Professor Elizabeth Savage

Harris, A., Johar, M., Jones, G., Savage, E.J. & Sharma, A. 2013, 'Australia' in Luigi Siciliani, Michael Borowitz and Valerie Moran (eds), Waiting times policies in the health sector: What works?, OECD, US, pp. 71-97.

Hall, J.P. & Savage, E.J. 2005, 'The role of the private sector in the Australian healthcare system' in Maynard, A (eds), The Public-Private Mix for Health, Radcliffe Publishing, Abingdon, UK, pp. 247-278.
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Apps, P., Jones, G. & Savage, E.J. 2003, 'Taxation' in McAllister, I; Dowrick, S; Hassan, R (eds), The Cambridge Handbook of Social Sciences in Australia, Cambridge University Press, Cambridge, pp. 138-152.
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Johar, M., Jones, G. & Savage, E.J. 2013, 'Emergency admissions and elective surgery waiting times', Health Economics, vol. 22, no. 6, pp. 749-756.
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An average patient waits between 2 and 3 months for an elective procedure in Australian public hospitals. Approximately 60% of all admissions occur through an emergency department, and bed competition from emergency admission provides one path by which waiting times for elective procedures may be lengthened. In this article, we investigated the extent to which public hospital waiting times are affected by the volume of emergency admissions and whether there is a differential impact by elective patient payment status. The latter has equity implications if the potential health cost associated with delayed treatment falls on public patients with lower ability to pay. Using annual data from public hospitals in the state of New South Wales, we found that, for a given available bed capacity, a one standard deviation increase in a hospital's emergency admissions lengthens waiting times by 19 days on average. However, paying (private) patients experience no delay overall. In fact, for some procedures, higher levels of emergency admissions are associated with lower private patient waiting times.

Johar, M., Jones, G. & Savage, E.J. 2013, 'The effect of lifestyle choices on emergency department use in Australia', Health Policy, vol. 110, no. 2-3, pp. 280-290.

Johar, M., Jones, G., Keane, M., Savage, E.J. & Stavrunova, O. 2012, 'Geographic differences in hospital waiting times', Economic Record, vol. 88, no. 281, pp. 165-181.
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Access to elective surgery in Australian public hospitals is rationed using waiting lists. In this article, we undertake a DiNardo-Fortin-Lemieux reweighting approach to attribute variation in waiting time to clinical need or to discrimination. Using data from NSW public patients in 2004-2005, we find the discrimination effect dominates clinical need especially in the upper tail of the waiting time distribution. We find evidence of favourable treatment of patients who reside in remote areas and discrimination in favour of patients residing in particular Area Health Services. These findings have policy implications for the design of equitable quality targets for public hospitals.

Johar, M. & Savage, E.J. 2012, 'Sources of advantageous selection: Evidence using actual health expenditure risk', Economics Letters, vol. 116, no. 3, pp. 579-582.
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In a market where insurers are not allowed to risk rate, we find evidence of advantageous selection using observed health expenditure risk. Selection is driven by income and optimism about the future. This may explain insurers' profitability, despite community rating.

King, M., Viney, R.C., Smith, D.P., Hossain, I., Street, D., Savage, E.J., Fowler, S., Berry, M.P., Stockler, M.R., Cozzi, P., Stricker, P.D., Ward, J. & Armstrong, B. 2012, 'Survival gains needed to offset persistent adverse treatment effects in localised prostate cancer', British Journal Of Cancer, vol. 106, no. 4, pp. 638-645.
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Men diagnosed with localised prostate cancer (LPC) face difficult choices between treatment options that can cause persistent problems with sexual, urinary and bowel function. Controlled trial evidence about the survival benefits of the full range of treatment alternatives is limited, and patients' views on the survival gains that might justify these problems have not been quantified. A discrete choice experiment (DCE) was administered in a random subsample (n = 357, stratified by treatment) of a population-based sample (n = 1381) of men, recurrence-free 3 years after diagnosis of LPC, and 65 age-matched controls (without prostate cancer). Survival gains needed to justify persistent problems were estimated by substituting side effect and survival parameters from the DCE into an equation for compensating variation (adapted from welfare economics). Median (2.5, 97.5 centiles) survival benefits needed to justify severe erectile dysfunction and severe loss of libido were 4.0 (3.4, 4.6) and 5.0 (4.9, 5.2) months. These problems were common, particularly after androgen deprivation therapy (ADT): 40 and 41% overall (n = 1381) and 88 and 78% in the ADT group (n = 33). Urinary leakage (most prevalent after radical prostatectomy (n - 839, mild 41%, severe 18%)) needed 4.2 (4.1, 4.3) and 27.7 (26.9, 28.5) months survival benefit, respectively. Mild bowel problems (most prevalent (30%) after external beam radiotherapy (n = 106)) needed 6.2 (6.1, 6.4) months survival benefit.

Johar, M., Jones, G., Keane, M., Savage, E.J. & Stavrunova, O. 2011, 'Waiting times for elective surgery and the decision to buy private health insurance', Health Economics, vol. 20, no. S1, pp. 68-86.
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More than 45% of Australians buy health insurance for private treatment in hospital. This is despite having access to universal and free public hospital treatment. Anecdotal evidence suggests that avoidance of long waits for public treatment is one possible explanation for the high rate of insurance coverage. In this study, we investigate the effect of waiting on individual decisions to buy private health insurance. Individuals are assumed to form an expectation of their own waiting time as a function of their demographics and health status. We model waiting times using administrative data on the population hospitalised for elective procedures in public hospitals and use the parameter estimates to impute the expected waiting time and the probability of a long wait for a representative sample of the population. We find that expected waiting time does not increase the probability of buying insurance but a high probability of experiencing a long wait does. On average, waiting time has no significant impact on insurance. In addition, we find that favourable selection into private insurance, measured by self-assessed health, is no longer significant once waiting time variables are included. This result suggests that a source of favourable selection may be aversion to waiting among healthier people.

Johar, M. & Savage, E.J. 2010, 'Do private patients have shorter waiting times for elective surgery? Evidence from New South Wales public hospitals', Economic Papers, vol. 29, no. 2, pp. 128-142.
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The Productivity Commission (2008) identified waiting times for elective surgery as a measure of governments+ success in providing accessible health care. At the 2007 COAG meeting, the Prime Minister identified reduction of elective surgery waiting times in public hospitals as a major policy priority. To date, the analysis of waiting time data has been limited to summary statistics by medical procedure, doctor specialty and state. In this paper, we look behind the summary statistics and analyse the extent to which private patients are prioritised over comparable public patients in public hospitals. Our empirical evidence is based on waiting list and admission data from public hospitals in NSW for 2004+2005. We find that private patients have substantially shorter waiting times, and tend to be admitted ahead of their listing rank, especially for procedures that have low urgency levels. We also explore the benefits and costs of this preferential treatment on waiting times.

Van Gool, K., Savage, E.J., Viney, R.C., Haas, M.R. & Anderson, R. 2009, 'Who's getting caught? An analysis of the Australian Medicare Safety Net', The Australian Economic Review, vol. 42, no. 2, pp. 143-154.
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The Medicare Safety Net (MSN) was introduced in March 2004 to provide financial relief for those who incur high out-of-pocket costs from medical services. The policy has the potential to improve equity. This study examines: (i) how the health and income profiles of small areas influence MSN expenditure; and (ii) the distribution of expenditure by medical service type. The results indicate that MSN expenditure is positively related to income and that patients who use private obstetricians and assisted reproductive services are the greatest beneficiaries. The MSN has possibly created greater inequities in Australia's health-care financing arrangements.

Doiron, D., Jones, G. & Savage, E.J. 2008, 'Healthy, wealthy and insured? The role of self-assessed health in the demand for private health insurance', Health Economics, vol. 17, no. 3, pp. 317-334.
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Both adverse selection and moral hazard models predict a positive relationship between risk and insurance; yet the most common finding in empirical studies of insurance is that of a negative correlation. In this paper, we investigate the relationship between ex ante risk and private health insurance using Australian data. The institutional features of the Australian system make the effects of asymmetric information more readily identifiable than in most other countries. We find a strong positive association between self-assessed health and private health cover. By applying the Lokshin and Ravallion (J. Econ. Behav. Organ 2005; 56:141Ô++172) technique we identify the factors responsible for this result and recover the conventional negative relationship predicted by adverse selection when using more objective indicators of health. Our results also provide support for the hypothesis that self-assessed health captures individual traits not necessarily related to risk of health expenditures, in particular, attitudes towards risk. Specifically, we find that those persons who engage in risk-taking behaviours are simultaneously less likely to be in good health and less likely to buy insurance.

Ellis, R. & Savage, E.J. 2008, 'Run for cover now or later? The impact of premiums, threats and deadlines on private health insurance in Australia', International Journal of Health Care Finance and Economics, vol. 8, no. 4, pp. 257-277.
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Between 1997 and 2000 the Australian government introduced three policy reforms that aimed to increase private health insurance coverage and reduce public hospital demand. The first provided income-based tax incentives; the second gave an across-the-board 30% premium subsidy; and the third introduced selective age-based premium increases for those enrolling after a deadline. Together the reforms increased enrolment by 50% and reduced the average age of enrollees. The deadline appeared to induce consumers to enroll now rather than delay. We estimate a model of individual insurance decisions and examine the effects of the reforms on the age and income distribution of those with private cover. We interpret the major driver of the increased enrollment as a response to a deadline and an advertising blitz, rather than a pure price response.

Jones, G., Savage, E.J. & Van Gool, K. 2008, 'The distribution of household health expenditures in Australia', The Economic Record, vol. 84, no. Special, pp. 99-114.
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Out-of-pocket health expenditures in Australia are high in international comparisons and have been growing at a faster rate than most other health costs in recent years. This raises concerns about the extent to which out-of-pocket costs have constrained access to health services for low income households. Using data from the ABS Household Expenditure Survey 2003-2004, we model the relationships between health expenditure shares and equivalised total expenditure for categories of out-of-pocket health expenditures and analyse the extent of protection given by concession cards. To allow for flexibility in the relationship we adopt Yatchew's semi-parametric estimation technique. This is the first detailed distributional analysis of household health expenditures in Australia. We find mixed evidence for the protection health concession cards give against high out-of-pocket health expenditures. Despite higher levels of subsidy, households with concession cards do not have lower out-of-pocket expenditures than non-cardholder households except for the highest expenditure quintile. Cards provide most protection for GP out-of-pocket expenditures

Van Doorslaer, E., Clarke, P., Savage, E.J. & Hall, J.P. 2008, 'Horizontal inequities in Australia's mixed public/private health care system', Health Policy, vol. 86, no. 1, pp. 97-108.
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Recent comparative evidence from OECD countries suggests that Australia's mixed public+private health system does a good job in ensuring high and fairly equal access to doctor, hospital and dental care services. This paper provides some further analysis of the same data from the Australian National Health Survey for 2001 to examine whether the general finding of horizontal equity remains when the full potential of the data is realized. We extend the common core cross-country comparative analysis by expanding the set of indicators used in the procedure of standardizing for health care need differences, by providing a separate analysis for the use for general practitioner and specialist care and by differentiating between admissions as public and private patients. Overall, our analysis confirms that in 2001 Medicare largely did seem to be attaining an equitable distribution of health care access: Australians in need of care did get to see a doctor and to be admitted to a hospital. However, they were not equally likely to see the same doctor and to end up in the same hospital bed. As in other OECD countries, higher income Australians are more likely to consult a specialist, all else equal, while lower income patients are more likely to consult a general practitioner. The unequal distribution of private health insurance coverage by income contributes to the phenomenon that the better-off and the less well-off do not receive the same mix of services. There is a risk that + as in some other OECD countries + the principle of equal access for equal need may be further compromised by the future expansion of the private sector in secondary care services. To the extent that such inequalities in use may translate in inequalities in health outcomes, there may be some reason for concern.

Birch, S., Haas, M.R., Savage, E.J. & Van Gool, K. 2007, 'Targeting services to reduce social inequalities in utilisation: An analysis of breast cancer screening in New South Wales', Australia and New Zealand Health Policy, vol. 4:12, pp. 1-9.
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Many jurisdictions have used public funding of health care to reduce or remove price at the point of delivery of services. Whilst this reduces an important barrier to accessing care, it does nothing to discriminate between groups considered to have greater or fewer needs. In this paper, we consider whether active targeted recruitment, in addition to offering a 'free' service, is associated with a reduction in social inequalities in self-reported utilization of the breast screening services in NSW, Australia.

Viney, R.C., Savage, E.J. & Louviere, J.J. 2005, 'Empirical investigation of experimental design properties of discrete choice experiments in health care', Health Economics, vol. 14, no. 4, pp. 349-362.
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Experimental design is critical to valid inference from the results of discrete choice experiments (DCEs). In health economics, DCEs have placed limited emphasis on experimental design, typically employing relatively small fractional factorial designs, w

Jones, G., Savage, E.J. & Hall, J.P. 2004, 'Pricing of general practice in Australia: some recent proposals to reform Medicare', Journal of Health Services Research and Policy, vol. 9, no. 2, pp. 63-68.
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Lancsar, E. & Savage, E.J. 2004, 'Deriving welfare measures from discrete choice experiments: inconsistency between current methods and random utility and welfare theory.', Health Economics, vol. 13, no. 9, pp. 901-907.
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Savage, E.J. & Jones, G. 2004, 'An analysis of the general practice access scheme on GP incomes, bulk billing and consumer copayments', The Australian Economic Review, vol. 37, no. 1, pp. 31-40.
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Savage, E.J. 2003, 'Equity, payment incentives and cost control in Medicare: an assessement of the government's proposals', Health Sociology Review, vol. 12, no. 1, pp. 5-16.
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Savage, E.J. & Wright, D.J. 2003, 'Moral hazard and adverse selection in Australian private hospitals: 1989-1990', Journal Of Health Economics, vol. 22, no. 3, pp. 331-359.
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Jones, G. & Savage, E.J. 1996, 'An Evaluation Of Income Splitting With Variable Female Labor Supply', Economic Record, vol. 72, no. 218, pp. 224-235.
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Debate on the tax unit in Australia often involves claims that a system with allows spouses to split their incomes for the purposes of taxation is superior to an individual based system. In this paper we estimate a female labour supply model on data for

Savage, E.J. & Hart, A. 1995, 'Environmental policy and the theory of second best', Economic Papers, vol. 14, no. 4, pp. 1-15.
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Over the past two decades there has been growing interest in environmental policy. Lobbying by conservationists and growing community concern over pollution and the degradation of the natural environment have stimulated governments to address problems of externalities more seriously. In this policy debate the views of economists are becoming increasingly prominent. There is little doubt that economics has an important contribution to make in environmental policy, however the dominant economists' view represents quite a restricted subset of the relevant economic theory.

Apps, P., Ray, R. & Savage, E.J. 2004, 'The economics of a two tier health system: A fairer Medicare? Discussion Paper 478', Centre for Economic Policy Research, Australian National University, Canberra, Australia, pp. 1-24.
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This paper analyses a recent proposal of the Australian Government to reform the existing Medicare system. It develops models of the physician+s behaviour and of a household+s demand for medical insurance under the proposed system, and then proceeds to characterise the equilibrium under the new proposals. It argues that those most likely to be made worse off are low income households with children, though a full evaluation of the effects of the proposal requires it to be analysed in a public finance framework.