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Objectives: Unwarranted clinical variations in radical prostatectomy (RP) procedures are frequently reported, yet less attention is given to the variations in associated costs. This issue can further widen disparities in access to care and provoke questions about the overall value of the procedure. The present paper aimed to delve into the disparities in hospital, medical provider and out-of-pocket costs for RP procedures in Australia, discussing plausible causes and potential policy opportunities. Methods: A retrospective cohort study using Medibank Private claims data for RP procedures conducted in Australian hospitals between 1 January 2015 and 31 December 2020 was undertaken. Results: Considerable variations in both medical provider and out-of-pocket costs were observed across the country, with variations evident between different states or territories. Particularly striking were the discrepancies in the costs charged by medical providers, with a notable contrast between the 10th and 90th percentiles revealing a substantial difference of A$9925. Hospitals in Australia exhibited relatively comparable charges for RP procedures. Conclusions: Initiatives such as enhancing transparency regarding individual medical provider costs and implementing fee regulations with healthcare providers may be useful in curbing the variations in RP procedure costs. What is known about the topic? Unwarranted clinical variations in radical prostatectomy procedures are well documented in the literature; however, variations in cost are less widely reported. What does this paper add? This paper aims to highlight the cost variations in radical prostatectomy procedures in Australia, discussing their plausible causes, implications and proposing potential policy opportunities. What are the implications for practitioners? Excessive fees imposed by medical providers may contribute to inequalities in healthcare access. Enhancing transparency of individual medical provider costs and implementing fee regulations may be useful in controlling unwarranted variations in procedure costs. This article belongs to the Special Issue: Value-based Healthcare. [ABSTRACT FROM AUTHOR]

This Perspective begins with a case study that raises two important questions: who is responsible for the existence of non-compliant Medicare billing, and who is responsible for eliminating it? In the discussion that follows, I argue, first, that the problem has been created by individual clinicians and by Medicare itself (i.e. the organisational structure that administers Medicare). Second, and more importantly, I argue that the ethical obligation to eliminate the problem extends more broadly to include both the government and the medical profession. What is known about the topic? The scale of non-compliant Medicare billing is contested. What does this paper add? This Perspective frames non-compliant Medicare billing (and denial of its existence) as a ubiquitous cultural problem. What are the implications for practitioners? Strategies aimed at reducing non-compliant Medicare billing need to target the normative behaviour of societal actors as well as individual practitioners. [ABSTRACT FROM AUTHOR]

Background: The introduction of the National Disability Insurance Scheme (NDIS) in Australia in 2013 promised significant improvements in the lives of adults with intellectual disabilities. Although the scheme enables support, there are challenges associated with establishing eligibility and administering funds. This scoping review explored perceived barriers and enablers to effectively utilising the NDIS for adults with intellectual disabilities and their families. Method: A scoping review of the empirical literature on the NDIS and intellectual disabilities included nine studies in this review. These papers were subjected to thematic analysis and the findings were presented as a narrative synthesis. Results: The key themes identified were: (1) Limited understanding of the NDIS process; (2) Language use and capacity assumptions; (3) Unrealistic goals and progress, and difficulty utilising plans; (4) Expectations of families and associated workloads; (5) Opening up opportunities not previously available; (6) Knowledgeable planners who actively seek to involve adults and their families. Conclusion: Although qualitative studies demonstrate that adults with an intellectual disability and their families are largely satisfied with the increased opportunities the NDIS has afforded them, there are various areas in which accessibility to services can be improved. In order for the NDIS to continue to improve, the results from this scoping review underline the need for adults with an intellectual disability and their support systems to have their voices heard and be utilised. [ABSTRACT FROM AUTHOR]

In this paper, the case study of ketamine as a new treatment for severe depression is used to outline the challenges of repurposing established medicines and we suggest potential solutions. The antidepressant effects of generic racemic ketamine were identified over 20 years ago, but there were insufficient incentives for commercial entities to pursue its registration, or support for non-commercial entities to fill this gap. As a result, the evaluation of generic ketamine was delayed, piecemeal, uncoordinated, and insufficient to gain approval. Meanwhile, substantial commercial investment enabled the widespread registration of a patented, intranasal s-enantiomeric ketamine formulation (Spravato®) for depression. However, Spravato is priced at $600–$900/dose compared to ~$5/dose for generic ketamine, and the ~AUD$100 million annual government investment requested in Australia (to cover drug costs alone) has been rejected twice, leaving this treatment largely inaccessible for Australian patients 2 years after Therapeutic Goods Administration approval. Moreover, emerging evidence indicates that generic racemic ketamine is at least as effective as Spravato, but no comparative trials were required for regulatory approval and have not been conducted. Without action, this story will repeat regularly in the next decade with a new wave of psychedelic-assisted psychotherapy treatments, for which the original off-patent molecules could be available at low-cost and reduce the overall cost of treatment. Several systemic reforms are required to ensure that affordable, effective options become accessible; these include commercial incentives, public and public–private funding schemes, reduced regulatory barriers and more coordinated international public funding schemes to support translational research. [ABSTRACT FROM AUTHOR]

Hydrogen is considered a key energy vector and carrier for the decarbonization of global energy systems. However, the economics of green hydrogen systems hinder their widespread application. This paper presents a techno-economic analysis of a green hydrogen production system using high-temperature water electrolysis integrated with a concentrated solar power system (CSP-SOEC) for Western Australia. Real-time solar resource data with 30-min resolution for a typical meteorological year were used to assess the performance of the entire system. The intermittent nature of solar resources is accounted for by integrating the system with a thermal energy storage medium and performing the analysis in off-design mode. The validity of the electrolysis stack model is crucial for overall system performance, which was confirmed through experimental testing conducted on a 15-cell stack. The system was designed to generate a 1 MWe output, and the results showed that a field area of 29,000 m2 and thermal energy storage capacity of 382,500 kWh can fulfil the design criteria. The system generates 0.86 tonne/day of hydrogen at a cost of 8.87 US$/kg-H 2 with a solar-to-hydrogen efficiency of 13.80 %. The cost breakdown revealed that the storage medium has the most significant contribution. Moreover, the sensitivity of the system to the production capacity was analyzed, which showed that larger-scale hydrogen production systems have the potential to further reduce the cost. An 8 MWe system has the capacity to produce 7.18 tonne/day of hydrogen at a cost of 6.1 US$/kg-H 2. The molten salt is currently utilized only 39.3 % for the hydrogen production process. To optimize resource utilization, a cogeneration system is devised and assessed for simultaneous steam and hydrogen production. The results reveal that the cogeneration system can achieve an LCOH reduction of 9 % by reaching 8.07 US$/kg-H 2. These findings are invaluable for academic and industry stakeholders in making informed decisions and fostering the green hydrogen sector in Australia. • A techno economic assessment of green H 2 production for Australia is done. • The electrolysis model is corroborated using experimental results. • The cost of green H 2 for such system in Australia is 8.87 US$/kg-H 2. • Higher production capacity favors the system economics. • The cogeneration system reduces the cost by 9 %. [ABSTRACT FROM AUTHOR]