Ruth F.G. Williams, D.P. Doessel, Roman W. Scheurer and Harvey Whiteford
The purpose of this paper is to demonstrate that, although there are some unique features associated with mental illness, such special features do not preclude economic analysis.
Abstract
Purpose
The purpose of this paper is to demonstrate that, although there are some unique features associated with mental illness, such special features do not preclude economic analysis.
Design/methodology/approach
As a mechanism for understanding how individual economic studies fit into the mental health sector, a conceptual framework of the components of mental health service provision is outlined. Emphasis is placed on, not simply institutional and market resources, but also on the services provided by relatives, self‐help groups, etc.
Findings
Australian data on parts of the mental health sector are employed to illustrate that some (and different) economic analyses can be undertaken in mental health. First, time‐series data on public psychiatric hospitals are employed to demonstrate trends associated with deinstitutionalisation. Other data (for Queensland alone) indicate that there are state‐based differences in the provision of such services. Second, attention is then directed to the analysis of time‐series data on private fee‐for‐service psychiatric services. Various concepts and measures from industrial economics are applied to analyse the relative size of this service industry, the pricing behaviour of the profession, the service‐mix of “the psychiatry firms” operating in Australia. In addition, the analysis also sheds some light on the distributional implications of Australia's national (and uniform) system of health funding, Medicare.
Originality/value
Apart from demonstrating that economic analyses can be undertaken in the difficult area of mental health, this paper indicates a number of puzzles (e.g. various regional variations within a unified profession and a uniform national funding scheme) that invite further investigation.
Details
Keywords
Ruth F.G. Williams and D.P. Doessel
Multiple connotations and conceptions of health need are currently in use. The purpose of this paper is to specify some important distinctions regarding this confusing…
Abstract
Purpose
Multiple connotations and conceptions of health need are currently in use. The purpose of this paper is to specify some important distinctions regarding this confusing multiplicity in a taxonomic fashion relevant to the economic problems that arise in addressing health need. Classification is possible with the relevant concepts in conventional economic theory. The classification applies wherever economic considerations bear upon health need.
Design/methodology/approach
Initially, some seminal economic ideas about need are presented from Marshall, Pauly, Banfield, Jevons, Deaton and Meullbauer, and Georgescu‐Roegen. Recent discussions of basic needs by Sen and Nussbaum concerning “capabilities” and human flourishing are also considered. Ruger's subsequent developments of these concepts specifically for health are noted. The paper then specifies and classifies the current economic connotations of “health need” by applying positive economic analysis and the framework of economic theory. In particular, the conventional theories of consumer demand and production supply are useful. Geometric tools of analysis along with illustrations from the health sector specify various distinctions and classifications.
Findings
The uses of the generic term “need” relate to quite different economic problems. The findings show how diverse interpretations of need can be specified.
Originality/value
Distinctions over health need are important since, in many Western countries, need is one of the “pillars” of the Welfare State. Effective policy requires sound conceptions and measurements of need. Given the relevance of economics for approaching competing resource uses in the face of health need, measurement of need is improved with taxonomy, and confusion reduced.
Details
Keywords
D.P. Doessel and Ruth F. Williams
The purpose of this paper is to provide an exposition of the concepts relevant to measuring the economic effect of premature mortality and the conception of how the social loss…
Abstract
Purpose
The purpose of this paper is to provide an exposition of the concepts relevant to measuring the economic effect of premature mortality and the conception of how the social loss from premature mortality can be incorporated into social welfare measurement. None of the conventional welfare measures currently pick up this welfare signal.
Design/methodology/approach
Various concepts are examined in the conventional and “new” literatures of welfare measurement. Six Venn diagrams show how various concepts “fit together”.
Findings
This paper outlines a framework for measuring the economic effect of premature mortality in a conceptually appropriate way. Thus the paper shows how the welfare loss associated with premature mortality can be incorporated into social welfare measurement.
Research limitations/implications
Accurate premature mortality measurement is difficult but this data problem hardly limits this exercise. Sensitivity analyses can alleviate this measurement problem.
Practical implications
The main practical implication is that empirical applications are feasible. Time series data can be analysed from this conceptual framework to determine whether the problem of the social loss from premature mortality is improving through time, or worsening.
Social implications
Knowing the size of the welfare impact of premature mortality is useful not only on policy fronts concerning premature mortality prevention.
Originality/value
“New welfare measurement” has not yet been applied to the notion of the social loss from premature mortality.
Details
Keywords
D.P. Doessel and Ruth F.G. Williams
Government policy can alleviate inequities in living standards. Disabled people often qualify for government assistance which is one way that their living standard can improve…
Abstract
Purpose
Government policy can alleviate inequities in living standards. Disabled people often qualify for government assistance which is one way that their living standard can improve, although arbitrary systems for distributing assistance are not likely to serve equity objectives. The purpose of this paper is to indicate the key variables to which government should direct attention, in order to alleviate both horizontal and vertical inequity in grants to disabled people.
Design/methodology/approach
There is no literature, either theoretical or empirical, that specifically addresses this problem. This paper invokes important economic concepts associated with the nineteenth century English philosopher/economist, John Stuart Mill, as well as the 1998 Nobel Laureate in Economics, Amartya Sen. Mill's general conception of how government should behave in treating citizens was elaborated subsequently in the public finance literature on principles of taxation. These notions are about “the equal treatment of equals” and “the unequal treatment of unequals”. Sen's recent discussion of the “conversion handicap” from his general framework of capabilities is highly relevant to the question addressed here.
Findings
These concepts, applied with some analytical tools of algebra and geometry, show that Mill's principles can combine with Sen's into a relevant conceptual framework. The central principles and concepts for policy formation on the standard of living for disabled people are not random; they can be specified with clarity.
Originality/value
This paper contributes the relevant conceptual “yardsticks” by which policy for distributing assistance to disabled people can be evaluated. Steps, towards devising better approaches to the distribution of assistance to disabled people can now be taken.
Details
Keywords
Ruth F.G. Williams and D.P. Doessel
It is usually unnecessary to define the output of an industry, but this is not the case with mental health services. Following Grossman's conception of health capital, the outputs…
Abstract
It is usually unnecessary to define the output of an industry, but this is not the case with mental health services. Following Grossman's conception of health capital, the outputs of mental health care enter a household production function as a commodity vector. Considering the multiple and heterogeneous nature of the services of this industry, preferences exist in multi‐dimensional space. An application of the characteristics theory of consumer demand associated with Ironmonger and Lancaster illustrates the outputs in terms of two characteristics, viz. symptom alleviation and disability reduction. Representing preferences by indifference curves, in the usual way, clarifies the relationship between mental health care inputs and the outputs of mental health care. The theoretical problem in the economics of mental health care of whether, or how, individual preferences can count is also addressed. It is shown on an indifference map what it means when society institutionalises some individuals. This approach also enables the deinstitutionalisation movement to be placed into an economic context. It is noted that empirical work on goods and services that have multiple characteristics involves the application of hedonic price analysis, a technique already applied in the economic literature on mental health.
Details
Keywords
Presents a brief account of the development of antibiotics so as to put such drugs in perspective. Then the issue of antibiotic resistance is considered and Tisdell’s economic…
Abstract
Presents a brief account of the development of antibiotics so as to put such drugs in perspective. Then the issue of antibiotic resistance is considered and Tisdell’s economic analysis of the phenomenon is presented. Emphasis is placed on the inter‐generational trade‐off that is associated with this important social issue. The paper concludes by discussing Australia’s institutional arrangements for funding pharmaceutical, and hence antibiotic, expenditures.
Details
Keywords
Zhiyong Hong, Keguang Bao and Clem Tisdell
Summarises the environmental cadmium loading, human body cadmium(Cd) burden and the biological indicators of the early‐stage healtheffects induced by exposure to cadmium on the…
Abstract
Summarises the environmental cadmium loading, human body cadmium (Cd) burden and the biological indicators of the early‐stage health effects induced by exposure to cadmium on the population of Daye county in China. Claims that urinary calcium and urinary low molecular weight protein are good biological indicators for the detection of the early‐stage renal dysfunction and recommend that the prevention and treatment of cadmium pollution be incorporated into primary health care. Cost‐benefit analysis of reduction of Cd emissions from the non‐ferrous smelter in Daye county indicates that the benefit‐cost ratio taking into account both direct health costs and indirect costs is far in excess of unity.
Details
Keywords
D.P. Doessel and Ruth F.G. Williams
The production of specialist psychiatric services in Australia reflects the “mixed” system of public and private production of health services generally. This paper, an exercise…
Abstract
The production of specialist psychiatric services in Australia reflects the “mixed” system of public and private production of health services generally. This paper, an exercise in descriptive or positive economics, is concerned only with private production, i.e. those services provided by psychiatrists operating in “private practice” on a fee‐for‐service basis. It is shown that there is a sharp distinction in Australian institutional arrangements between psychiatric services produced in‐hospital and out‐of‐hospital. The main differences relate to the general coinsurance rates applied, 75 per cent in the former case and 85 per cent in the latter case. In addition out‐of‐hospital services are subject to a “gap” safety‐net provision. Using both algebraic and geometric expositions, the central relationships between gross prices, net prices, schedule fees and subsidies/rebates are illustrated in general, and in various special cases, e.g. where a psychiatrist “direct bills” or “bulk bills” the Health Insurance Commission.
Details
Keywords
D.P. Doessel and Abbas Valadkhani
The purpose of this paper is to investigate the relationship between economic development and income distribution for Iran. Using time series data for the period 1967‐1993, it is…
Abstract
The purpose of this paper is to investigate the relationship between economic development and income distribution for Iran. Using time series data for the period 1967‐1993, it is found that there is no significant relationship between the Gini coefficient for household expenditure and per capita income. This result means there is no evidence in Iran, for the period analysed here, of there being a U‐relationship between these two variables as suggested by Kuznets. However, the empirical econometric results lend support for the view that institutional or structural variables affect income distribution. This paper has four policy messages for Iranian decision makers. First, income inequality can be reduced by stimulating the goods‐producing sectors of the economy such as agriculture, manufacturing etc. Second, expansion of most of the service sectors, such as trade, real estate etc., in Iran, because of the association in such sectors with rent seeking behaviour, is found to be positively related to inequality. Third, government subsidies and transfers have not decreased income inequality in Iran. On the contrary, the empirical evidence indicates that government transfers have exacerbated inequality. Fourth, government per capita expenditures (current and capital) have played an important role in alleviating relative poverty.
Details
Keywords
Therese Jefferson, Des Klass, Linley Lord, Margaret Nowak and Gail Thomas
Leadership studies which focus on categorising leadership styles have been critiqued for failure to consider the lived experience of leadership. The purpose of this paper is to…
Abstract
Purpose
Leadership studies which focus on categorising leadership styles have been critiqued for failure to consider the lived experience of leadership. The purpose of this paper is to use the framework of Jepson’s model of contextual dynamics to explore whether this framework assists understanding of the “how and why” of lived leadership experience within the nursing profession.
Design/methodology/approach
Themes for a purposeful literature search and review, having regard to the Jepson model, are drawn from the contemporary and dynamic context of nursing. Government reports, coupled with preliminary interviews with a nurse leadership team, guided selection of contextual issues.
Findings
The contextual interactions arising from managerialism, existing hierarchical models of leadership and increasing knowledge work provided insights into leadership experience in nursing, in the contexts of professional identity and changing educational and generational profiles of nurses. The authors conclude that employing a contextual frame provides insights in studying leadership experience. The author propose additions to the cultural and institutional dimensions of Jepson’s model.
Practical implications
The findings have implications for structuring and communicating key roles and policies relevant to nursing leadership. These include the need to: address perceptions around the legitimacy of current nursing leaders to provide clinical leadership; modify hierarchical models of nursing leadership; address implications of the role of the knowledge workers.
Originality/value
Observing nursing leadership through the lens of Jepson’s model of contextual dynamics confirms that this is an important way of exploring how leadership is enacted. The authors found, however, the model also provided a useful frame for considering the experience and understanding of leadership by those to be led.