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Rejoinder to John Deeble's comment
DP Doessel
Department of Economics, The University of Queensland, Queensland, Australia
Abstract
My paper, 'Policy and Empirical Evidence: The Case of General Practice Changes', is concerned with two issues that have been the subject of recent policy debate, viz. the growth of the medical workforce and the growth of medical service utilization in Australia. Both of these issues have been considered by Deeble (1991) in his analysis of Medicare.
My argument on the first issue is that, because of the data Deeble employed, his measure over-estimates the growth in the medical workforce. The reason for this overestimation is quite simple: the data he employed are an administrative by-product of Australia's health insurance arrangements and have been affected by the extent to which substitution has taken place between public medical practice and private medical practice. This has been illustrated by the data in Deeble (1991) Table 15 for the Northern Territory and Queensland. It is noteworthy that Deeble (1992) at no point refers to the extraordinary increases (between 1984-85 and 1989-90) of 41.5 per cent and 28.8 per cent respectively that his measure produces. The problem with the data employed by Deeble (1991) is that it is only a partial measure of the medical workforce relating to 'fee-forservice' medical practice, a component of total medical practice which has altered through time.
In his Comment Deeble wishes to distance himself in several ways from his own work.
References
Commonwealth of Australia (1991) Health Care in Australia - Directions for Reform in
the 1991-92 Budget. Budget Related Paper No. 9, Canberra: AGPS.
Deeble, J. (1991) Medical Services Through Medicare. National Health Strategy
Background Paper No. 2, Melbourne: National Health Strategy.
Deeble, J. (1992) 'Comment', Annual Review of Health Social Sciences, (this issue).
Doessel, D.P. (1992) 'Rejoinder', Annual Review of Health Social Sciences, (this issue).
Fuchs, V.R. (1978) 'The Supply of Surgeons and the Demand for Operations', Journal of
Human Resources. 13, Supplement, 34-56.
Gujarah, D.N. (1988) Basic Econometrics, New York: McGraw-Hill.
Howe, B. (1991) 'Changes to Medicare', Healthcover, 1, 12-4.
Richardson, J. (1981) "The Inducement Hypothesis: That Doctors Generate Demand for
Their Own Services'. In van der Gaag, J. and Perlman, M. (eds) (1981) Health.
Economics. Amsterdam: North-Holland, 189-214.
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