fange issue news from the m 04 centre for health economics · sinha from the centre for health...
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Fange
Centre for Health Economics NEWS FROM THE MONASH
IN THIS ISSUE
NEW RESEARCH
COMMENCES
REGIONAL
COMPARISONS
QUALITY OF LIFE
RESEARCH
REPORTING
HETEROGENEITY
IN THE PRESS
UPCOMING EVENTS
AWARDS,
PUBLICATIONS
& PRESENTATIONS
Issue
04
Sept 2014
New Research Commences
burden due to preventable maternal
mortality and morbidity.
Professor Anthony Harris has received a grant through Medibank’s new
Health Research Fund (MHRF), one of only nine awarded Australia-wide. The
grant will fund development of an online tool to assist in the routine collection
of outcome data by healthcare providers, insurers and fund holders to help
improve the allocation of resources in the healthcare sector. The project is
part of a wider research program at the Centre for Health Economics into the
measurement of health-related quality of life and wellbeing and its social
value, and in particular an extension of the Multi-Instrument Comparison
(MIC) program initiated by Professor Jeff Richardson.
A/Prof Paula Lorgelly and Katherine Gilbert have been awarded funding
from a new grant scheme, initiated by the Faculty of Business and Economics
to encourage interdisciplinary collaboration. The grant supports collaboration
between CHE researchers and specialists in public health, development
studies and international health. CHE researchers will work closely with Prof
Jane Fisher (School of Public Health and Preventive Medicine, Faculty of
Medicine, Nursing and Health Sciences), Dr Elissa Kennedy (Centre for
International Health, Burnet Institute) and Dr Divi Ogaoga (Ministry of Health
and Medical Services, Solomon Islands) to investigate the determinants,
impacts and costs of unsafe abortion in the Solomon Islands. Findings from
the study will help policy makers and providers in the Solomon Islands to
mount a better public health response, helping to address the significant
International comparisons of living standards, ranking of countries by GDP, and comparisons of
inequality or poverty across countries all require conversion of one currency into another. An
important drawback of purchasing power parities (PPPs) and other conversion factors is that they
treat each country as a single identity, ignoring the fact that prices may be higher in London than in
Birmingham and lower in Wagga Wagga than in Sydney. They ignore the fact that in large
countries, such as Brazil and India, there is much greater variation in prices and consumer
preferences between states or provinces than there is between many smaller countries. Cross-
country comparisons between Adelaide and London, Sydney and Birmingham, or between Brasilia
and New Delhi may therefore be confounded by differences in purchasing power and consumer
preferences even after converting currencies into international dollars using standard PPP
conversion factors. What’s more, comparisons within countries will suffer from similar problems
unless corrected for the fact that a dollar is worth less in Sydney than in Wagga Wagga and for the
fact that the consumption patterns of Sydneysiders are different in kind than consumption patterns
in country and regional New South Wales.
Contributing to recent literature modelling spatial variation in prices within countries, Kompal
Sinha from the Centre for Health Economics along with Ranjan Ray (Economics, Monash
University) and Amita Majumder (Indian Statistical Institute, India) have recently conducted
research, published in Macroeconomic Dynamics and Review of Income and Wealth that derives
spatial prices (within-country conversion factors) and uses them for welfare comparisons within
countries and across countries. This research departs from the previous literature on PPPs in
proposing a demand system based methodology for calculating conversion factors that takes
account of consumer preferences and allows for the substitution effect of price changes. It shows
how unit values obtained from expenditure and quantity information on purchases can be used to
provide the necessary price information after adjusting for quality and demographic characteristics,
and describes the procedure of generating quality-adjusted unit values as prices. The usefulness of
this approach is shown by making ‘corrected’ expenditure comparisons of food items between
states of India, demonstrating that this type of correction may be just as important for price and
expenditure comparisons within countries as it is for comparisons between countries. Applying this
approach more broadly could make exercises such as the World Bank’s ICP even more useful for
evidence-based policy making.
The role that PPPs perform in converting an internationally denominated poverty line, for example, US$1 a day, into a poverty line in Indian rupees or Solomon Island dollars is much the same as the role that spatial prices play inside a country in converting the national poverty line into regional poverty lines, taking into account regional prices and preferences. ”
“
Including quality of life in economic evaluations of new
technologies raises a number of difficult questions. In order to
determine whether services are above or below a funding
threshold quality of life must be reduced to a single number:
itself a controversial issue.
But who should judge the relevant health states – patients, or
the public which pays for the services provided by Medicare?
Should the person making the judgement be asked to evaluate
the health state on behalf of society, hopefully achieving
impartiality in the comparison of different health states (a
social perspective) or should they be asked to adopt a selfish
individual perspective? Which elements of a person’s
wellbeing should be included in the health state evaluation: a
narrow range of symptoms such as pain and physical mobility
or a wider range, including, for example, social relationships
and self-esteem? Once decisions are made with respect to
these questions how do we measure and combine the
elements of the quality of life in a way which is valid and
reliable?
An ongoing program at the CHE led by Professor Jeff
Richardson has been investigating these issues and raising
questions with respect to current measurement procedures. A
new instrument developed at the CHE to measure quality of
life from a social perspective – the Relative Social Willingness
to Pay instrument – suggests that, when it does not concern
themselves directly, individuals place greater emphasis upon
quality of life and less upon life expectancy.(1)
A second instrument, the Assessment of Quality of Life (AQoL-8D) has expanded the number of elements
included in measurement to capture details of a person’s psycho-social wellbeing.(2) The instrument,
which has recently passed a number of rigorous validation tests,(3) demonstrates that these psycho-social
elements are the most important determinants of subjective wellbeing as measured by well-established
psychological instruments. Nevertheless these psycho-social elements are largely omitted from more
established instruments used for current evaluation studies.
The results of recent quality of life research at the CHE suggest the need for a revision of the methods
adopted by economists who evaluate health services. Read more here:
(1) Jeff Richardson, Angelo Iezzi, Kompal Sinha, Munir Khan, John McKie 2014, An Instrument for
measuring the Relative Social Willingness to Pay for health state improvement. Health Economics
23:792-805.
(2) Jeff Richardson, Kompal Sinha, Angelo Iezzi, Munir Khan 2014. Modelling utility weights for the
Assessment of Quality of Life (AQoL) 8D. Quality of Life Research DOI 10.1007/s11136-014-0686-8
(3) Jeff Richardson, Angelo Iezzi, Munir Khan, Aimee Maxwell 2014. Validity and reliability of the
Assessment of Quality of Life (AQoL-8D) multi attribute utility instrument. The Patient: Patient-Centered
Outcomes Research 7:85-96.
Quality of Life Research at the CHE
The EQ-5D, the most commonly used multi-attribute utility instrument, asks respondents to rate their
health using ordered-response categories on five domains: mobility, personal care, usual activities,
pain/discomfort and anxiety/depression. While commonly used in clinical trials, the EQ-5D has also been
included in a number of population health surveys, where it is used to compare health across population
sub-groups.
A limitation with any measure that asks respondents to report on subjective categorical scales, as the EQ-
5D does, is that people may interpret the response categories in different ways. For example, a female
may attach a completely different meaning to what constitutes ‘moderate pain’ compared to a male. This
phenomenon, known as reporting heterogeneity or response scale differential item functioning (DIF), may
lead to conclusions that are misleading in analyses which rely on these measure. Rachel Knott, A/Prof
Paula Lorgelly, Dr Nicole Au from the Centre for Health Economics, and Prof Bruce Hollingsworth from
Lancaster University (UK) have been undertaking ARC funded research to formally test for and adjust
reporting heterogeneity in the EQ-5D-5L, using the anchoring vignettes approach.
In a survey of 2000 Australians they found significant variation in reporting styles across gender, age,
income and country of birth. When adjusting for DIF they found that EQ-5D-5L summary indices are
adjusted upwards across all respondent groups. This reflects a movement of respondents away from the
moderate, severe or extreme problem categories, which impose the highest penalties to EQ-5D-5L
scores. While the inter-group ordering of respondents by EQ-5D-5L indices did not change after
controlling for DIF, relative changes across sub-groups are apparent in their results. For example, the
average difference in EQ-5D-5L score between males and females increased from 0.07 to 0.10; while the
difference between the oldest and youngest age groups reduced from 0.12 to 0.07.
This work is ongoing, and the next phase will apply the adjustments to an external dataset. If this
application is successful, then researchers will be able to more accurately make inferences about
inequalities in health and what drives them.
…a female may attach a completely different meaning to what
constitutes ‘moderate pain’ compared to a male. This
phenomenon is known as reporting heterogeneity or differential
item functioning (DIF). ”
“
Reporting heterogeneity in the EQ-5D
Original and DIF-adjusted EQ-5D scores
CHE Researchers in the Popular Press
Brian Vandenberg & Dr Anurag Sharma: Alcohol tax reform: a
minimum price is in the public interest
Dr Sonja Kassenboehmer: Being unemployed isn’t as bad as you
think
Dr Agne Suziedelyte: Early start to school a boost for
disadvantaged children
Prof Jeff Richardson: Australia’s ‘unsustainable’ health spending
is a myth
Prof Anthony Harris: On being treated well: reforming Medicare
after 30 years
A/Prof David Johnston, Prof Michael Shields & Jean Spinks: It’s
the quality of school, not its location
Prof Anthony Harris: Commission of Audit’s health hit list: experts
respond
CHE Staff Out + About
A/Prof Paula Lorgelly and Brett Doble presented papers on quality of life
measurement in oncology at the Health Economists’ Study Group (HESG),
2014 Winter Meeting.
Dr Nicole Au and Visiting Professor Fabrice Etile presented papers at the
Fifth Australasian Workshop on Econometrics & Health Economics, Fremantle.
A/Prof Paula Lorgelly and Dr Anurag Sharma presented papers at ASHEcon
2014, Leonard D. Schaeffer Centre for Health Policy & Economics, Los
Angeles, California.
CHE staff met with international collaborators including Prof Jan Olsen, Prof
John Brazier and Prof Julie Ratcliffe at the Special Workshop on the Multi-
Instrument Comparison (MIC) project, Sommarøy, Norway.
Prof Jeff Richardson, Dr Agne Suziedelyte, Angelo Iezzi, Rachel Knott and
A/Prof Paula Lorgelly presented papers at the Joint iHEA & ECHE Congress,
Trinity College, Dublin, Ireland.
Dr Agne Suziedelyte presented a paper on education and health knowledge
at the fourth edition of the Italian Health Econometrics Workshop, Padua, Italy.
Dr Sonja Kassenboehmer presented a paper on re-employment expectations
at SOEP 2014: 11th International German Socio-Economic Panel User
Conference, Berlin.
Dr Kompal Sinha presented a paper on estimation of intra and inter-country
food purchasing power parities at the Texas A&M University under their
Agriculture Economics Department Seminar Program.
Professor Anthony Harris presented a paper entitled Unsustainability of
health expenditure in Australia – the myths and their solutions at a conference
sponsored by The Conversation on The Future of Medicare, Sydney.
Upcoming Events
3 September: Prof Kirsten Howard (Sydney) will present a seminar
entitled ‘Community preferences for organ donation policy: a discrete
choice experiment’ in the CHE Seminars Series.
9 September: Prof Andrew Briggs (Glasgow) will present a seminar in the
CHE Seminar Series.
17 September: Catherine Keating (Deakin) will present a seminar in the
CHE Seminar Series.
24-26 September: Australian Health Economics Doctoral Workshop &
36th Annual Australian Health Economics Society Conference, Adelaide.
15 October: The Centre for Health Economics will host the Victorian Data
Linkage Unit Seminar, with speakers to include A/Prof Paula Lorgelly.
20 October: Prof Jordan Louviere (UniSA) will present a seminar in the
CHE Seminar Series.
28-30 October: A/Prof Paula Lorgelly, A/Prof Duncan Mortimer &
Katherine Gilbert will present at the Solomon Islands Ministry of Health /
World Bank / CHE Workshop on Health Facilities Costing, Honiara.
29 October: A/Prof Anna Peeters (Baker IDI) will present a seminar in the
CHE Seminar Series.
November: Prof Barbara McPake (Nossal Institute) will present a seminar
in the CHE Seminar Series.
10-12 November: Priorities 2014, 10th Conference of the International
Society on Priorities in Health Care (ISPHC), Melbourne.
26 November: A/Prof Jennifer Whitty (UQ) will present a seminar in the
CHE Seminar Series.
3MT win for CHE
Two of the CHE’s outstanding cohort of PhD students, Brian
Vandenberg (pictured with Faculty 3MT judge, Prof Fang Lee
Cook) and Anthony Niu, recently competed at the Faculty
Three Minute Thesis (3MT) competition.
Brian’s thesis investigates the role of price and income in
alcohol consumption, whereas Anthony is investigating links
between socio-economic status and childhood health, and
between childhood health and health outcomes in adulthood.
Both did an excellent job of summarising their PhD research in
just three minutes flat, with Brian’s presentation making a
particular strong impact on the judges.
Brian took out the Faculty heat and moves on to represent the
Faculty in the cross-faculty competition in mid-September.
Congratulations Brian, good luck in September!
Johnston D, Schurer S, Shields M. 2014, Maternal gender role attitudes, human capital
investment and labour supply of sons and daughters. Oxford Economic Papers, 66:631-659.
Barnieh L, Clement F, Harris A, Blom M, Donaldson C, et al. 2014, A systematic review of cost-
sharing strategies used within publicly-funded drug plans in the OECD. PLoS ONE, 9:e90434.
Richardson J, Iezzi A, Sinha K, Khan M, Mckie J. 2014, An instrument for measuring the social
willingness to pay for health state improvement. Health Economics, 23:792-805.
Ray R, Sinha K. 2014, Multidimensional Deprivation in China, India and Vietnam: A Comparative
Study on Micro Data. Journal of Human Development and Capabilities, 16:3.
Sweeney R, Mortimer D, Johnson D. 2014, Further investigations of the donor-flight response.
Social Science & Medicine, 113:179–182.
Au N, Lorgelly P. 2014, Anchoring vignettes for health comparisons: an analysis of response
consistency. Quality of Life Research, 23:1721-31.
Bosch M, McKenzie J, Mortimer D, et al. 2014, Implementing evidence-based recommended
practices for the management of patients with mild head injuries in Australian emergency care
departments: a CRT study protocol. Trials, 15:281.
Richardson J, Iezzi A, Khan M, Maxwell A. 2014, Validity and reliability of the Assessment of
Quality of Life (AQoL-8D) multi attribute utility instrument. The Patient, 7:85-96.
Au N, Hollingsworth B, Spinks J. 2014, Measuring the efficiency of health services in lower
income countries: The case of Papua New Guinea. Development Policy Review, 32:259-272.
Kassenboehmer S, Sinning M. 2014, Distributional Changes in the Gender Wage Gap. Industrial
and Labor Relations Review, 67:2, 335-361.
Selected recent publications
Doiron D, Fiebig D, Suziedelyte A. 2014, Hips and Hearts: The Variation in Incentive Effects of
Insurance across Hospital Procedures. Journal of Health Economics 37:81-97.
Sharma A, Hauck K, Hollingsworth B, Siciliani L. 2014, The Effects of Taxing Sugar-sweetened
beverages across different income groups. Health Economics, 23:1159-1184.
Frijters P, Johnston D, Shields M. 2014, The Effect of Mental Health on Employment: Evidence
from Australian Panel Data. Health Economics, 23:1058-1071.
Gu Y, Norman R, Viney R. 2014, Estimating Health State Utility Values from Discrete Choice
Experiments – A QALY Space Model Approach. Health Economics, 23:1098-1114.
Bennell KL, Egerton T, Martin J, Abbott JH, Metcalf B, McManus F, Sims K, Pua YH, Wrigley TV,
Forbes A, Smith C, Harris A, Buchbinder R. 2014, Effect of physical therapy on pain and function
in patients with hip osteoarthritis: a randomized clinical trial. Journal of the American Medical
Association, 311:1987-97.
Richardson J. 2014, Can we sustain health spending? Medical Journal of Australia, 200:629-631.
Centre for Health Economics Building 75, Monash University, Clayton 3800 AUSTRALIA
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