On the third Thursday of every month, we speak to a recent graduate about their thesis and their studies. This month’s guest is Dr Junran Cao who has a PhD from the University of Western Australia. If you would like to suggest a candidate for an upcoming Thesis Thursday, get in touch.
Three essays in health economics
What inspired your research topics?
The overarching theme in my topic selections is their relevance to policy-making. In this I received valuable help from my thesis supervisor, Professor Rammohan, who has a long track record in health economics and guided me on both identifying the research areas as well as narrowing down the questions so they could be analysed quantitatively.
The first paper is concerned with the role of social norms, interactions, and networks for physical and mental health. The second paper looks at the issue of general practitioner shortages in rural areas, which is a long-standing policy challenge in Australia. The third paper examines the determinants of the gender workload gap – it’s a rather curious pattern that, in Australia, we are simultaneously seeing a persistent gender gap in work supply and an increasing proportion of female physicians and medical students.
How does social capital relate to mental and physical health in Indonesia?
Social capital is a catch-all term that captures things like the frequency of one’s interactions with others and the general level of trust in a community. It was first postulated by political scientists and sociologists as something that can improve social efficiency, including the health of its population. There was not, however, a great deal of empirical studies looking to falsify this assertion or whether it is similarly applicable in a developing economy.
As such, for our study, we used the RAND Corporation’s Indonesia Family Life Survey East data to address this question in a context where universal social security coverage is absent and where the health infrastructure is poor (at least when the survey was conducted). The analysis was also subjected to the usual identification considerations economists are so fond of.
We found that social capital has no effect on one’s management of chronic illnesses. However, it is associated with a higher degree of mental well-being and physical independence among the elderly. And this association is robust across the gender and rural-urban divides.
What does your research tell us about the behaviour of doctors?
Using the Medicine in Australia (more commonly known as MABEL) panel survey data, I found a number of interesting patterns of physician behaviour.
When it comes to deciding whether to work in a metro or rural area, the list of potential considerations for general practitioners is dominated by the socioeconomic conditions of the area, such as its closeness to amenities, the quality of schooling for their children, and the like.
Stated as such, this seems self-evident. However, it does suggest why the many policies tailored at reducing rural general practitioner shortage – conditional scholarship schemes, extra allowances, more clinical practice and other incentives – have had limited success. When the decision to relocate to a rural area impacts the whole family, personal and professional factors often take a backseat to the needs of the family.
Does you research highlight any important differences between doctors in Australia?
The divergence in the work supply (and hence pay) between male and female physicians is remarkably similar to Bertrand, Goldin, and Katz’s (2010) study of MBA students. That is, there is no difference at the start of their careers; but due to the impact of motherhood, the gender gap widens over time.
But the story doesn’t end there. What is quite interesting is how the gender gap differs between medical specialisations. General practitioners exhibit the pattern just described. Internal specialists do too, though to a lesser extent. However, other than maternity leaves, we do not observe a persistent gender workload gap for surgical specialists. Indeed, for surgeons with dependent children, we are more likely to see male surgeons increasing their hours rather than female surgeons reducing theirs.
All this points to a degree of self-selection: in addition to their professional interests and opportunities, medical students also choose their specialisation on the basis of anticipated workload and their willingness to trade-off between work and family time.
What was the biggest challenge that you faced in your research?
It is something of a coincidence that the biggest challenge I faced when writing my thesis on health economics was my own health! Partway through the PhD journey, I was diagnosed with Meniere’s disease. This is a highly debilitating condition of the inner ear which does not yet have a cure. Experiencing periodic vertigo attacks and losing a large chunk of my hearing were not on the to-do list, but I was most fortunate to meet some extraordinary physicians in Professor Bill Gibson, Dr Philip Baigent, and Dr Brett Levin.
If anything, this experience heightened my interest in health economics – after all, as I had come to realise, the MABEL dataset was no longer just a dispassionate display of numbers and variables, but that it represents the very best and brightest our society has to offer!