Please note: All research in progress seminars are off-the-record. Any information about methodology and/or results are embargoed until publication.

Abstract:

The past two decades have witnessed an unprecedented expansion of investment in healthcare in developing countries with corresponding widespread improvement in health indicators, though there still remain a billion people without basic access to primary care. Though there is a growing emphasis on integrating international donor funds with broad-based health system strengthening (HSS) efforts, very little is known about the process in which healthcare systems improve at the point of service, and how that, in turn, impacts population health.   Unlike the role of randomized trials on individual interventions, there is no gold standard for health systems research.  As global health expands its scope to the new field of planetary health broadly associated with the SDGs, the gaps in knowledge and research grow even further. Here, we present a framework for adaptive district-level HSS in Madagascar.  The program simultaneously strengthens the WHO’s six building blocks of HSS at all levels of the health system within a government district, while pioneering a rigorous system for policy and implementation research that includes 1) strengthening the district’s health management information systems (HMIS); 2) a prospective longitudinal cohort demographic and health study of over 1500 households; and 3) selected qualitative and biomedical research projects.  The research platform allows for the evaluation of system output indicators as well as population-level impact indicators, such as mortality rates.  Moreover, it provides a platform for scientific research on socio-economic and environmental determinants of health that are fundamental to the new field of planetary health.

All research in progress seminars are off-the-record. Any information about methodology and/or results are embargoed until publication.

Abstract:

The Vaccine Confidence Project (VCP) is a research group, led by Dr. Heidi Larson. The VCP studies the diverse sociocultural, political and psychological influences which affect confidence in vaccines and immunisation programmes in local settings worldwide, as well as examining trans-national influences. The VCP has developed multiple metrics to measure population confidence in vaccines and immunization programmes, from a survey-based Vaccine Confidence Index to temporal analysis of media and social media monitoring of vaccine sentiment  and local qualitative research to understand the drivers of vaccine reluctance and refusal. Together, these diverse metrics  generate a rich picture of the drivers of vaccine confidence to hep inform interventions.

While all the evidence points to the importance of understanding locally nuanced drivers of vaccine reluctance to inform interventions, Dr. Larson will talk about the equally important transnational impacts of local vaccine events and emotions through global cases studies on HPV, Polio, Flu and Ebola, and the implications for vaccine preparedness around newly introduced vaccines and programmes as well as pandemic preparedness.

Bio:

Heidi J. Larson, PhD,  is an anthropologist and Senior Lecturer, Department of Infectious Disease Epidemiology, LSHTM, an Associate Clinical Professor, Institute of Health Metrics and Evaluation, University of Washington, Seattle, and a Fellow at the Chatham House Centre on Global Health Security. Dr. Larson previously headed Global Communication for Immunisation at UNICEF and chaired the Advocacy Task Force for GAVI (Global Alliance for Vaccines and Immunisation). She was also a  member of the WHO SAGE working group dealing with vaccine hesitancy.   Dr. Larson’s research focuses on the analysis of the social and political factors that can affect uptake on health interventions, particularly vaccines, and the implications for policies and programmes. Her particular interest is on risk and rumour management from clinical trials to delivery – and building public trust. Dr. Larson is currently the Principle Investigator for a large European Union grant (EBODAC) on the deployment, acceptance and compliance of an Ebola prime-boost vaccine trial in Sierra Leone.

*This seminar is co-sponsored with the Stanford Center for Innovation in Global Health*

Please note: All research in progress seminars are off-the-record. Any information about methodology and/or results are embargoed until publication.

Abstract:

Quantitative evaluation of environmental, health, and safety policies requires a metric for the value of changes in health risk. This metric should be consistent with both the preferences of the affected individuals and social preferences for distribution of health risks in the population. There are two classes of metrics widely used in practice: monetary measures (e.g., compensating and equivalent variations, willingness to pay and willingness to accept compensation) and health-utility measures (e.g., quality-adjusted life years (QALYs), disability-adjusted life years (DALYs)), both of which are summed across the population. Health-utility measures impose more structure on individual preferences than monetary measures, with the result that individuals’ preferences often appear inconsistent with these measures; for the same reason, health-utility measures help protect against cognitive errors and other sources of incoherence in estimates of the values of monetary measures obtained from revealed- and stated-preference studies. This paper presents theoretical and empirical evidence comparing these metrics and examining how they co-vary.

Please note: All research in progress seminars are off-the-record. Any information about methodology and/or results are embargoed until publication.

Abstract:

The Norwegian universal health care system is built on the fundamental principle of equal access to high quality health services regardless of socioeconomic status, ethnicity and geographical residence. Norway (approx. 5 Million people) is recognized for being an overall top performer among OECD countries on various health measures. However, the aging population has led to substantial cost increases as well as long waiting times for elective surgery, due to insufficient ability of hospitals to absorb patient inflows. These were some of the main motivations for Norway’s Hospital Reform and the implementation of the Free Choice System in the early years following the millennium. The responsibility for financing and providing specialized health services was transferred to four Regional Health Authorities (Central State), which in turn were given the right to contract (usually by tendering competition) with Private For-Profit Hospitals (PFPs). In the Free Choice System, patients holding a referral from their general practitioner (GP) can choose any hospital, both PFPs and Non-Profit Hospitals, for the same out of pocket cost. We have previously found that PFPs deliver the same procedures at a substantially lower cost (down to 50.6% of the National DRG-price). However, due to relatively large variations in waiting times between PFPs and Non-Profit Hospitals, we hypothesized that some groups may be better at navigating in this new system and achieve lower waiting times. We were particularly interested in whether the reform, aimed to contain costs and reduce waiting time for elective surgery, has compromised the fundamental principle equal access to care. Patients who underwent day surgery during the period 2009 – 2014 were identified through the Norwegian Patient Register and linked with socioeconomic data using the Norwegian Tax Register and the Norwegian Education Register. Preliminary findings suggest that otherwise similar younger patients, poorer patients, and those with more comorbidities are less likely to use PFPs, using Non-profit Hospitals instead. Higher educated patients go more frequently to PFPs and the difference between lower educated and higher educated patients is increasing with longer waiting times. We also find an overall increasing secular trend to use PFPs.

BIO:

Geir H. Holom, MD, is a Visiting Scholar at Stanford School of Medicine (CHP/PCOR) from the University of Oslo. His research focuses on the expansion of private for-profit hospitals in the Nordic countries and its effect on prices, quality of care and selection of patients. He received a BSc in Economics and Business Administration from the Norwegian School of Economics and an MD from the University of Bergen. While in medical school, he conducted research on patients diagnosed with head and neck cancer who underwent head and neck reconstruction using microsurgery. Since receiving his MD, he has worked as a physician in both primary care and specialized health services. Prior to entering the field of medicine, he worked in the business and finance sector. Dr. Holom volunteers for the Children's Program at Oslo University Hospital.

Please note: All research in progress seminars are off-the-record. Any information about methodology and/or results are embargoed until publication.

Abstract:

This project aims to develop an index, composed of established and available social and economic measures, that provides a quantitative and reproducible estimate of the degree to which societies are currently adapting and likely will in the future adapt to the demographic transformation. Such an index, which currently does not exist, is required if we are to measure the degree of success, or failure, of policies designed to facilitate successful societal aging and thus provide a context that facilitates the capacity of older persons to access the health care and social and economic supports needed to function effectively.

Please note: All research in progress seminars are off-the-record. Any information about methodology and/or results are embargoed until publication.

Abstract

The United Nations endorses universal health coverage (UHC) as part of the Sustainable Development Goals as a mechanism to “ensure healthy lives and promote well-being for all,” yet evidence about the impact of coverage on health in lower- and middle-income countries is limited. For example, if UHC improves survival then China’s dramatic expansion of health insurance coverage in rural areas since 2003 would have been expected to reduce mortality, especially among the rural poor; yet such impacts have not been found in research to date. 

We study whether insurance expansion played a causal role in adult mortality reductions in rural China. Our analysis uses Disease Surveillance Point (DSP) system data on age-standardized death rates per 1,000 population from 72 rural counties. We utilize differences across counties in the timing of the introduction of NCMS between 2004 and 2012 to show that NCMS reduced ischaemic heart disease mortality among elderly rural Chinese, with the most pronounced effects among men.

In collaboration with Maigeng Zhou, Shiwei Liu, Kate Bundorf, Sen Zhou