioeconomic status after controlling for age, sex, state of residence, and geographic remoteness. The concentration index was used to quantify the extent of inequality. Results Our results indicate that the distribution of specialist visits favoured the people living in wealthier areas of Australia. There was a pro-rich inequality in specialist visits associated with OOP costs. However, the distribution of the visits incurring zero OOP cost was slightly favourable to the people living in lower socioeconomic areas. The pro-poor distribution of visits with zero OOP cost was insufficient to offset the pro-rich distribution among the visits with OOP costs. Conclusions OOP costs for specialist care might partly undermine the equity principle of Medicare in Australia. This presents a challenge to the government on how best to influence the rate and distribution of specialists' services.
- Published
- 2022
5. Non-IgE-Mediated Rhinitis
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Van Gool, K. and Hox, V.
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- 2015
- Full Text
- View/download PDF
6. Pricing Long-term Care for Older Persons. Australian Case Study
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Wise, S, Woods, M, and Van Gool, K
- Published
- 2021
7. How much of Australia's health expenditure is allocated to general practice and primary healthcare?
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Wright, M, Versteeg, R, and van Gool, K
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Primary Health Care ,General Practice ,Australia ,Humans ,Health Expenditures ,behavioral disciplines and activities - Abstract
ackground and objectives Understanding resource allocation is important to ensure that limited health resources are spent where they bring the greatest benefit. The aim of this study was to explore how much of Australia’s national health expenditure is allocated specifically to general practice services, and more broadly to primary healthcare (PHC) services. Methods This study used multiple Australian institutional reports – produced by the Australian Institute of Health and Welfare, Productivity Commission and Services Australia – to classify, compare and quantify general practice and PHC expenditure. Results National statistics report that approximately 34% of Australian health expenditure is spent on PHC. However, less than 20% of PHC expenditure (approximately 6.5% of total health expenditure) is allocated to delivering general practice services. Spending on general practitioners and general practice services varies between 4.2% and 6.8% of total health expenditure (between $7.8 billion and $12.4 billion) depending on the classification used. Discussion Significant differences exist in how different institutions classify general practice and PHC spending. Clearer, agreed and more precise methods of classification and reporting of health expenditure are needed.
- Published
- 2021
8. Health care use in response to health shocks: Does socio-economic status matter?
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Fiebig, DG, van Gool, K, Hall, J, and Mu, C
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1117 Public Health and Health Services, 1402 Applied Economics, 1403 Econometrics ,Health Policy & Services - Abstract
We investigate how utilization of primary care, specialist care, and emergency department (ED) care (and the mix across the three) changes in response to a change in health need. We determine whether any changes in utilization are impacted by socio-economic status. The use of a unique Australian data set that consists of a large survey linked to multiple years of detailed administrative records enables us to better control for individual heterogeneity and allows us to exploit changes in health that are related to the onset of two health shocks: a new diagnosis of diabetes and heart disease. We extend the analysis by also examining changes to patient out-of-pocket costs. We find significant differences in the mix between primary and specialist care use according to income and type of health shock but no evidence of using ED as a substitute for other care. Our results indicate that low- and high-income patients navigate very different pathways for their care following the onset of diabetes and to a lesser extent heart disease. These pathways appear to be chosen on the basis of ability to pay, rather than the most effective or efficient bundle of care delivered through a combination of GP and specialist care.
- Published
- 2021
9. International comparison of spending and utilization at the end of life for hip fracture patients
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Blankart, CR, van Gool, K, Papanicolas, I, Bernal-Delgado, E, Bowden, N, Estupiñán-Romero, F, Gauld, R, Knight, H, Abiona, O, Riley, K, Schoenfeld, AJ, Shatrov, K, Wodchis, WP, Figueroa, JF, and ICCONIC Collaboration
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Aged, 80 and over ,Cross-Cultural Comparison ,Male ,Terminal Care ,Hip Fractures ,Developed Countries ,Australia ,Health Care Costs ,Patient Acceptance of Health Care ,Europe ,Hospitalization ,Insurance Claim Review ,Sex Factors ,North America ,Health Policy & Services ,1117 Public Health and Health Services, 1605 Policy and Administration ,Humans ,Female ,Longitudinal Studies ,Aged ,Retrospective Studies - Abstract
ObjectiveTo identify and explore differences in spending and utilization of key health services at the end of life among hip fracture patients across seven developed countries.Data sourcesIndividual-level claims data from the inpatient and outpatient health care sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC).Study designWe retrospectively analyzed utilization and spending from acute hospital care, emergency department, outpatient primary care and specialty physician visits, and outpatient drugs. Patterns of spending and utilization were compared in the last 30, 90, and 180 days across Australia, Canada, England, Germany, New Zealand, Spain, and the United States. We employed linear regression models to measure age- and sex-specific effects within and across countries. In addition, we analyzed hospital-centricity, that is, the days spent in hospital and site of death.Data collection/extraction methodsWe identified patients who sustained a hip fracture in 2016 and died within 12 months from date of admission.Principal findingsResource use, costs, and the proportion of deaths in hospital showed large variability being high in England and Spain, while low in New Zealand. Days in hospital significantly decreased with increasing age in Canada, Germany, Spain, and the United States. Hospital spending near date of death was significantly lower for women in Canada, Germany, and the United States. The age gradient and the sex effect were less pronounced in utilization and spending of emergency care, outpatient care, and drugs.ConclusionsAcross seven countries, we find important variations in end-of-life care for patients who sustained a hip fracture, with some differences explained by sex and age. Our work sheds important insights that may help ongoing health policy discussions on equity, efficiency, and reimbursement in health care systems.
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- 2021
10. Personal protection and delivery of rhinologic and endoscopic skull base procedures during the COVID-19 outbreak: ERS endorsed advises
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Van Gerven, L., Hellings, P. W., Cox, T., Fokkens, W., Hopkins, C., Hox, V, Jorissen, M., Schuermans, A., Sinonquel, P., Speleman, K., Vander Poorten, V., Van Gool, K., Van Zele, T., Alobid, I, Ear, Nose and Throat, AII - Inflammatory diseases, COX, Tony, Vander Poorten, V, Alobid, I, Van Gerven, L, Van Gool, K, Schuermans, A, Van Zele, T, Jorissen, M, Hopkins, C, Hox, V, Speleman, K, Sinonquel, P, Hellings, PW, and Fokkens, W
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SARS-CoV-2 ,Infection prevention ,Personal protective equipment ,COVID-19 ,Skull base surgery ,Human medicine ,Rhinology ,Endoscopic surgery - Abstract
On March 11th 2020, the World Health Organization (WHO) declared COVID-19 pandemic, with subsequent profound impact on the entire health care system. During the COVID-19 outbreak, activities in the rhinology outpatient clinic and operation rooms are limited to emergency care only. Health care practitioners are faced with the need to perform rhinological and skull base emergency procedures in patients with a positive or unknown COVID-19 status. This article aims to provide recommendations and relevant information for rhinologists, based on the limited amount of (anecdotal) data, to guarantee high-quality patient care and adequate levels of infection prevention in the rhinology clinic.
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- 2020
11. Payment reform for value-based health care: challenges for Australia
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Wise, S, Hall, J, Haywood, P, Nikita, K, Hussain, L, and Van Gool, K
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- 2021
12. Horizontal inequity in the utilisation of healthcare services in Australia
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Pulok MH, van Gool K, and Hall J
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Health Policy & Services ,1117 Public Health and Health Services, 1605 Policy and Administration - Abstract
The Australian universal healthcare system aims to ensure affordable and equitable use of healthcare services based on individual health needs. This paper presents empirical evidence on the extent of horizontal inequity (HI) in healthcare services (unequal utilisation by income for equal need) in Australia during the period of promoting reliance on private healthcare financing. Using data from the most recent Australian National Health Survey of 2011-12 and 2014-15, we examined and measured the extent of HI in eight indicators of out-of-hospital services and hospital-related care. Contrary to earlier studies, our results show a small but pro-rich inequity in the probability of general practitioner visits. Inequity in the distribution of specialist and dentist visits was in favour of richer people, a result that is commonly found in other developed countries and is also consistent with existing Australian evidence. Hospital-related care was equitably distributed compared to the pro-poor pattern found in earlier studies. Despite the universal health insurance system in Australia, there was inequity in the utilisation of needed healthcare services. Our evidence is relevant to similar health systems as governments move to higher out-of-pocket payments and other private sources to reduce pressure on public healthcare expenditure.
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- 2020
13. Improving outcomes for marginalised rural families through an care navigator program
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Kirby S, Edwards K, Yu S, van Gool K, Powell-Davies G, Harris-Roxas B, Gresham E, Harris M, and Hall J
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Public Health ,1117 Public Health and Health Services - Abstract
ISSUES ADDRESSED:Health promotion programs are based on the premise that health and well-being is impacted by a person's living circumstances, not just factors within the health arena. Chronic health issues require integrated services from health and social services. Navigator positions are effective in assisting chronic disease patients to access services. This family program in a small rural town in Western New South Wales targeted marginalised families with children under five years of age with a chronic health issue. The navigator developed a cross sectoral care plan to provide services to address family issues. The study aimed to identify navigator factors supporting improved family outcomes. METHODS:Participants included parent/clients (n=4) and the cross sectoral professional team (n=9) involved in the program. During the interview, participants were asked about their perspective of the program. Interview transcripts were thematically analysed informed by the Chronic Care Model underpinned by Health Promotion Theory. RESULTS:The program improved client family's lives in relation to children's health and other family health and social issues. Trust in the care navigator was the most important factor for parents to join engage with the program. The care navigator role was essential to maintaining client engagement and supporting cooperation between services to support families. CONCLUSION:Essential care navigator skills were commitment, ability to persuade and empower parents and other professionals. SO WHAT?: This descriptive study demonstrated the positive influence of the care navigator and the program on high risk families in a small isolated community. It can be adopted by other community to improve life for families at risk.
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- 2020
14. Inequity in physician visits: the case of the unregulated fee market in Australia
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Pulok, M, Van Gool, K, and Hall, J
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11 Medical and Health Sciences, 14 Economics, 16 Studies in Human Society ,Public Health - Abstract
Equity is one of the key goals of universal healthcare coverage (UHC). Achieving this goal does not just depend on the presence of UHC, but also on its design and organisation. In Australia, out-of-hospital medical services are provided by private physicians in a market where fees are unregulated. This makes an interesting case to study equity. Using data from the Australian National Health Survey of 2014–15, we distinguish between the probability of any visit and the number of visits conditional on having any visit to analyse income-related inequity in general practitioner (GP) and specialist visits. We apply the horizontal inequity approach to measure the extent of inequity, and the decomposition method to explain the factors accounting for inequity. Our results show a small pro-rich inequity in the probability of any GP visit, but the distribution of conditional GP visits was concentrated among the poor. Inequity in the probability of any specialist visit was pro-rich. However, there was almost no inequity in conditional specialist visits. We find holding a concession card explained pro-poor inequity while income, education, and private health insurance contributed to pro-rich inequity in specialist visits. Although Australia has a universal health insurance system, there is unequal use (adjusted for health need) of physician services by socioeconomic status. This has implications for insurance design in other countries.
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- 2020
15. Measuring horizontal inequity in healthcare utilisation: A review of methodological developments and debates
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Pulok, M, Van Gool, K, Hall, J, and Allin, S
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1117 Public Health and Health Services, 1402 Applied Economics ,Health Policy & Services - Abstract
Equity in healthcare is an overarching goal of many healthcare systems around the world. Empirical studies of equity in healthcare utilisation primarily rely on the horizontal inequity (HI) approach which measures unequal utilisation of healthcare services by socioeconomic status (SES) for equal medical need. The HI method examines, quantifies, and explains inequity which is based on regression analysis, the concentration index, and the decomposition technique. However, this method is not beyond limitations and criticisms, and it has been subject to several methodological challenges in the past decade. This review presents a summary of the recent developments and debates on various methodological issues and their implications on the assessment of HI in healthcare utilisation. We discuss the key disputes centred on measurement scale of healthcare variables as well as the evolution of the decomposition technique. We also highlight the issues about the choice of variables as the indicator of SES in measuring inequity. This follows a discussion on the application of the longitudinal method and use of administrative data to quantify inequity. Future research could exploit the potential for health administrative data linked to social data to generate more comprehensive estimates of inequity across the healthcare continuum. This review would be helpful to guide future applied research to examine inequity in healthcare utilisation.
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- 2019
16. Failure to access prescribed pharmaceuticals by older patients with chronic conditions
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McRae I, Van Gool K, Hall J, Yen L, and Wright M
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Adult ,Aged, 80 and over ,Male ,Prescription Drugs ,Health Care Costs ,1110 Nursing, 1117 Public Health and Health Services, 1605 Policy and Administration ,Middle Aged ,Insurance Coverage ,Medication Adherence ,Chronic Disease ,Humans ,Female ,Public Health ,New South Wales ,Aged - Abstract
Objective Medication adherence is a significant public health concern. Australian studies of statins show patients facing the highest copayments are the least likely to be adherent. This study examined whether the association identified between adherence and costs for statins also applies to a wider group of medications prescribed for Australian patients with chronic conditions. Methods Data from 267086 participants in the Sax Institute's 45 and Up Study linked to data from the Pharmaceutical Benefits Scheme (PBS) provided by the Department of Human Services were used. Patients using angiotensin II receptor blockers, angiotensin-converting enzyme inhibitors, glitazones and bisphosphonates were identified and classified according to concessional status and whether they had access to the PBS 'safety net'. Data were analysed using mainly descriptive methods to investigate the association of adherence with cost and other selected covariates. Results Across medications, the group facing the highest copayment was least adherent. Speaking a language other than English at home and facing high levels of psychological distress were also associated with lower levels of adherence. Conclusions As for statins, the main financial determinant of adherence is cost in the form of prescribed copayments, suggesting that this may apply across many medications. What is known about the topic? Previous studies have shown patients' concern about the costs of pharmaceuticals, and more detailed studies of statins show that the lowest adherence relates to patients facing the highest copayments. What does this paper add? This paper provides support for the contention that the results found for statins broadly apply across more medications used by people with chronic conditions. What are the implications for practitioners? Although practitioners cannot affect legislated copayments, they can consider the costs of options for medications for patients with chronic conditions, especially those general patients who have not reached the safety net, and they can be aware that patients from homes where English is not spoken and patients with high levels of psychological distress are also likely to have low adherence without intervention.
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- 2018
17. Palliative care in residential aged care: Identifying and funding palliative care needs in Australia
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Lemmon, E, Woods, MC, and Van Gool, K
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- 2018
18. Palliative care in community care: Identifying and funding palliative care needs in Australia
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Lemmon, E, Woods, MC, and Van Gool, K
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- 2018
19. Towards actionable international comparisons of health system performance: expert revision of the OECD framework and quality indicators
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Carinci, F., Van Gool, K., Mainz, J., Veillard, J., Pichora, E. C., Januel, J. M., Arispe, I., Kim, S. M., Klazinga, N.S., Haelterman, M., Meeus, P., Lacroix, J., Cenek, J., Barsøe, C.R., Grau, K., Rooväli, L., Hämaläinen, P., Garcia, V., Grenier, C., Le Cossec, B., Marbach, M., Scheidt-Nave, C., Mulholland, D., Ekka-Zohar, A., Kumakawa, T., Okamoto, E., Byeon, E.H., Kim, K.H., Park, C.S., Lepiksone, J., Berthet, F., Margue, C., Van Den Berg, M., Lindahl, A.K., Narbuvold, H., Dudzik-Urbaniak, E., Boto, P., Lim, E.K., Mok, W.Y., Pribakovic, R., Gogorcena, M. A., Aggestam, M., Köster, M., Lawrence, M., Langenegger, M., Fehst, K., Yilmaz, S., Everard, K., and Raleigh, V.
- Abstract
Objective To review and update the conceptual framework, indicator content and research priorities of the Organisation for Economic Cooperation and Development's (OECD) Health Care Quality Indicators (HCQI) project, after a decade of collaborative work. Design A structured assessment was carried out using a modified Delphi approach, followed by a consensus meeting, to assess the suite of HCQI for international comparisons, agree on revisions to the original framework and set priorities for research and development. Setting International group of countries participating to OECD projects. Participants Members of the OECD HCQI expert group. Results A reference matrix, based on a revised performance framework, was used to map and assess all seventy HCQI routinely calculated by the OECD expert group. A total of 21 indicators were agreed to be excluded, due to the following concerns: (i) relevance, (ii) international comparability, particularly where heterogeneous coding practices might induce bias, (iii) feasibility, when the number of countries able to report was limited and the added value did not justify sustained effort and (iv) actionability, for indicators that were unlikely to improve on the basis of targeted policy interventions. Conclusions The revised OECD framework for HCQI represents a new milestone of a long-standing international collaboration among a group of countries committed to building common ground for performance measurement. The expert group believes that the continuation of this work is paramount to provide decision makers with a validated toolbox to directly act on quality improvement strategies
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- 2017
20. The rise and fall in out-of-pocket costs in Australia: An analysis of the Strengthening Medicare Reforms
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Wong, C, Greene, J, Dolja-Gore, X, and van Gool, K
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Health Policy & Services - Published
- 2017
21. EUFOREA Rhinology Research Forum 2016:report of the brainstorming sessions on needs and priorities in rhinitis and rhinosinusitis
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Hellings, P W, Akdis, C A, Bachert, C, Bousquet, J., Pugin, B, Adriaensen, G, Advani, R, Agache, I, Anjo, C, Anmolsingh, R, Annoni, E, Bieber, T, Bizaki, A, Braverman, I, Callebaut, I, Castillo Vizuete, J A, Chalermwatanachai, T, Chmielewski, R, Cingi, Cemal, Cools, L, Coppije, C, Cornet, M E, De Boeck, I, De Corso, E, De Greve, G, Doulaptsi, M, Edmiston, R, Erskine, S, Gevaert, E, Gevaert, P, Golebski, K, Hopkins, C, Hox, V, Jaeggi, C, Joos, G, Khwaja, Tina Storm, Kjeldsen, Anette Drøhse, Klimek, L, Koennecke, M, Kortekaas Krohn, I, Krysko, O, Kumar, Bernadette Nimal, Langdon, C, Lange, B, Lekakis, G, Levie, P, Lourijsen, E, Lund, V J, Martens, Kerstin, Mösges, R, Mullol, J., Nyembue, T D, Palkonen, S, Philpott, C, Aguilar-Pimentel, Juan A, Poirrier, A, Pratas, A C, Prokopakis, E, Pujols, L, Rombaux, P, Schmidt-Weber, C B, Segboer, C, Spacova, I, Staikuniene, J, Steelant, B, Steinsvik, E A, Teufelberger, A, Van Gerven, Luuk P A, Van Gool, K., Verbrugge, R, Verhaeghe, B, Virkkula, P, Vlaminck, S, Vries-Uss, E, Wagenmann, M, Zuberbier, T, Seys, S F, and Fokkens, W J
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Care pathway ,Rhinosinusitis ,Research ,Precision medicine ,Rhinitis - Abstract
The first European Rhinology Research Forum organized by the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) was held in the Royal Academy of Medicine in Brussels on 17th and 18th November 2016, in collaboration with the European Rhinologic Society (ERS) and the Global Allergy and Asthma European Network (GA2LEN). One hundred and thirty participants (medical doctors from different specialties, researchers, as well as patients and industry representatives) from 27 countries took part in the multiple perspective discussions including brainstorming sessions on care pathways and research needs in rhinitis and rhinosinusitis. The debates started with an overview of the current state of the art, including weaknesses and strengths of the current practices, followed by the identification of essential research needs, thoroughly integrated in the context of Precision Medicine (PM), with personalized care, prediction of success of treatment, participation of the patient and prevention of disease as key principles for improving current clinical practices. This report provides a concise summary of the outcomes of the brainstorming sessions of the European Rhinology Research Forum 2016.
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- 2017
22. EUFOREA Rhinology Research Forum 2016: report of the brainstorming sessions on needs and priorities in rhinitis and rhinosinusitis
- Author
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Hellings, PW, Akdis, CA, Bachert, C, Bousquet, J, Pugin, B, Adriaensen, G, Advani, R, Agache, I, Anjo, C, Anmolsingh, R, Annoni, E, Bieber, T, Bizaki, A, Braverman, I, Callebaut, I, Castillo Vizuete, JA, Chalermwatanachai, T, Chmielewski, R, Cingi, C, Cools, L, Coppije, C, Cornet, M, De Boeck, I, De Corso, E, De Greve, G, Doulaptsi, M, Erskine, S, Gevaert, E, Gevaert, P, Golebski, K, Hopkins, C, Hox, V, Jaeggi, C, Joos, G, Khwaja, S, Kjeldsen, A, Klimek, L, Koennecke, M, Kortekaas Krohn, I, Krysko, O, Kumar, BN, Langdon, C, Lange, B, Lekakis, G, Levie, P, Lourijsen, E, Lund, V, Martens, K, Mösges, R, Mullol, J, Nyembue, TD, Palkonen, S, Philpott, C, Pimentel, J, Poirrier, A, Pratas, AC, Prokopakis, E, Pujols, L, Rombaux, P, Schmidt-Weber, C, Segboer, C, Spacova, I, Staikuniene, J, Steelant, B, Steinsvik, EA, Teufelberger, A, Van Gerven, L, Van Gool, K, Verbrugge, R, Verhaeghe, B, Virkkula, P, Vlaminck, S, Vries-Uss, E, Wagenmann, M, Zuberbier, T, Seys, SF, and Fokkens, WJ
- Abstract
The first European Rhinology Research Forum organized by the European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) was held in the Royal Academy of Medicine in Brussels on 17th and 18th November 2016, in collaboration with the European Rhinologic Society (ERS) and the Global Allergy and Asthma European Network (GA2LEN). One hundred and thirty participants (medical doctors from different specialties, researchers, as well as patients and industry representatives) from 27 countries took part in the multiple perspective discussions including brainstorming sessions on care pathways and research needs in rhinitis and rhinosinusitis. The debates started with an overview of the current state of the art, including weaknesses and strengths of the current practices, followed by the identification of essential research needs, thoroughly integrated in the context of Precision Medicine (PM), with personalized care, prediction of success of treatment, participation of the patient and prevention of disease as key principles for improving current clinical practices. This report provides a concise summary of the outcomes of the brainstorming sessions of the European Rhinology Research Forum 2016.
- Published
- 2017
23. Informing the Design of Weight Loss Programs Using a Discrete Choice Experiment
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Church, J, primary, Goodall, S, additional, Mulhern, B, additional, van Gool, K, additional, and Haas, M, additional
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- 2018
- Full Text
- View/download PDF
24. EUFOREA Rhinology Research Forum 2017: report of the brainstorming sessions on endotype-driven treatment, patient empowerment and digital future in airways care
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Lund, V.J., primary, Hopkins, C., additional, Akdis, C., additional, Bachert, C., additional, Bousquet, J., additional, Fokkens, W.J., additional, Seys, S., additional, Van Gerven, L., additional, Akdis, M., additional, Ban, G.Y., additional, Biswas, K., additional, Boscke, R., additional, Boeva, V., additional, Canonica, G.W., additional, Castillo, J.A., additional, Chung, S.K., additional, Claes, J.A.M., additional, Cools, L., additional, De Carlo, G., additional, De Corso, E., additional, Djandji, M., additional, Doulaptsi, M., additional, Feijen, J., additional, Gallo, S., additional, Gane, S., additional, Gevaert, P., additional, Golebski, K., additional, Halewyck, S., additional, Hummel, T., additional, Izquierdo, I., additional, Jagerschmidt, A., additional, Joos, G.F., additional, Kjeldsen, A.D., additional, Kloeck, I., additional, Koennecke, M., additional, Kokorina, O., additional, Koren, I., additional, Kortekaas-Krohn, I., additional, Krysko, O., additional, Landis, B.N., additional, Lange, B., additional, Launders, N., additional, Lee, J., additional, Lekakis, G., additional, Mannent, L., additional, Martens, K., additional, Morghenti, D., additional, Mullol, J., additional, Murray, R., additional, O'Sullivan, D., additional, Philpott, C., additional, Popov, T.A., additional, Prokopakis, E., additional, Rombaux, P., additional, Rondon, C., additional, Rowe, P.J., additional, Seyed-Tabib, N.S., additional, Sleurs, K., additional, Speleman, K.J.S., additional, Staikuniene, J., additional, Steelant, B., additional, Talavera-Perez, K., additional, Taube, C., additional, Toppila-Salmi, S., additional, Tran-Le, T., additional, Vaitkus, J., additional, Vaitkus, S., additional, Van Gool, K., additional, Van Hoolst, A., additional, Verbrugge, R., additional, Verhaeghe, B., additional, Vlaminck, S., additional, Wagenmann, M., additional, Zuberbier, T., additional, Tasman, A.-J., additional, Pugin, B., additional, and Hellings, P.W., additional
- Published
- 2018
- Full Text
- View/download PDF
25. Evaluating the impact of hospital based drug and alcohol consultation liaison services
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Reeve, R, Arora, S, Butler, K, Viney, R, Burns, L, Goodall, S, and van Gool, K
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Adult ,Aged, 80 and over ,Male ,Adolescent ,Substance-Related Disorders ,Substance Abuse ,Interrupted Time Series Analysis ,Middle Aged ,Health Services Accessibility ,Hospitalization ,Alcoholism ,Young Adult ,Treatment Outcome ,Surveys and Questionnaires ,Costs and Cost Analysis ,Humans ,Female ,New South Wales ,Emergency Service, Hospital ,Referral and Consultation ,Aged - Abstract
© 2016 Elsevier Inc. Consultation liaison (CL) services provide direct access to specialist services for support, treatment advice and assistance with the management of a given condition. Alcohol and other drugs (AOD) CL services aim to improve identification and treatment of patients with AOD morbidity. Our objective was to evaluate the costs and consequences of AOD CL services in hospitals in New South Wales, Australia. Patients were surveyed at eight hospitals and problematic AOD use was identified using the Alcohol, Smoking and Substance Involvement Screening Test (n = 1615). For consenting participants, medical record data were obtained from 18 months pre- to 12 months post-survey. We used interrupted time series analyses to compare utilization and costs for patients with and without AOD problems and changes over time between those who received AOD CL and similar patients. Approximately 35% of patients surveyed had AOD problems (excluding tobacco) with 7% requiring intensive treatment. Only 24% of patients requiring intensive treatment were treated by AOD CL. Those treated had relative improvements over time in the cost of presentations to emergency departments, emergency admission performance and increased uptake of appropriate pharmaceuticals. The estimated net benefit of AOD CL services was at least AUD$100,000 savings per hospital per year. Expanding AOD CL services to address current unmet need may lead to even greater cost savings for hospitals.
- Published
- 2016
26. Bleeding Hearts, Profiteers, or Both: Specialist Physician Fees in an Unregulated Market
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Johar, M, Mu, C, Van Gool, K, and Wong, CY
- Subjects
Adult ,Male ,Insurance, Health ,Australia ,Middle Aged ,Insurance Claim Review ,Fees, Medical ,Surveys and Questionnaires ,Health Policy & Services ,Income ,Humans ,Medicine ,Female ,Poverty ,Referral and Consultation ,Specialization - Abstract
Copyright © 2016 John Wiley & Sons, Ltd. This study shows that, in an unregulated fee-setting environment, specialist physicians practise price discrimination on the basis of their patients' income status. Our results are consistent with profit maximisation behaviour by specialists. These findings are based on a large population survey that is linked to administrative medical claims records. We find that, for an initial consultation, specialist physicians charge their high-income patients AU$26 more than their low-income patients. While this gap equates to a 19% lower fees for the poorest patients (bottom 25% of the household income distribution), it is unlikely to remove the substantial financial barriers they face in accessing specialist care. There are large variations across specialties, with neurologists exhibiting the largest fee gap between the high-income and low-income patients. Several possible channels for deducing the patient's income are examined. We find that patient characteristics such as age, health concession card status and private health insurance status are all used by specialists as proxies for income status. These characteristics are particularly important to further practise price discrimination among the low-income patients but are less relevant for the high-income patients. Copyright © 2016 John Wiley & Sons, Ltd.
- Published
- 2015
27. EUFOREA Rhinology Research Forum 2016: report of the brainstorming sessions on needs and priorities in rhinitis and rhinosinusitis
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Hellings, P.W., primary, Akdis, C.A., additional, Bachert, C., additional, Bousquet, J., additional, Pugin, B., additional, Adriaensen, G., additional, Advani, R., additional, Agache, I., additional, Anjo, C., additional, Anmolsingh, R., additional, Annoni, E., additional, Bieber, T., additional, Bizaki, A., additional, Braverman, I., additional, Callebaut, I., additional, Castillo Vizuete, J.A., additional, Chalermwatanachai, T., additional, Chmielewski, R., additional, Cingi, C., additional, Cools, L., additional, Coppije, C., additional, Cornet, M.E., additional, de Boeck, I., additional, de Corso, E., additional, De Greve, G., additional, Doulaptsi, M., additional, Edmiston, R., additional, Erskine, S., additional, Gevaert, E., additional, Gevaert, P., additional, Golebski, K., additional, Hopkins, C., additional, Hox, V., additional, Jaeggi, C., additional, Joos, G., additional, Khwaja, S., additional, Kjeldsen, A., additional, Klimek, L., additional, Koennecke, M., additional, Kortekaas Krohn, I., additional, Krysko, O., additional, Kumar, B.N., additional, Langdon, C., additional, Lange, B., additional, Lekakis, G., additional, Levie, P., additional, Lourijsen, E., additional, Lund, V.J., additional, Martens, K., additional, Mösgens, R., additional, Mullol, J., additional, Nyembue, T.D., additional, Palkonen, S., additional, Philpott, C., additional, Pimentel, J., additional, Poirrier, A., additional, Pratas, A.C., additional, Prokopakis, E., additional, Pujols, L., additional, Rombaux, P., additional, Schmidt-Weber, C., additional, Segboer, C., additional, Spacova, I, additional, Staikuniene, J., additional, Steelant, B., additional, Steinsvik, E.A., additional, Teufelberger, A., additional, van Gerven, L., additional, van Gool, K., additional, Verbrugge, R., additional, Verhaeghe, B., additional, Virkkula, P., additional, Vlaminck, S., additional, Vries-Uss, E., additional, Wagenmann, M., additional, Zuberbier, T., additional, Seys, S.F., additional, and Fokkens, W.J., additional
- Published
- 2017
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28. The hidden costs of drug and alcohol use in hospital emergency departments
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Butler, K, Reeve, R, Arora, S, Viney, R, Goodall, S, van Gool, K, and Burns, L
- Subjects
Adult ,Aged, 80 and over ,Male ,Adolescent ,Substance-Related Disorders ,Hospitals, Public ,Substance Abuse ,Length of Stay ,Middle Aged ,Hospitalization ,Young Adult ,Surveys and Questionnaires ,Prevalence ,Humans ,Female ,New South Wales ,Emergency Service, Hospital ,Alcohol-Related Disorders ,Aged - Abstract
© 2016 Australasian Professional Society on Alcohol and other Drugs. Introduction and Aims: This study estimates the burden of drug and alcohol morbidity on hospitals in New South Wales (NSW) by observing a multi-site collective sample utilising survey information and data linkage. Specifically we aimed to determine the prevalence of alcohol and other drug (AOD) problems and to estimate patterns of utilisation of hospital services, costs of presentations, and admissions for patients with AOD problems. Design and Methods: Patients were recruited from eight NSW public hospitals presenting to the hospital emergency department over a 10 day period. Participants completed a self-administered survey with demographic characteristics and questions about substance use. More than two-thirds (68%) of participants consented to provide access to their NSW Health medical data for a period spanning 2.5 years. Results: One-third (35%) of the total sample were identified as having problematic AOD use with one in five of these patients requiring a high level of intervention. Those patients requiring a high level of intervention present more often and cost more per presentation. If admitted they were more likely to have longer stays and were also more likely to be admitted to a psychiatric ward and have a longer stay in the ward. Discussion: This study demonstrates a need for AOD interventions in the emergency department setting, both because it represents an opportunity for intervention in a population in which problems with substance use is highly prevalent, and because there is evidence that AOD imposes additional costs on the health system.
- Published
- 2015
29. Health, austerity and the economic crisis: assessing the short-term impact in OECD countries
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Van Gool, K
- Published
- 2014
30. Evaluation of NSW Health Drug and Alcohol Consultation Liaison Services. Report for the Mental Health Drug and Alcohol Office (MHDAO)
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Reeve, R, Arora, S, Viney, R, Goodall, S, van Gool, K, Knox, S, and Kenny, PM
- Published
- 2014
31. PSY19 - Informing the Design of Weight Loss Programs Using a Discrete Choice Experiment
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Church, J, Goodall, S, Mulhern, B, van Gool, K, and Haas, M
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- 2018
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32. Surgeon's veiws of health technology assessment in Australia: Online pilot survey
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Gallego, G, Van Gool, K, Casey, R, and Maddern, G
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Questionnaires ,Male ,Health Knowledge, Attitudes, Practice ,Internet ,Technology Assessment, Biomedical ,education ,Australia ,Pilot Projects ,Cross-Sectional Studies ,Physicians ,General Surgery ,Surveys and Questionnaires ,Health Policy & Services ,Humans ,Female - Abstract
Introduction: Many governments have introduced health technology assessment (HTA) as an important tool to manage the uptake and use of health-related technologies efficiently. Although surgeons play a central role in the uptake and diffusion of new technologies, little is known about their opinion and understanding of the HTA role and process. Methods: A cross-sectional pilot study was conducted using an online questionnaire which was distributed to Fellows of the Royal Australasian College of Surgeons over a 4-week period. Information was sought about knowledge and views of the HTA process. Descriptive statistics were used to summarize the data, frequencies, and proportions were calculated. Results: Sixty-two surgeons completed the survey; of these, 55 percent reported their primary work place as a public hospital. Twenty-four percent of the participants reported that they had never heard of the HTA agency and 60 percent reported that surgical procedures are most likely to be introduced in the Australian healthcare system at the public hospital level (which is beyond the HTA's scope and dealt with at a state level). However, 61 percent considered that decisions about funding and adoption of new technologies should take place at the national level. Conclusions: This survey provides some evidence that many surgeons remain unaware of the federal government's HTA process but still value evidence-based information. In order for HTA to be an effective aid to rational adoption of health-related technologies, there is a need for an evidence-based approach that is integrated and is accepted and understood by the medical professions. © 2013 Cambridge University Press.
- Published
- 2013
33. Extended Medicare Safety Net review of capping arrangements report 2011: a report by the Centre for Health Economics Research and Evaluation
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Van Gool, K, Savage, EJ, Johar, M, Knox, SA, Jones, G, and Viney, RC
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- 2011
34. Out-of-pocket costs and health care : evidence from Australia's Medicare program
- Author
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Van Gool, K
- Abstract
University of Technology, Sydney. Faculty of Business. NO FULL TEXT AVAILABLE. Access is restricted indefinitely. The hardcopy may be available for consultation at the UTS Library. NO FULL TEXT AVAILABLE. Access is restricted indefinitely. ----- Most Australians face low out-of-pocket (OOP) costs for Medicare-funded services. However, in the mid-1990s these costs started to increase, placing pressure on the Commonwealth Government to act. In 2004 the Government introduced the Strengthening Medicare package, designed to reduce the OOP costs for medical services. This thesis examines the impact of OOP costs on the demand for general practice services and on participation in the cervical screening program. The analysis employs panel data econometric techniques, using both survey and administrative data from the Australian Longitudinal Study of Women’s Health. The thesis also examines the impact of the Strengthening Medicare policy; in particular the Medicare Safety Net. Time discontinuity regressions are used to estimate the impact of the Safety Net on provider charges, Medicare benefits, OOP costs and service use. This thesis finds that the increases in OOP cost have had a small but significant impact on the demand for general practice services. The level of response is dependent on income, with poorer sections of the community being more responsive than wealthier sections. The results also show that people in ill health are just as responsive as people who are healthy. In terms of health investment activities, the role of OOP costs is less clear cut. Nevertheless, there is some evidence that individuals who have faced relatively large increases in OOP costs reduce their compliance with recommended cancer screening intervals. The analysis of the Government’s Medicare Safety Net shows that the policy is regressive and has led to an increase in provider charges amongst some medical professions. In turn, this has resulted in a significant amount of leakage of Medicare benefits towards providers’ pockets, rather than patients’ pockets.
- Published
- 2011
35. The evaluation of Brighter Futures, NSW Community Services' early intervention program: Final report
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Hilferty, F, Mullan, K, Van Gool, K, Chan, S, Eastman, C, Reeve, RD, Heese, K, Haas, MR, Newton, B, Griffiths, M, and Katz, I
- Subjects
sense organs - Abstract
This report presents the findings of the evaluation of the NSW Community Services` early intervention program, Brighter Futures. Brighter Futures is an innovative program, which has changed the practice of child abuse prevention services in NSW. The program has broken new ground nationally and internationally by developing an evidence-based service model; requiring caseworkers to use validated instruments for assessment and reporting; and being delivered through a cross-sectoral partnership between Community Services and non-government organisations. It is also innovative in specifically targeting families who are at most risk of entering the child protection system.
- Published
- 2010
36. Economic evaluation of cystic fibrosis screening: A review of the literature
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Radhakrishnan, M, van Gool, K, Hall, J, Delatycki, M, and Massie, J
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Cystic Fibrosis ,Victoria ,Health Policy & Services ,Humans ,Mass Screening - Abstract
Objectives: To critically examine the economic evidence regarding cystic fibrosis (CF) carrier screening and to understand issues relating to the transferability of international findings to any national context for policy decisions. Methods: A systematic literature search identified 14 studies (out of 29 economic studies on CF) focusing on preconception or prenatal screening between 1990 and 2006. These studies were then assessed against international benchmarks on conducting and reporting of economic evaluations, costing methodology used and focusing on the transferability of the evidence to national contexts. Results: The primary outcome measures varied considerably between studies and there was considerable ambiguity and variation on how costs were estimated. The Incremental Cost Effectiveness Ratio (ICER) and net savings, for preconception and prenatal screening were inconsistent and varied significantly, even after adjusting for timing and exchange rates. Differences in screening participation rates, reproductive choices, test sensitivity, cost of test and lifetime cost of care make up a large part of the ICER variations. Conclusion: The heterogeneity in study design, model inputs and reporting of economic evaluations of CF carrier screening makes comparability and transferability across countries and even within countries difficult. This reinforces the need to assess any technology within the relevant context, and to not simply generalize from reported studies. In turn, this adds to the complex task of making efficient resource allocation decisions in the area of CF carrier screening. Our evaluation adds weight to the calls for revisiting the way economic studies are conducted and reported. © 2007 Elsevier Ireland Ltd. All rights reserved.
- Published
- 2007
37. Adapting portfolio theory for the evaluation of multiple investments in health with a multiplicative extension for treatment synergies
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Bridges, JFP, Stewart, M, King, MT, and Van Gool, K
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education ,Health Policy & Services - Abstract
Portfolio theory is central to the analysis of risk in many areas of economics but is seldom used appropriately in health economics. This contribution examines the use of portfolio theory in the context of cost-effectiveness analysis (CEA). A number of modifications are needed to apply portfolio analysis to the economic evaluation of health care interventions. First, the method of reporting the results of a CEA, and consequently some of the underlying assumptions, needs to be modified. Second, portfolio theory needs to be expressed in terms of effects on individuals aggregated to a population. Finally, one needs to allow for the possibility of synergy between the various health interventions. This paper derives a general formula for a portfolio of health care interventions that allows for synergies between interventions where the population effects are aggregated from individual effects. A number of special cases are also derived to highlight the nature of the formulation of the modified portfolio theory. We conclude that, while modified portfolio theory adds a theoretical foundation to health care evaluations, it may not be operational until estimates of the correlation between interventions are available, and the question of uncertainty is resolved in health care evaluation. Also, while a synergy may be present at the individual level, when aggregated over a large population it may not be significant given the standard assumption of constant returns to scale. © Springer-Verlag 2002.
- Published
- 2002
38. PCN27 THE COST OF CHEMOTHERAPY SIDE EFFECTS
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Pearce, AM, primary, Haas, M, additional, and van Gool, K, additional
- Published
- 2010
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39. From Flying Doctor to Virtual Doctor: An Economic Perspective on Australia's Telemedicine Experience
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van Gool, K, primary, Haas, M R, additional, and Viney, R, additional
- Published
- 2002
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40. Decision makers' perceptions of health technology decision making and priority setting at the institutional level.
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Gallego G, Fowler S, and van Gool K
- Abstract
This study describes health care decision makers' perceptions about decision making processes for the introduction, diffusion and prioritisation of new health technologies at the regional and institutional level. The aim of the study was to aid the design of a new process of technology assessment and decision making for the Northern Sydney and Central Coast Area Health Service (NSCCAHS). Twelve in-depth, semi-structured interviews were conducted with senior health service managers, nurse managers and senior medical clinicians in the NSCCAHS. Interviewees described prioritisation and decision-making processes as 'ad hoc'. Safety and effectiveness were considered the most important criteria in decision making but budgetary consideration often drove decisions about the uptake and diffusion of new technologies. Current dissatisfaction with decision-making processes creates opportunities for reform, including the introduction of consistent local technology assessments. [ABSTRACT FROM AUTHOR]
- Published
- 2008
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41. Impact of time of diagnosis on out-of-pocket costs of cancer treatment, a side effect of health insurance design in Australia.
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Naghsh-Nejad M and van Gool K
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- Humans, Australia, Male, Female, Middle Aged, Insurance, Health economics, Aged, Time Factors, Neoplasms economics, Neoplasms therapy, Health Expenditures statistics & numerical data
- Abstract
The Extended Medicare Safety Net (EMSN) in Australia was designed to provide financial assistance to patients with high out-of-pocket (OOP) costs for medical treatment. The EMSN works on a calendar year basis. Once a patient incurs a specified amount of OOP costs, the EMSN provides additional financial benefits for the remainder of the calendar year. Its design is similar to many types of insurance products that have large deductibles and are applied on a calendar year basis. This study examines if the annual quarter within which a patient is diagnosed with cancer has an impact on the OOP costs incurred for treatment. We use administrative linked data from the Sax Institute's 45 and Up Study. Our results indicate that the timing of cancer diagnosis has a significant impact on OOP costs. Specifically, patients diagnosed in the fourth quarter of the calendar year experience significantly higher OOP costs compared to those diagnosed in the first quarter of the year. This pattern persists after controlling for different types of cancer and different stages of cancer and robustness checks. These findings have important implications for the design of the EMSN, as well as other insurance products., Competing Interests: Declaration of competing interest The authors have no conflict of interest., (Copyright © 2024. Published by Elsevier B.V.)
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- 2024
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42. Physician responses to insurance benefit restrictions: The case of ophthalmology.
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Abiona O, Haywood P, Yu S, Hall J, Fiebig DG, and van Gool K
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- Humans, United States, Insurance Benefits, Fees, Medical, Fees and Charges, Ophthalmology, Physicians
- Abstract
This study examines the impact of social insurance benefit restrictions on physician behaviour, using ophthalmologists as a case study. We examine whether ophthalmologists use their market power to alter their fees and rebates across services to compensate for potential policy-induced income losses. The results show that ophthalmologists substantially reduced their fees and rebates for services directly targeted by the benefit restriction compared to other medical specialists' fees and rebates. There is also some evidence that they increased their fees for services that were not targeted. High-fee charging ophthalmologists exhibited larger fee and rebate responses while the low-fee charging group raise their rebates to match the reference price provided by the policy environment., (© 2024 The Authors. Health Economics published by John Wiley & Sons Ltd.)
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- 2024
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43. Specialist Palliative Care and Health Care Costs at the End of Life.
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Kenny P, Liu D, Fiebig D, Hall J, Millican J, Aranda S, van Gool K, and Haywood P
- Abstract
Background/aims: The use and costs of health care rise substantially in the months prior to death, and although the use of palliative care services may be expected to lead to less costly care, the evidence is mixed. We analysed the costs of care over the last year of life and the extent to which these are associated with the use and duration of specialist palliative care (SPC) for decedents who died from cancer or another life-limiting illness., Methods: The decedents were participants in a cohort study of older residents of the state of New South Wales, Australia. Using linked survey and administrative health data from 2007 to 2016, two cohorts were identified: n = 10,535 where the cause of death was cancer; and n = 11,179 where the cause of death was another life-limiting illness. Costs of various types were analysed with separate risk-adjusted linear regression models for the last 1, 3, 6, 9 and 12 months before death and for both cohorts. SPC was categorised according to time to death from first contact with the service as 1-7 days, 7-30 days, 30-180 days and more than 180 days., Results: SPC use was higher among the cancer cohort (30.0%) relative to the non-cancer cohort (4.8%). The mean costs over the final year of life were AU$55,037 (SD 45,059) for the cancer cohort and AU$35,318 (SD 41,948) for the non-cancer cohort. Earlier use of SPC was associated with higher costs over the last year of life but lower costs in the last 1 and 3 months for both cohorts. Initiating SPC use more than 180 days before death was associated with a mean difference relative to the no SPC group of AU$15,590 (95% CI 10,617 to 20,562) and AU$13,739 (95% CI 733 to 26,746) over the last year of life for those dying from cancer and another illness, respectively. The same differences over the last month of life were - AU$2810 (95% CI - 3945 to - 1676) and - AU$4345 (95% CI - 6625 to - 2066). Admitted hospital care was the major driver of costs, with longer SPC associated with lower rates of death in hospital for both cohorts., Conclusion: Early initiation of SPC was associated with higher costs over the last year of life and lower costs over the last months of life. This was the case for both the cancer and non-cancer cohorts, and appeared to be largely attributed to reduced hospitalisation. Although further investigation is required, our results suggest that expanding the availability of SPC services to provide more equitable access could enable patients to spend more time at their usual place of residence, reduce pressure on inpatient services and facilitate death at home when that is preferred., (© 2023. The Author(s).)
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- 2024
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44. Two Cases of Atraumatic Laryngeal Fractures.
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Feijen J, Verguts M, Van Gool K, Maryn Y, Bernaerts A, De Foer B, and van Dinther JJS
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- Male, Humans, Adult, Sneezing, Thyroid Cartilage, Adrenal Cortex Hormones, Dysphonia diagnosis, Dysphonia etiology, Laryngeal Diseases diagnosis, Subcutaneous Emphysema
- Abstract
Introduction and Aim: Atraumatic laryngeal fractures are extremely rare and are most commonly provoked by sneezing or coughing. Only seven cases have been described in medical literature, and only one case described a fracture after swallowing. We present two cases of atraumatic laryngeal fracture after swallowing., Case Report: A 37-year-old male presented to the outpatient ENT clinic with severe dysphonia and odynophagia. He reported feeling a crack in the throat after swallowing with a flexed head. The patient's physical examination showed diffuse swelling and tenderness over the thyroid cartilage without subcutaneous emphysema. Flexible nasolaryngoscopy showed a large right true vocal fold hematoma with normal vocal fold movement. Computed tomography (CT) showed a fracture of the thyroid. Treatment consisted of corticosteroids and pantoprazole. Two years later he presented again at the emergency department with extreme odynophagia after suffering a knee punch on the larynx. CT showed a new fracture line, slightly off midline to the left in the thyroid cartilage. A 42-year-old male presented at the emergency department with odynophagia, dysphonia, and fever after feeling a crack in the throat during forceful swallowing in an extended neck position. Physical examination demonstrated a painful thyroid cartilage with subcutaneous emphysema. Flexible nasolaryngoscopy was normal but CT scan showed a slightly displaced fracture line of the median thyroid cartilage. Complaints gradually disappeared with conservative treatment with corticosteroids and antibiotics., Conclusion: Congenital anomalies by abnormal mineralization and ossification could lead to focal weakness of the thyroid cartilage and thus predispose to non-traumatic fractures. The double triad of odynophagia, dysphagia, and dysphonia after sneezing, coughing or swallowing should raise the physician's attention to the possibility of thyroid cartilage fracture, especially after feeling or hearing a crack. Further investigation is obligatory with high-resolution CT of the neck and examination by an ENT specialist., Competing Interests: DECLARATION OF COMPETING INTEREST The authors have no financial relationships, or conflicts of interest to disclose., (Copyright © 2021 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2023
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45. In-hospital outcomes by insurance type among patients undergoing percutaneous coronary interventions for acute myocardial infarction in New South Wales public hospitals.
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de Oliveira Costa J, Pearson SA, Brieger D, Lujic S, Shawon MSR, Jorm LR, van Gool K, and Falster MO
- Subjects
- Humans, Cohort Studies, New South Wales epidemiology, Australia, Insurance, Health, Hospitals, Public, Treatment Outcome, Hospital Mortality, Percutaneous Coronary Intervention adverse effects, Myocardial Infarction surgery
- Abstract
Background: International evidence suggests patients receiving cardiac interventions experience differential outcomes by their insurance status. We investigated outcomes of in-hospital care according to insurance status among patients admitted in public hospitals with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI)., Methods: We conducted a cohort study within the Australian universal health care system with supplemental private insurance. Using linked hospital and mortality data, we included patients aged 18 + years admitted to New South Wales public hospitals with AMI and undergoing their first PCI from 2017-2020. We measured hospital-acquired complications (HACs), length of stay (LOS) and in-hospital mortality among propensity score-matched private and publicly funded patients. Matching was based on socio-demographic, clinical, admission and hospital-related factors., Results: Of 18,237 inpatients, 30.0% were privately funded. In the propensity-matched cohort (n = 10,630), private patients had lower rates of in-hospital mortality than public patients (odds ratio: 0.59, 95% CI: 0.45-0.77; approximately 11 deaths avoided per 1,000 people undergoing PCI procedures). Mortality differences were mostly driven by STEMI patients and those from major cities. There were no significant differences in rates of HACs or average LOS in private, compared to public, patients., Conclusion: Our findings suggest patients undergoing PCI in Australian public hospitals with private health insurance experience lower in-hospital mortality compared with their publicly insured counterparts, but in-hospital complications are not related to patient health insurance status. Our findings are likely due to unmeasured confounding of broader patient selection, socioeconomic differences and pathways of care (e.g. access to emergency and ambulatory care; delays in treatment) that should be investigated to improve equity in health outcomes., (© 2023. BioMed Central Ltd., part of Springer Nature.)
- Published
- 2023
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46. Incorporating Safety and Quality Measures Into Australia's Activity-Based Funding of Public Hospital Services.
- Author
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Webster SBG, Neville SE, Nobbs J, Ching J, and van Gool K
- Abstract
In a bid to improve quality of care, numerous countries have incorporated rewards and penalties into the funding and pricing of hospital services. This paper outlines recent advances in Australia to incorporate financial penalties for hospital acquired complications (HACs) and avoidable hospital readmissions (AHRs) adjustments into the funding of public hospital services. It describes the work in the development of suitable measures to identify episodes, the design of the analytical approach used for risk adjustment and the calculation of the funding implications including dampening effects to account for the level of risk. Using the 2019 to 20 round of data collection, this paper reports on the risk adjustment analysis, incremental costs of HACs and AHRs, and the funding dampening effects, the paper further discusses the implementation strategies undertaken by the Independent Health and Aged Care Pricing Authority (IHACPA) to ensure transparency, stakeholder consultation and engagement. The paper argues that both the technical development and its implementation strategies have been central to making safety and quality an integral and accepted part of Australia's public hospital funding arrangements., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)
- Published
- 2023
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47. Higher fees and out-of-pocket costs in radiotherapy point to a need for funding reform.
- Author
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van Gool K, Hall J, Haywood P, Liu D, Yu S, Webster SBG, Moradi B, and Aranda S
- Subjects
- Aged, Humans, Australia, National Health Programs, Fees and Charges, Health Expenditures, Radiation Oncology
- Abstract
Objective To elucidate the policy implications of recent trends in the funding of radiotherapy services between 2009-10 and 2021-22. Method We use national aggregate claims data to determine time trends in the fees, benefits and out-of-pocket (OOP) costs of radiotherapy and nuclear therapeutic medicine claims funded through the Medicare Benefits Schedule (MBS) program. All dollar figures are expressed in constant 2021 Australian dollars. Results Radiotherapy and nuclear therapeutic medicine MBS claims increased by 78% whereas MBS funding increased by 137% between 2009-10 and 2021-22. The main driver of Medicare funding growth has been the Extended Medicare Safety Net, which has increased by 404%. Over the 13 year observation period, the percentage of bulk-billed claims peaked in 2017-18 at 76.1% but fell to 69.8% in 2021-22. For non-bulk billed services, average OOP costs per claim increased from $20.40 in 2009-10 to $69.78 in 2021-22. Conclusion Despite increased Medicare funding, patients face increasing financial barriers to access radiation oncology services. Policies with regard to funding radiotherapy services should be reviewed to ensure that services are easily accessible and affordable for all those needing treatment and at a reasonable cost to Government.
- Published
- 2023
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48. Geographic variation in out-of-pocket costs for radiation oncology services.
- Author
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Liu D, Yu S, Webster SB, Moradi B, Haywood P, Hall J, Aranda S, and van Gool K
- Subjects
- Aged, Humans, United States, Health Expenditures, New South Wales, Health Care Costs, Medicare, Radiation Oncology
- Abstract
Objectives: To examine out-of-pocket costs incurred by patients for radiation oncology services and their variation by geographic location., Design: Analysis of patient-level Medical Benefits Schedule (MBS) claims data linked with data from the Sax Institute 45 and Up Study., Setting, Participants: People who received Medicare-subsidised radiation oncology services in New South Wales, 2006-2017., Main Outcome Measure: Mean out-of-pocket costs for an episode of radiation oncology (during 90 days from start of radiotherapy planning service), by geographic location (postcode-based), overall and after excluding episodes with no out-of-pocket costs (fully bulk-billed)., Results: During 2006-2017, 12 724 people received 15 506 episodes of radiation oncology care in 25 postcode-defined geographic areas. The proportion of episodes for which the out-of-pocket cost was less than $1 increased from 39% in 2006 to 76% in 2017; the proportion for which out-of-pocket costs exceeded $500 declined from 43% in 2006 to 10% in 2014, before increasing to 17% in 2017. For care episodes with non-zero out-of-pocket costs, the mean amount rose from around $1186 to $1611 per episode of care during 2006-2017. The proportion of radiation oncology episodes bulk-billed exceeded 90% in nine areas; in seven areas, all with exclusively private care provision of radiation oncology, it was 21% or smaller. Within geographic areas, out-of-pocket costs for individual care episodes varied widely; in ten areas with lower bulk-billing rates, the interquartile range for costs ranged from $240 to $1857., Conclusion: Out-of-pocket costs are an important determinant of access to care. Although radiotherapy costs for most people are moderate, some face very high costs, and these vary markedly by location. It is important to ensure that radiation oncology services remain affordable for all people who need treatment., (© 2023 The Authors. Medical Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of AMPCo Pty Ltd.)
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- 2023
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49. The link between out-of-pocket costs and inequality in specialist care in Australia.
- Author
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Pulok MH, van Gool K, and Hall J
- Subjects
- Humans, Aged, Australia, National Health Programs
- Abstract
Objective Out-of-pocket (OOP) costs could act as a potential barrier to accessing specialist services, particularly among low-income patients. The aim of this study is to examine the link between OOP costs and socioeconomic inequality in specialist services in Australia. Methods This study is based on population-level data from the Medicare Benefits Schedule of Australia in 2014-15. Three outcomes of specialist care were used: all visits, visits without OOP costs (bulk-billed services), and visits with OOP costs. Logistic and zero-inflated negative binomial regression models were used to examine the association between outcome variables and area-level socioeconomic status after controlling for age, sex, state of residence, and geographic remoteness. The concentration index was used to quantify the extent of inequality. Results Our results indicate that the distribution of specialist visits favoured the people living in wealthier areas of Australia. There was a pro-rich inequality in specialist visits associated with OOP costs. However, the distribution of the visits incurring zero OOP cost was slightly favourable to the people living in lower socioeconomic areas. The pro-poor distribution of visits with zero OOP cost was insufficient to offset the pro-rich distribution among the visits with OOP costs. Conclusions OOP costs for specialist care might partly undermine the equity principle of Medicare in Australia. This presents a challenge to the government on how best to influence the rate and distribution of specialists' services.
- Published
- 2022
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50. Evaluation of the Victorian Healthy Homes Program: protocol for a randomised controlled trial.
- Author
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Campbell M, Page K, Longden T, Kenny P, Hossain L, Wilmot K, Kelly S, Kim Y, Haywood P, Mulhern B, Goodall S, van Gool K, Viney R, Cumming T, and Soeberg M
- Subjects
- Cost-Benefit Analysis, Humans, Randomized Controlled Trials as Topic, Schools, Victoria, Health Promotion methods, Quality of Life
- Abstract
Introduction: The evaluation of the Victorian Healthy Homes Program (VHHP) will generate evidence about the efficacy and cost-effectiveness of home upgrades to improve thermal comfort, reduce energy use and produce health and economic benefits to vulnerable households in Victoria, Australia., Methods and Analysis: The VHHP evaluation will use a staggered, parallel group clustered randomised controlled trial to test the home energy intervention in 1000 households. All households will receive the intervention either before (intervention group) or after (control group) winter (defined as 22 June to 21 September). The trial spans three winters with differing numbers of households in each cohort. The primary outcome is the mean difference in indoor average daily temperature between intervention and control households during the winter period. Secondary outcomes include household energy consumption and residential energy efficiency, self-reported respiratory symptoms, health-related quality of life, healthcare utilisation, absences from school/work and self-reported conditions within the home. Linear and logistic regression will be used to analyse the primary and secondary outcomes, controlling for clustering of households by area and the possible confounders of year and timing of intervention, to compare the treatment and control groups over the winter period. Economic evaluation will include a cost-effectiveness and cost-benefit analysis., Ethics and Dissemination: Ethical approval was received from Victorian Department of Human Services Human Research Ethics Committee (reference number: 04/17), University of Technology Sydney Human Research Ethics Committee (reference number: ETH18-2273) and Australian Government Department of Veterans Affairs. Study results will be disseminated in a final report and peer-reviewed journals., Trial Registration Number: ACTRN12618000160235., Competing Interests: Competing interests: MC, KP, TL, PK, LH, KW, YK, RV, KvG, BM, PH, SG and SK declare that their institution (University Technology Sydney) received payment from Sustainability Victoria for Victorian Government to independently conduct the research. TC and MC confirm that Sustainability Victoria, their employer, funded Healthy Homes., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2022
- Full Text
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