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dc.contributor.authorChalmers, Kelsey
dc.date.accessioned2019-06-17T04:20:49Z
dc.date.available2019-06-17T04:20:49Z
dc.date.issued2019-01-10
dc.identifier.urihttp://hdl.handle.net/2123/20574
dc.description.abstractLow-value health care provides little benefit relative to its cost. Australian policy makers, health care payers and providers want to reduce its use due to unnecessary costs and harms. These decisions, however, need to be informed by the measurement of low-value care in the context of Australia’s mixed public-private health care system. This thesis investigated low-value procedures using routinely collected data and direct measures. Direct measures use patient- or episode-level clinical information to distinguish low-value from appropriate care. Based on our review of the literature, we introduced a framework to classify direct measures as providing either a service-centric or a patient-centric result. The Choosing Wisely campaign publishes clinician-endorsed ‘do-not-do’ recommendations, and provides a source of potential direct measures. We screened 824 recommendations, and found only a small proportion measurable in a hospital-claims data set. We used these and other recommendations to develop 21 measures applicable to private health insurance claims from 376,354 patients (approximately 7% of the Australian privately insured population). There were 14,662 patients with at least one of the 21 procedures in 2014 (the service-centric result, according to our framework). Of these patients, 20.8 to 32.0% had a low-value procedure according to a narrow (more specific) and broad (more sensitive) set of measures. We extended this investigation to all payer types using the New South Wales (NSW) Admitted Patient Data Collection, and generally found higher proportions and volumes of low-value procedures in the private sector. In 2014-15, 40.3% of all low-value procedures in NSW state were for privately insured patients in private hospitals (relative to 35.6% of all procedures). Despite the limited scope of health care captured by these measures, the work in this thesis has already led to several policy-focussed projects informing governments and payers on low-value care.en_AU
dc.publisherUniversity of Sydneyen_AU
dc.publisherFaculty of Medicine and Healthen_AU
dc.publisherSchool of Public Healthen_AU
dc.rightsThe author retains copyright of this thesis. It may only be used for the purposes of research and study. It must not be used for any other purposes and may not be transmitted or shared with others without prior permission.en_AU
dc.subjectHealth servicesen_AU
dc.subjectPrivate health insuranceen_AU
dc.subjectlow-value careen_AU
dc.subjectoveruseen_AU
dc.subject.otherincludes published articlesen_AU
dc.titleUtilising Big Data in the search for low-value health careen_AU
dc.typePhD Doctorateen_AU
dc.type.pubtypeDoctor of Philosophy Ph.D.en_AU
dc.description.disclaimerAccess is restricted to staff and students of the University of Sydney . UniKey credentials are required. Non university access may be obtained by visiting the University of Sydney Library.en_AU


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