The Use and Cost of Child Care in Australia

The use and cost of child care have become important policy issues with rising labour force participation for women responsible for young children. In this article it is shown that for children aged less than 2 informal care is much more important than formal care. For children aged 3 to 5 by far the most important, and cheapest, form of formal care is preschool. The category of formal care which has expanded most rapidly is child care centre places. However the recent expansion of female employment has been effected with no rise in the share of formal care in the total. Publicly supplied child care centre places are over 40 per cent more expensive to produce than private ones. It is argued that for those who do not receive a fee relief subsidy public care is more expensive than private care. The inference is drawn that people are willing to pay more for public than private care because public care is of higher quality. However those buying this higher quality care pay (at most) only 80 per cent of the cost of producing the care. The shortage of care in the public sector is not solved by private sector expansion because users of care are not willing to pay the price of producing high quality care.     

Nurses leading the response to the crisis of palliative care for vulnerable populations

All nurses are prepared to be generalists in palliative care. Within the discipline there are nurses who seek advanced educational preparation and develop clinical expertise in palliative care nursing. These are our leaders in palliative care nursing who can exert influence in all health care settings to support nurses providing palliative care. It is nurses and advanced practice nurses in partnership who are capable of developing and advocating for palliative care across settings. The focus of care is the person, not the diagnosis or the setting. The viewpoint that "all nursing care is palliative care" can transform health care with nurses taking the lead.     

The determinants of health care expenditure in Australia

The objective of this article is to examine the long-run relationship and short-run dynamics of the health care expenditure in Australia during the period 1960–2003. Consistent with the conventional findings, the income elasticity for health care is found to be greater than one, suggesting that health care is a luxury good in Australia. Demographic structure is found to exert a significant positive impact on health care expenditure. An increase in the accessibility to health care services is associated with higher per capita real health care expenditure. Finally, public funding of health care appears to have a contributory effect on the formation of health care expenditure in Australia.     

Palliative care: a paradigm of care responsive to the demands for health care reform in America

Palliative care is poised to become a universally available approach to health care which addresses both the needs of patients and families experiencing serious, progressive, and life-threatening illness, and also the costs of delivering such needed services. Palliative care and hospice are part of a continuum of care with palliative care provided at any time during the illness trajectory, while hospice care is offered at the end of life. Within the context of health care reform, we believe palliative care addresses critical economic imperatives while enhancing quality of life even as death approaches. As leaders in health care, advance practice nurses, specifically, and the nursing community in general are best positioned with the knowledge, expertise, and commitment to advance the specialty of palliative care and lead the way in the reform of America's health care system.     

Price and quantity in international comparisons of health care expenditure

An important omission from earlier cross-national comparisons of health care expenditure has been the failure to distinguish between price and quantity. Using recent data on purchasing power parities, the purpose of this article is to report some preliminary results regarding health care expenditure and quantity across 22 OECD countries. The article concludes that, contrary to what has been suggested in some recent articles, the relative price of health care is not correlated to the aggregate per capita income. The fraction of the national income that is devoted to health care provision increases with the per capita income regardless of whether health care is measured in terms of expenditure or quantity. The relative price of health care has a rationing effect on the quantity of health care that is offered, with a price alasticity close to minus one. The latter finding means that the health care expenditure is not greater in countries with higherprices. Furthermore, the differences in health care expenditure or quantity between countries persist after correction for the relative price and the income level. Part of these differences can be explained by differences in the definition of health care in the various countries.     

Ex Post Welfare under Alternative Health Care Systems

The implications of a societal aversion to inequality for the optimal structure of the health care system are studied. The agents are assumed to be ex ante identical, but to differ ex post in the state of their health. Inequality aversion is introduced by postulating a strictly concave ex post social welfare function. It is shown that the optimal public health care system allocates health care differently than would private health insurance; specifically, people who are relatively unhealthy with and without treatment receive more health care, and people who are relatively healthy with and without treatment receive less health care. The aggregate quantity of health care under the optimal public health care system can be either greater or smaller than under private health care insurance. If the public health care system is optimally designed, allowing agents to purchase supplementary private health care insurance cannot raise social welfare and is likely to decrease it.     

Managed care, quality of care, and patient rights

The growth of managed care has been accompanied by calls for increased government regulation because HMOs and other forms of managed care are seen by the public as more concerned about controlling costs than with protecting the rights of patients to quality care. This paper applies a theory of health care rights and clinical evidence of managed care quality in an analysis of public opinion about managed care. The paper concludes that there is no persuasive evidence that managed care has resulted in a general deterioration in the quality of care and that, with one exception, restrictions imposed by managed care plans are consistent with a theory of health care rights. The paper concludes with the recommendation that public policy should dispense with attempts to fine tune managed care and address an unquestionable violation of health care rights, the failure to guarantee a minimum standard of care to some 43 million Americans.     

Measuring the Impact of Child Care Subsidies on the Incomes of Mothers Returning to Work

The cost of child care is one of the greatest financial barriers faced by mothers returning to work. In recognition of this cost, the federal government provides child care subsidies to assist families to meet the cost of child care.
This paper models the use of child care services and the provision of child care subsidies to determine how effective the Australian government child care support programs are in reducing the financial barriers that make returning to work difficult for many mothers. Both childcare assistance and the newer childcare cash rebate are modelled. The impact of these assistance measures is examined for couples and sole parents on different incomes with one or two children in child care.
It was found that child care subsidies are highly progressive and make a substantial contribution to vertical equity by offsetting child care costs related to employment. They also contribute to horizontal equity, by providing greater assistance in meeting child care costs for families with more than one child in care, in recognition of their greater need. Sole parents derived the greatest benefit from child care subsidies, particularly those on low incomes working full-time and with two children in care.     

The MISSCARE Survey-Turkish: psychometric properties and findings

One measure of the process of nursing care is missed nursing care, which refers to any aspect of required care that is omitted either in part or in whole or delayed. Little is understood about how the quality and processes of nursing care differs among countries around the world. The aims of this study were (a) to test the psychometric properties of the MISSCARE Survey-Turkish and (b) to compare the extent and type of missed care as well as reasons for missing care between Turkey and the United States. There was less missed care reported by Turkish nurses as compared to U.S. nurses (p < 0.0001). Turkey nurses identified more problems with inadequate staffing resources (p < 0.0001), materials resources (p < 0.0001), and communication/teamwork (p < 0.0001) as reasons for missed nursing care than did U.S. nurses. Missed nursing care is a critical problem that needs to be addressed in both countries.     

A second warning by the club of Rome

The growth of managed care has been accompanied by calls for increased government regulation because HMOs and other forms of managed care are seen by the public as more concerned about controlling costs than with protecting the rights of patients to quality care. This paper applies a theory of health care rights and clinical evidence of managed care quality in an analysis of public opinion about managed care. The paper concludes that there is no persuasive evidence that managed care has resulted in a general deterioration in the quality of care and that, with one exception, restrictions imposed by managed care plans are consistent with a theory of health care rights. The paper concludes with the recommendation that public policy should dispense with attempts to fine tune managed care and address an unquestionable violation of health care rights, the failure to guarantee a minimum standard of care to some 43 million Americans.     

Supplementary private health insurance and health care utilization of people aged 50+

Does supplementary private health insurance (PHI) coverage influence health care utilization in countries where the coverage ratio with public health insurance is high? I estimate this effect using the Survey of Health, Ageing and Retirement in Europe. Handling the potential endogeneity of supplementary insurance coverage and the large fraction of zero observations in the utilization models influences the empirical results. I show that the effect of PHI coverage on inpatient and outpatient care utilization is not trivial even in countries with generous public health funding. The main finding is that supplementary PHI coverage increases dental care utilization, but decreases the visits to general practitioners. Private insurance is estimated to have little and insignificant influence on the utilization of inpatient care and outpatient specialist care. The magnitude of the effect of supplementary PHI on health care utilization varies with the characteristics of the health care systems.     

The importance of measuring patient satisfaction

Managed care has demonstrated its ability to contain costs. Its emergence as a dominant factor in the health care marketplace has raised concerns about measuring health care quality. As the field of quality assurance is evolving, it is becoming clearer that patient satisfaction surveys should be an integral component of assessing care.     

Unmet need for health care during pregnancy: A French – Romanian comparison

ABSTRACT

Health inequalities emerge from birth, the early neonatal mortality and infant mortality rates being different between countries. These differences may be related to inequalities in use of health care during pregnancy. The aim of this research is to identify and compare the profiles of women who do not follow pregnancy health care recommendations in two European countries with different health systems and indicators: namely France and Romania. However, health care recommendations for pregnant women are free in the two countries. Firstly, unmet need for health care during pregnancy is observed. Secondly, our results reveal that there is a relationship between perinatal health care abandonment and several forms of inequalities (social, informational and psychological). Thirdly, the much higher probability of forgoing perinatal health care for Romanian women could be associated with financial or informational problems which seems counterintuitive because perinatal health care recommendations are free. Free coverage is too insufficient to ensure the efficiency of the perinatal health care system.     

Is health care a luxury? The debate revisited with new evidence from emerging economies

This paper studies the long-run relationship between health care expenditure and income using a panel data set of emerging economies over the period 1995–2012. The results show that expenditure on health care and income are non-stationary and cointegrated. After controlling for cross-sectional dependence and unobserved heterogeneity among different countries, we find that the income elasticity of health care is less than 1, indicating that health care is a necessity and not a luxury. Government expenditure and out-of-pocket expenditure turn out to be important determinants of health care expenditure. Among non-monetary factors, results show that old age dependency and female education seem to have significant bearings on health care expenditures. Policy recommendations suggest that government should increase spending on health care in emerging economies since higher incomes may not automatically translate into higher health care spending by the people of these countries.     

“过度医疗”的制度根源与医生声誉激励机制

近年来,"看病贵"成为我国医疗服务中的突出问题,导致"看病贵"的一个直接推动因素是医疗服务中的"过度医疗"问题。医疗服务具有显著的信息不对称特征,在此背景下会形成医患之间合约谈判权的非对称分布,形成"权责不对等"的"委托困境"问题,从而引发"过度医疗"和医疗市场中"富人驱逐穷人"的现象。在此情况下,政府管制并不能改变医患之间合约谈判权的非对称分布格局,解决过度医疗问题的核心应该是建立以医生声誉激励机制为核心的制度体系。     

Child care voucher and labour market behaviour: experimental evidence from Finland

This article provides experimental estimates of the impact of a voucher for private care on labour force participation and use of private and public child care within the Nordic system of universal provision of public care. In a market that was providing high-quality, low-cost public child care, a voucher is nevertheless found to have a significant, positive effect for the use of private child care with zero effects on either use of public care or labour force participation. The use of private increased by five percentage points in the whole country and by five to seven percentage points in areas that suffer from excess demand for child care as a result of the introduction of the private child care voucher.     

转轨过程中政府卫生投入与体制改革的评价及建议

健康权是最基本的公民权利,是社会起点公平的保障,对健康投入是国家和政府不可推卸的职责。改革以来,我国卫生费用增长较快,然而卫生绩效却不容乐观。中国医疗卫生体系从改革前被国际组织推崇的典范“沦落”为当前的反面案例,[1]结果令人深思。卫生领域的过度、扭曲的市场化和高度分权化是问题的主要根源。因此,建议确立公共卫生和基本医疗支出的政府主导地位,特别要强化中央财政的支出责任,建立不同层级政府间规范的责任分担与资金筹集机制。通过有效的体制构建以及合理的管理制度安排,提高投入绩效,满足广大人民群众基本医疗需求。     

公共卫生投资与区域经济增长关系的实证研究

本文利用1990年以来我国公共卫生投资的Pool数据,通过引入公共卫生投资变量的经济增长模型,对公共卫生投资与区域经济增长的关系进行了实证研究。本文的研究结果表明,一方面公共卫生投资与区域经济增长密不可分;另一方面公共卫生投资对区域经济增长的影响呈现出阶段性特征,目前西部地区的公共卫生投资对区域经济增长的贡献最大。     

Aggregated dynamic demand equations for specialistic-outpatient medical care

In this paper a dynamic model is presented which describes the development of the demand for specialistic medical care in The Netherlands, during the period 1960–1972. The “regionally correlated, time-wise auto-regressive” model is consistently estimated from a time-series of cross-sections, using a modified Aitken estimator. The dependent variables are the number of publicly insured patients referred from general care to specialistic care, and the amount of care consumed per patient referred. As independent variables we took demographic factors, the supply of different levels of medical care and the insurance system. The estimation results show a.o. important substitution possibilities between general and specialistic care, and a significant influence of supply and supply-related variables on the demand for specialistic care.