Elizabeth Savage

Evidence supporting the effects of mergers in healthcare markets on quality is mixed. In this study we exploit a government policy in NSW that imposed mergers on area health services (AHSs) to evaluate the effects of the merger on patient waiting times, an indicator of quality. We focus on the specific question of whether the merger had a larger impact on worse‐performing AHSs. Our results show heterogeneous impacts, reducing waiting times for relatively urgent public patients but further delaying non‐urgent patients. In addition, we find the merger reduced the waiting time gap between public and private patients.

We examine patient socioeconomic status, the strength of the patient–doctor relationship and local area competition as determinants of the quality and price of GP services. We exploit a large‐sample patient data set in Australia and its linkage to administrative databases. The sample contains over 260 000 patients and over 12 600 GPs, observed between 2005 and 2010. Controlling for GP fixed effects and patient health, we find no strong evidence that quality differs by patient age, gender, country of origin, health concession card status and income, but quality is increased by stronger patient–doctor relationship. Using a competition measure that is defined at the individual GP level and not restricted to a local market, we find that competition lowers quality. Price is increasing in patient income, whereas competition has a small impact on price. Copyright © 2014 John Wiley & Sons, Ltd.

Explaining individual, regional, and provider variation in health care spending is of enormous value to policymakers but is often hampered by the lack of individual level detail in universal public health systems because budgeted spending is often not attributable to specific individuals. Even rarer is self‐reported survey information that helps explain this variation in large samples. In this paper, we link a cross‐sectional survey of 267 188 Australians age 45 and over to a panel dataset of annual healthcare costs calculated from several years of hospital, medical and pharmaceutical records. We use this data to distinguish between cost variations due to health shocks and those that are intrinsic (fixed) to an individual over three years. We find that high fixed expenditures are positively associated with age, especially older males, poor health, obesity, smoking, cancer, stroke and heart conditions. Being foreign born, speaking a foreign language at home and low income are more strongly associated with higher time‐varying expenditures, suggesting greater exposure to adverse health shocks. Copyright © 2013 John Wiley & Sons, Ltd.

This article provides a comprehensive profile of individual healthcare expenditure using the 45 and Up Study of over 267,000 NSW residents linked to administrative medical service records. Individuals aged 45 and over consume two‐thirds of healthcare expenditure in Australia. We compute annual total healthcare expenditure comprising hospital admissions, emergency presentations, out‐of‐hospital medical consultations and diagnostic tests and subsidised drugs. The average annual expenditure in the sample is $4334 in 2009 dollars. Less than 3 per cent have zero expenditure. Health service mix varies with age, with the share of hospital expenditure increasing with age. The age trends of total expenditure and its components are then examined by key demographic, socioeconomic and health characteristics, providing important insights into future healthcare demand and a foundation for future research into the drivers of healthcare expenditures and the distribution of health subsidies.