Anthony Scott

The market for non‐GP specialist services in Australia is characterised by widely dispersed fees and out‐ of‐ pocket costs, creating uncertainty about the price patients will have to pay. This is primarily driven by doctor‐level variation in pricing rather than patient characteristics, clinical risk or quality, which reflects a referral‐based market with severe information asymmetry and weak price competition. A response to help patients navigate this system has been the promotion of fee transparency websites. While this is a welcome step to empower patients, evidence suggests such tools have limited impact and may increase prices in concentrated markets. We argue that to improve transparency tools, risk‐adjusted information on expected costs and quality indicators must be provided and this information should be targeted at the referee, often the general practitioner.

Despite their low cost, the use of email invitations to distribute surveys to medical practitioners have been associated with lower response rates. This research compares the difference in response rates from using email approach plus online completion rather than a mailed invitation letter plus a choice of online or paper completion. A parallel randomised controlled trial was conducted during the 11^th annual wave of the nationally representative Medicine in Australia: Balancing Employment and Life (MABEL) longitudinal survey of doctors. The control group was invited using a mailed paper letter (including a paper survey plus instructions to complete online) and three mailed paper reminders. The intervention group was approached in the same way apart from the second reminder when they were approached by email only. The primary outcome is the response rate and the statistical analysis was blinded. 18,247 doctors were randomly allocated to the control (9,125) or intervention group (9,127), with 9,108 and 9,107 included in the analysis. Using intention to treat analysis, the response rate in the intervention group was 35.92% compared to 37.59% in the control group, a difference of -1.66 percentage points (95% CI: -3.06 to -0.26). The difference was larger for General Practitioners (-2.76 percentage points, 95% CI: -4.65 to -0.87) compared to other specialists (-0.47 percentage points, 95% CI: -2.53 to 1.60). For those who supplied an email address, the average treatment effect on the treated was higher at -2.63 percentage points (95% CI: -4.50 to -0.75) for all physicians, -3.17 percentage points (95% CI: -5.83 to -0.53) for General Practitioners, and -2.1 percentage points (95% CI: -4.75 to 0.56) for other specialists. For qualified physicians, using email to invite participants to complete a survey leads to lower response rates compared to a mailed letter. Lower response rates need to be traded off with the lower costs of using email rather than mailed letters.

Objective To examine the association between financial incentives from entry into a vaccine competition with the probability of vaccination for COVID-19. Design A cross-sectional study with adjustment for covariates using logistic regression. Setting October and November 2021, Australia. Participants 2375 respondents of the Taking the Pulse of the Nation survey. Primary and secondary outcome measures The proportion of respondents who had any vaccination, a first dose only, or second dose after the competition opened. Results Those who entered the competition were 2.27 (95% CI 1.73 to 2.99) times more likely to be vaccinated after the competition opened on 1 October than those who did not enter—an increase in the probability of having any dose of 0.16 (95 % CI 0.10 to 0.21) percentage points. This increase was mostly driven by those receiving second doses. Entrants were 2.39 (95% CI 1.80 to 3.17) times more likely to receive their second dose after the competition opened. Conclusions Those who entered the Million Dollar Vax competition were more likely to have a vaccination after the competition opened compared with those who did not enter the competition, with this effect dominated by those receiving second doses.

Non‐pecuniary sources of motivation are a strong feature of the health care sector and the impact of competitive incentives on behavior may be lower where pecuniary motivation is low. This paper measures the marginal utility of income (MUY) of physicians from a stated‐choice experiment, and examines whether this measure influences the association between competition faced by physicians and the prices they charge. We find that physicians are more likely to exploit a lack of competition with higher prices if they have a high MUY.