- WOC2.11 - APHID Are 'potentially preventable hospitalisations' a valid inDicator of the quality and affordability of primary and community care in Australia?
Rates of potentially preventable hospitalisations (PPH) are regarded as an indicator of the quality and affordability of primary and community care. They are increasingly being used to track the progress of health reform in Australia and internationally.
This project validated PPH as a measure of health system performance in Australia. Using linked person-level data, we explored relationships between frequency, volume, nature and costs of primary care services; hospital admissions for PPH diagnoses; health outcomes; and factors that confound and mediate these relationships. Using multilevel modelling techniques we quantified the contributions of person-, geographic- and service-level factors to variation in PPH rates, including socio-economic status, country of birth, geographic remoteness, physical and mental health status, availability of general practitioner (GP) and other services, and hospital characteristics.
Outcome and Translation
Our findings will inform the ongoing use of PPH to track the progress of health reform in Australia and internationally.
External collaborators: L Jorm (University of Western Sydney); A Leyland, F Blyth (MRC Social and Public Health Sciences Unit, Glasgow); K Douglas (Royal North Shore Hospital, Sydney); S Redman (The Mater Hospital, Sydney);
Jorm, L.R., Leyland, A.H., Blyth, F.M., Elliott, R.F, Douglas, K.M.A., Redman, S. and On behalf of the Aphid Investigators (2012) 'Assessing Preventable Hospitalisation InDicators (APHID): protocol for a data-linkage study using cohort study and administrative data', BMJ Open,2, e002344.
Falster, M. O., Jorm, L. R., Douglas, K. A., Blyth, F. M., Elliott, R.F. and Leyland, A. H. (2015) 'Sociodemographic and health characteristics, rather than primary care supply, are major drivers of geographic variation in preventable hospitalizations in Australia', Medical Care, 53(5), 436-445.
Elliott, R.F. (2012) 'Developing measures of the supply and efficiency of the health workforce', APHID (Assessing Preventable Hospitilisation InDicators) Reference Group, Sydney, Australia, November 2012.v
- WOC2.14 - ASH: Avoidable Scottish Hospitalisations
Admissions for ACSC are those that could potentially be prevented by timely and effective disease management within primary care. ACSC admissions are increasingly used within Scotland as NHS performance indicators. However, key questions remain about the validity of these measures. The aim of the project was to test the robustness of ACSC admissions as indicators of the quality of primary care in Scotland and where appropriate to propose methods for refining these measures so that they might be better used to set targets for and monitor health system performance. Using practice-level data, we explored relationships between quality of and access to primary care services, hospital admissions for a range of ACSCs, and factors that confound and mediate these relationships. The results showed that higher achievement on some quality measures of primary care was associated with reduced ACSC admissions while access to primary care was also associated with ACSC admissions. However, the effects were small and inconsistent and ACSC admissions were associated with several confounding factors such as composition of the practice population.
Outcome and Translation
Our findings can inform the use of ACSC admissions as a health system performance measure in Scotland and internationally. The research identified refinements to the ACSC admissions indicator to improve its utility as a performance measure.
External collaborators: M Dusheiko (University of York); B Guthrie (University of Dundee); L Jorm (University of Western Sydney) and A Leyland (MRC/CSO Social and Public Health Sciences Unit)
Pol, M. van der, Olajide, D., Dusheiko, M., Guthrie, B., Elliott, R.F., Jorm, L.R. and Leyland, A.H. (2015) Avoidable Scottish Hospitalisations (ASH). Final report submitted to Chief Scientist Office.
Pol, M. van der, Olajide, D., Dusheiko, M., Guthrie, B., Elliott, R.F., Jorm, L.R. and Leyland, A.H. (2015) The impact of quality and accessibility of primary care on admissions for Ambulatory Care Sensitive Conditions (ACSCs) in Scotland, CSO Focus on Research, Edinburgh: Chief Scientist Office.
Pol, M. van der, Olajide, D., Dusheiko, M., Elliott, R.F., Guthrie, B., Jorm, L. R. and Leyland, A. H. (2016) 'Does quality and accessibility of primary care reduce admissions for Ambulatory Care Sensitive Conditions (ACSCs) in Scotland?' HERU Policy Brief, June 2016, University of Aberdeen.
Pol, M. van der, Olajide, D., Dusheiko, M., Elliott, R., Guthrie, B., Jorm, L. and Leyland, A.H. (2019) 'The impact of quality and accessibility of primary care on emergency admissions for a range of chronic ambulatory care sensitive conditions (ACSCs) in Scotland: longitudinal analysis', BMC Family Practice, 20(1), 32.
Konstantinidou, M., Olajide, D. and Pol, M. van der (2014) 'The relationship between provider and patient reported quality of primary care. ', Health Economics in the Age of Longevity: a Joint iHEA & ECHE Congress, Trinity College, Dublin, 13-16 July 2014.
Olajide, D., Konstantinidou, M. and Pol, M. van der (2015) 'The relative influence of practice characteristics, patient access, and disease management in primary care on potentially preventable hospitalisations in Scotland', International Health Economics Association (iHEA) 11th World Congress, Milan, Italy, 12-15 July 2015.
- WOC1.10 - Attitudes to regulatory guidelines among clinicians in three countries: the UK dimension
The study explored whether, how and why attitudes to economic considerations in clinical decision making vary between different groups of medical doctors in different healthcare systems. The research comprised of a discrete choice experiment to elicit preferences on prescribing behaviour of GPs in Norway, Denmark, England and Scotland.
Outcome and Translation
This cross-country study of stated prescription behaviour allowed researchers to examine the influence of different organisational cultures on individual prescribing behaviour across the four countries surveyed. The influence of the institutional framework in GP decision making is an importance area to understand, where drug expenditures continue to be a significant component of health budgets. We find that GPs in different countries respond differently to information about societal costs, benefits and effectiveness.
HERU researchers involved in this research project: Diane Skåtun
External collaborators: B Carlsen, JR Kolstad (University of Bergen); B Bringedal (Research Institute of the Norwegian Medical Association); DG Hansen, PK Kjellberg (Danish Institute for Health Services Research); AR Hole (University of Sheffield) and S Holm (University of Oslo and University of Manchester)
Riise, J., Hole, A. R., Gyrd-Hansen, D. and Skåtun, D. (2015) 'GPs’ implicit prioritization through clinical choices – evidence from three national health services', Working Paper in Economics, No. 2/15, Beregn, Norway: University of Bergen. [pdf]
Riise, J., Hole, A. R., Gyrd-Hansen, D. and Skåtun, D. (2016) 'GPs' implicit prioritization through clinical choices: evidence from three national health services', Journal of Health Economics, 49, 169-183.
Hole, A. R., Gyrd-Hansen, D., Riise, J. and Skåtun, D. (2013) 'Medical doctors' priorities in complex choice situations: a cross country comparison', Third Applied Health Econometrics Symposium, University of Leeds, 18 October 2013.
Kolstad, J., Gyrd-Hansen, D., Hole, A. R. and Skåtun, D. (2012) 'Implicit prioritisation through prescription choices among GPs: evidence from Great Britain, Denmark and Norway', European Conference on Health Economics (ECHE), Zurich, July 2012.
Kolstad, J., Gyrd-Hansen, D., Hole, A. R. and Skåtun, D. (2012) 'GPs' prescription patterns in four countries; implicit prioritizations and shifting agencies', Dilemmas in the doctor's role: findings, methods and future challenges, Legeforeningens Forskningsinstitutt, Oslo, December 2012.
- WOC2.5 - Data envelopment analysis: an application to investigate differences in performance in NHS Scotland
Hospital performance in Scotland is usually measured using uni-dimensional approaches, e.g. cost per case, length of stay. These can be useful indicators. However, because hospitals are multi-dimensional in their output this rarely captures an overall picture of how efficiently a hospital is functioning.
This study investigated the application of a multi-dimensional approach to measuring hospital efficiency in Scotland: data envelopment analysis. This is a non-parametric method of measuring efficiency in organisations, most commonly used where the relative efficiency of a small number of organisations (such as hospitals in Scotland) is being analysed. We estimated the relative technical efficiency (TE) of Scottish hospitals under the assumptions of variable (VRS) and constant returns to scale (CRS) and tested for the importance of controlling for case-mix.
We found that teaching and large general hospitals were the most efficient and that there was no discernible improvement in efficiency over time. Case-mix adjustment had a small impact on efficiency scores but for some individual hospitals this had a substantial impact on their ranking and TE score. Using time-series regression analysis to gauge changes without the obfuscation by white noise we found a definite and statistically significant trend of improvement, from 2003 to 2007.
Outcome and Translation
The findings of this study addressed questions and objectives raised in the NHS Scotland Efficiency and Productivity Delivery Framework. They informed the SGHD via the Efficiency and Productivity Information Development Group. The research identified differences in efficiency of NHS organisations and the characteristics of those organisations. Such information is vital for targeting improvements in performance.
HERU researchers involved in this research project: Shelley Farrar
External collaborators: M Tavakoli (University of St Andrews) and M Rosko (Widener University, USA)
Valdmanis, V., Rosko, M., Mancuso, P., Tavakoli, M. and Farrar, S. (2017) 'Measuring performance change in Scottish hospitals: a Malmquist and times-series approach', Health Services and Outcomes Research Methodology, 17(2), 113-126.
Rosko, M., Tavakoli, M. and Farrar, S. (2012) 'Variations in relative efficiency in Scottish hospitals: a DEA approach', European Conference on Health Economics, Zurich. July 2012.
Rosko, M., Tavakoli, M. and Farrar, S. (2012) 'Variations in relative efficiency in Scottish hospitals: a DEA approach', Efficiency and Productivity Information and Development Group, Scottish Government Health Department, Edinburgh, August 2012.
- WOC2.10 - Evaluating the effect of free dental check-ups in Scotland
The Scottish Government introduced free NHS dental check-ups in April 2006 as a way of encouraging utilisation and improving the oral health of residents. We used data from the British Household Panel Survey (BHPS), a nationally representative data set covering 117,761 individual respondents in the United Kingdom, over the period between 2001 and 2008 to evaluate the impact of this policy on utilisation of NHS dental check-ups in Scotland, using a difference-in-difference approach.
This project provided the first systematic evidence of the effect of the introduction of free dental check-ups introduced in Scotland in April 2006. Results showed that there was a 3–4 per cent increase in NHS dental check-up in Scotland, compared to the rest of the UK.
Outcome and Translation
Results suggested that a removal of financial barrier to dental check-ups does indeed lead to a modest increase in utilisation, and may have wider implications for the delivery of dental care in Scotland.
HERU researchers involved in this research project: Divine Ikenwilo
Ikenwilo, D. (2013) 'A difference-in-differences analysis of the effect of free dental check-ups in Scotland', Social Science & Medicine, 83, 10-18.
Ikenwilo, D. (2013) 'Abolishing charges for check-ups within NHS Scotland: two case-studies', HERU Briefing Paper, December 2013, University of Aberdeen.
- WOC2.12 - An evaluation of the effect of informal care targeting the elderly on elderly mortality
Exogenous variation in volunteering caused by an earthquake was used to identify the causal effect of volunteering on mortality. The level of volunteering considerably increased in municipalities hit by the earthquake, while other municipalities did not experience such a sharp increase in volunteering. The identification was based on a comparison of mortality between the municipalities with no or little loss of life attributable to the earthquake, that experienced the sharp increase in the level of volunteering, and the nearby municipalities that were not hit by the earthquake.
The UK government has been promoting ‘a culture of generosity’, which encourages the public to volunteer to help improve life for all. It spent £13.9 billion on voluntary organisations in 2009/10, corresponding to approximately 2 per cent of total spending. Over the past decade, government spending on the voluntary sector has grown by 61 per cent in real terms, showing a growing importance of the voluntary sector in providing public services. Results aided in assessing whether citizens (volunteers) can contribute to the well-being of the elderly.
The results indicated that volunteering significantly reduced the mortality of people in their 70s and 80s or older. Furthermore, supplementary regressions to infer the mechanisms through which volunteering reduces mortality suggested that volunteering is likely to have reduced elderly morality by improving general health conditions of the elderly. Following the manual on the measurement of volunteer work (International Labour Office, 2011), it is estimated that approximately $71,360 worth of labour was used to save the lives of two individuals aged 70 or older in a given year. Broadly, these results yielded various important policy implications. For instance, by encouraging volunteer work for the elderly, a government may be able to curb public healthcare expenditures without compromising health support for the elderly.
Outcome and Translation
This could be an important policy measure amid the ongoing population ageing and resulting increase in healthcare expenditures across the world. Similarly, in countries with limited provision of public healthcare services, a government, by supporting volunteer activity for the elderly, may still be able to improve the health of the elderly who cannot afford private healthcare.
In December 2016 the project was featured by the University of Aberdeen as a news item to highlight the causal link between volunteering and care recipients living longer. It was also featured in the Times newspaper (paywall), the Daily Mail, the Daily Express, the Daily News in India, the Aberdeen Evening Express, and was featured on BBC Radio Scotland.
HERU researchers involved in this research project: Yu Aoki
Aoki, Y. (2014) Donating time to charity: not working for nothing. IZA Discussion Paper No. 7990, Bonn, Germany: Institute for the Study of Labor (IZA).
Aoki, Y. (2014) More schooling, less youth crime? Learning from an earthquake in Japan, IZA Discussion Paper No. 8619, Bonn, Germany: Institute for the Study of Labor (IZA).
Aoki, Y. (2016) 'Donating time to charity: working for nothing?', Oxford Economic Papers, 69(1), 97-117.
Aoki, Y. (2016) The power of volunteering: you make me happy and I make you happy, OUP Blog, Oxford: Oxford University Press.
Aoki, Y. (2013) 'An outcome of free labour supply: effect of volunteer work on mortality. A natural experiment using earthquake shocks in Japan', Scottish Institute for Research in Economics Young Researchers' Forum, Edinburgh, 8 March 2013.
Aoki, Y. (2013) 'An outcome of free labour supply: effect of volunteer work on mortality. A natural experiment using earthquake shocks in Japan', Scottish Economics Society Annual Conference, Perth, 8-10 April 2013.
Aoki, Y. (2013) 'An outcome of free labour supply: effect of volunteer work on mortality. A natural experiment using earthquake shocks in Japan,' 8th Annual CEDI Conference: Economics of Disasters - Natural and Man-made, London, 22 May 2013.
Aoki, Y. (2013) 'An outcome of free labour supply: effect of volunteer work on mortality. A natural experiment using earthquake shocks in Japan', Annual Conference of the European Society for Population Economics, Aarhus, Denmark, 12-15 June 2013.
Aoki, Y. (2013) 'Donating time to charity: not working for nothing. Social externality of volunteer work', Stirling University Economics Department Seminar, Stirling University, September 2013.
Aoki, Y. (2013) 'Donating time to charity: not working for nothing. Social externality of volunteer work', TEPP Conference: Research on Health and Labour, Le Mans, France, 26-27 September 2013.
Aoki, Y. (2013) 'Donating time to charity: not working for nothing. Social externality of volunteer work', Newcastle University Economics Department and Institute of Health & Society Joint Seminar, Newcastle University, October 2013.
Aoki, Y. (2015) 'Donating time to charity: not working for nothing', Heriot-Watt University, Economics Department Seminar, Heriot-Watt University, Edinburgh, 16 January 2015.
- WOC2.2 - EVEREST: Explaining the Variation in Epidemiology of Renal Replacement Therapy (RRT) outcomes through Expert opinion, Secondary data sources and Technology adoption
Having collected information on the organisation of healthcare systems and delivery of renal services, EVEREST quantified the influence of non-medical factors on RRT incidence independent of population need. Analyses also identified the characteristics of healthcare systems and renal services that are most strongly associated with higher rates of RRT, information that is relevant to policy makers in all countries, especially those in countries with developing economies.
Outcome and Translation
The systematic approach that has been adopted to establish the key medical and non-medical factors behind the worldwide variation in RRT will enable future research and policy to target these factors, refining their measurement and improving our understanding of how they act.
HERU reserchers involved in this research project: Bob Elliott
External collaborators: FJ Caskey (North Bristol NHS Trust, University of Bristol); AM MacLeod (School of Medicine, Medical Sciences and Nutrition, University of Aberdeen) and K Jager (European Renal Association, Amsterdam)
Caskey, F., Jager, K., Elliott, R. and MacLeod, A.M. for the EVEREST Study Group (2009) 'The EVEREST study: explaining variation in RRT through expert opinion secondary data sources and trend analysis', ERA-EDTA Registry Newsletter
Caskey, FJ., Stel, VS., Elliott, R., Jager, KJ., Covic, A., Cusumano, A., Geue, C., Kramer, A., Stengel, B. and MacLeod, AM. The EVEREST study: an international collaboration. Nephrology Dialysis Transplantation (NDT) Plus. October 2009.
Caskey, F., Jager, K., Elliott, R. and MacLeod, A.M. for the EVEREST Study Group (2009) 'The EVEREST study: explaining variation in RRT through expert opinion secondary data sources and trend analysis', NDT Educational.
Caskey, F.J., Stel, V.S., Elliott, R.F., Jager, K.J., Covic, A., Cusumano, A., Geue, C., Kramer, A., Stengel, B. and MacLeod, A.M. (2010) 'The Everest study: an international collaboration', Nephrology Dialysis Transplantation, 3(1), 28-36.
Kramer, A., Stel, V. S., Caskey, F. J., Stengel, B., Elliott, R. F., Covic, A., Geue, C., Cusumano, A., MacLeod, A. M. and Jager, K. J. (2012) 'Exploring the association between macroeconomic indicators and dialysis mortality', Clinical Journal of the American Society of Nephrology, 7(10), 1655-1663.
van de Luijtgaarden, M.W., Jager, K.J., Stel, V.S., Kramer, A., Cusumano, A., Elliott, R.F., Geue, C., MacLeod, A.M., Stengel, B., Covic, A. and Caskey, F.J. (2013) 'Global differences in dialysis modality mix: the role of patient characteristics, macroeconomics and renal service indicators', Nephrology Dialysis Transplantation, 28(5), 1264-1275.
Caskey, FJ., MacLeod, AM. (2008) ‘Health care organisation and RRT outcomes around the World’, The ERA-EDTA Registry Symposium, ERA-EDTA Annual Congress, Stockholm, May 2008.
Caskey, FJ., Jager, K., Elliott, R., Covic, A., Cusumano, A., Geue, C., Kramer, A., Stengel, B., Stel, V. and MacLeod, AM. (2008) ‘The EVEREST study: Explaining variation in RRT through expert opinion, secondary data sources and trend analysis’, Renal Week - American Society of Nephrology, Philadelphia, November 2008.
Caskey, F., Stel, VS., Jager, KF., Kamer, A., McLeod, A., Elliott, R. and Geue, C. (2009) ‘The EVEREST study: exploring the worldwide variation in RRT incidence’, World Congress of Nephrology, Milan. May 2009.
- WOC1.9 - An examination of changes introduced in the Quality and Outcomes Framework in 2006/07 and their effects on the delivery of primary care in Scotland
The Quality and Outcomes Framework (QOF) was introduced in 2004 across the UK National Health Service. It is an expensive and elaborate performance-related pay scheme for general practices. All participating practices report their achievements on almost 150 quality indicators to receive a performance-related bonus that could increase their income by up to 25%.
Most of the quality indicators are related to clinical diagnosis and treatment. Rewards increase linearly with the proportion of patients treated to provide an incentive to practices to treat more patients up to a maximum threshold. Changes in the reward structure were introduced in 2006/7, 2007/8 and 2009/10.
Using data from 1,000 practices in Scotland and 8,000 in England, we examined how general practices responded to these changes. We then modelled treatment rates in later years as functions of earlier years’ treatment rates and changes to the reward functions across the years. This will inform future adjustments to the QOF.
Outcome and Translation
This research indicated that practices are responsive to even small changes in financial rewards and suggests that even small changes to the design of pay-for-performance schemes can stimulate further improvements in quality.
HERU researchers involved in this research project: Diane Skåtun and Ada Ma
External collaborators: M Sutton (University of Manchester); B Guthrie (University of Dundee) and H Gravelle (University of York)
Ma, A., Skåtun, D., Sutton, M., Guthrie, B. and Gravelle, H. (2011) An examination of changes introduced in the quality and outcomes framework in 2006/07 and their effects of the delivery of primary care in Scotland. Chief Scientist Office Final Report, Edinburgh: Scottish Government Chief Scientist Office.
- WOC2.8 - Eye care services in Scotland: did the Scots get it right?
In April 2006 the Scottish Executive introduced free eye care in Scotland and commissioned private ophthalmic optician practices to perform eye examinations. The introduction of free NHS eye examinations in Scotland was expected to encourage wider use of optometry services and to benefit the majority of patients from regular sight testing. We evaluated the impact of this policy. Until 2006 eye-care service delivery was the same in Scotland and England; the introduction of this policy could be viewed as a natural experiment. We exploited this experimental element to identify the effects of the policy.
Outcome and Translation
The policy succeeded in getting more people to have their eyes tested but socio-economic differences suggest that the policy has not reached the more vulnerable segments in society to the same extent, in particular, those with low education and low income. As a result, inequalities in utilisation of eye care services have widened in Scotland since the free eye care policy was introduced.
External collaborators: A Zangelidis and H Dickey (University of Aberdeen Business School (UABS))
Zangelidis, A., Dickey, H., Ikenwilo, D. and Watson, V. (2011) 'Eye care services in Scotland: did the Scots get it right?', SIRE Focus, 2011-SIRE-02
Dickey, H., Ikenwilo, D., Nowood, P., Watson, V. and Zangelidis, A. (2012) Utilisation of eye care services: examining the effect of Scotland's eye care policy, Edinburgh: Scottish Government Chief Scientists Office (CSO).
Dickey, H., Ikenwilo, D., Norwood, P., Watson, V. and Zangelidis, A. (2012) 'Utilisation of eye-care services: the effect of Scotland's free eye examination policy', Health Policy, 108(2-3), 286-293.
Dickey, H., Ikenwilo, D., Norwood, P., Watson, V. and Zangelidis, A. (2016) 'Doctor my eyes: a natural experiment on the demand for eye care services', Social Science and Medicine, 150, 117-127.
Dickey, H., Norwood, P., Watson, V. and Zangelidis, A. (2018) More than meets the eye: has the eye care policy in Scotland had wider health benefits?, Discussion Papers in Economics, 18-1, Aberdeen: University of Aberdeen Business School.
Dickey, H., Ikenwilo, D., Norwood, P., Watson, V. and Zangelidis, A. (2014) 'Did the Scots get it right? A natural experiment on the demand for eye care services', Health Economics in the Age of Longevity: a Joint iHEA & ECHE Congress, Trinity College, Dublin, 13-16 July 2014.
- WOC2.6 - Feasibility study of use of direct payments for informal care
The study involved a review of relevant literature to inform the design of a questionnaire for older people and their carers or potential carers. The questionnaires collected a range of information about older people and their carers and related this to their attitudes towards the use of direct payments and how these would affect the supply of care. The results showed that there was little enthusiasm for modifications to the current system of self-directed support payments; that is, moving to a system that would allow direct payments to be used to support unpaid care provided by family members.
Outcome and Translation
The result of the study informed government policy about care for older people in their own homes and provides a basis for further research.
HERU researchers involved in this research project: Anne Ludbrook, Paul McNamee and Yan Feng
Ludbrook, A. and McNamee, P. (2011) Feasibility study of use of direct payments for informal care. Chief Scientist Office final report, Scottish Government Chief Scientist Office (CSO).
McNamee, P. and Ludbrook, A. (2010) 'Feasibility study of use of direct payments for informal care', Scottish Collaboration for Public Health Research and Policy, Edinburgh, November 2010.
- WOC1.6 - How to attract health workers to rural areas: findings from discrete choice experiments
One of the biggest challenges for policy makers in the health sector in both developed and developing countries is attracting health workers to rural areas. Globally, approximately one-half of the population lives in rural areas, but these areas are served by only 38 per cent of the total nursing workforce and by less 25 per cent of the total physician workforce.
This lack of qualified health workers in rural areas is a significant barrier to service delivery, impeding access to healthcare services for a significant percentage of the population. In low- and middle-income countries such shortages slow progress towards attaining the Sustainable Development Goals and challenge the aspiration of achieving health for all.
This project, carried out in collaboration with a number of external bodies (World Bank; World Health Organization; Health Economics Unit, University of Cape Town; National Centre for Global Health and Medicine, Japan) explored the use of discrete choice experiments to better understand health worker preferences in low- and middle-income countries. DCEs have been conducted in Liberia, Vietnam, India and Senegal.
Outcome and Translation
This work provides guidance to policy makers on optimal contracts to induce health workers to live in remote and rural areas. We have also produced a ‘User Guide on How to Conduct a Discrete Choice Experiment for Health Workforce Recruitment and Retention in Remote and Rural Areas’ . This should be useful for those considering using a DCE to address issues around health worker recruitment and retention.
HERU researchers involved in this research project: Mandy Ryan and Nicolas Krucien
External collaborators: A Amaeda (World Bank); M Alfano (University College London); A Honda (University of Cape Town); M Nagai, N Fujita (National Centre for Global Health and Medicine, Japan).
Rao, K., Ramani, S., Murthy, S., Hazarik, I., Khandpur, N., Choskshi, M., Khanna, S., Vujicic, M., Berman, P. and Ryan, M. (2010) Health worker attitudes towards rural services in India: results from qualitative research. Health, nutrition and population discussion paper, HNP, World Bank.
Vujicic, M., Alfano, M., Ryan, M., Sanford Wesseh, C. and Brown-Annan, J. (2010) Policy options to attract nurses to rural Liberia. Evidence from a discrete choice experiment, Health, Nutrition and Population Discussion Paper, World Bank
Rao, K., Shroff, Z., Ramani, S., Khandpur, N., Murthy, S., Hazarika, I., Choksi, M., Ryan, M., Berman, P. and Vijuvic, M. (2012) How to attract health workers to rural areas. Findings from a discrete choice experiment from India, World Bank.
Ryan, M., Kolstad, J., Rockers, P. and Dolea, C. (2012) How to conduct a discrete choice experiment for health workforce recruitment and retention in remote and rural areas: a user guide with case studies, Geneva:World Health Organization and World Bank.
Ramani, S., Rao, K. D., Ryan, M., Vujicic, M. and Berman, P. (2013) 'For more than love or money: attitudes of student and in-service health workers towards rural service in India', Human Resources for Health, 11(1), 58.
Rao, K. D., Ryan, M., Shroff, Z., Vujicic, M., Ramani, S. and Berman, P. (2013) 'Rural clinician scarcity and job preferences of doctors and nurses in India: a discrete choice experiment', PLoS One, 8(12), e82984.
Honda, A., Krucien, N., Ryan, M., Diouf, I.S.N., Salla, M., Nagai, M. and Fujita, N. (2019) 'For more than money: willingness of health professionals to stay in remote Senegal', Human Resources for Health, 17(1), 28.
Alfano, M., Vujicic, M. and Ryan, M. (2011) 'Formulating effective policies for health worker recruitment to rural areas: a joint estimation of preferences, costs, motivation and attitudes', International Health Economic Association Conference, Toronto, July 2011.
Ryan, M. (2011) 'Policy options to attract health workers to rural Liberia: evidence from a discrete choice experiment', Yunus Centre for Social Business and Health, Glasgow Caledonian University, November 2011.
Vujicic, M., Ryan, M. and Alfano, M. (2011) 'Estimating conditional and unconditional demand using discrete choice experiments: an application to nurse location decisions in Liberia', International Choice Modelling Conference, Institute of Transport Studies, University of Leeds, July 2011.
Rao, K., Shroff, Z., Ramani, S., Khandpur, N., Murthy, S., Hazarika, I., Choski, Ryan, M., Berman, P. and Vijuvic, M. (2012) 'How to attract health workers to rural areas? Findings from a discrete choice experiment from India', Bringing Evidence into Public Health Policy (EPHP) Conference., Bangladore, India, October 2012.
Ryan, M. (2012) 'Using discrete choice experiments to inform health services research: an application to health worker choices in rural Liberia', Centre for Clinical Epidemiology and Evaluation, University British Columbia, Vancouver, Canada, March 2012.
Honda, A., Krucien, N. and Ryan, M. (2017) 'What makes you happy? The role of intrinsic motivation on health workers’ decisions to stay in rural areas', 5th International Choice Modelling Conference, Cape Town, South Africa, 3-5 April 2017.
- WOC1.8 - Impact of revalidation on clinical and non-clinical activity
Revalidation is the new process required for doctors to confirm periodically that they are continuing to practise at the level required by their regulatory body, the General Medical Council (GMC). The process centres around an enhanced appraisal with doctors providing supporting evidence of their fitness to practise.
This project assessed the potential impact of this mandatory participation in strengthened appraisal and revalidation on patients, on the NHS, and on the professional, non-clinical supporting professional activities (SPAs) responsibilities of doctors within the NHS. Using a survey, the project aimed to achieve a greater understanding of how consultants (and SAS doctors) currently use their time across the variety of activities they undertake. It elicited the priority given by doctors to different SPA activities (including the current appraisal system) through two methods: the actual time spent in activities (given their current job plan) and the second through a discrete choice experiment using hypothetical scenarios.
The study showed no strong evidence that direct patient care by consultants will be compromised in the short term by the requirements of new appraisal and revalidation processes but suggested SAS doctors may find it more difficult to protect direct patient care. However, with various pressures on medical time and once the full requirements of revalidation in practice are known, further modelling will be required to quantify the full impact on wider professional responsibilities.
Outcome and Translation
The information gained from the survey helped understand the likely impact of mandatory participation in revalidation on the availability of this time and provided information to predict the likely impact of revalidation on different groups of doctors and across the spectrum of professional activity.
HERU researchers involved in this research project: Diane Skåtun and Divine Ikenwilo
External collaborators: B Frier, E Tait, C Pottinger (RCPE); G Youngston, A Rooney (RCSEd); R Nothcote (RCPSG); I Starke (RCPL); C Dodds (RCoA); B Cunliffe, K Rodgers (NHS North-East) and F French (NES/ISD)
Skåtun, D. and Ikenwilo, D. (2012) Impact of revalidation on the clinical and non clinical activity of hospital doctors. Research Report to the Academy of Medical Royal Colleges, Academy of Medical Royal Colleges.
Ikenwilo, D. and Skåtun, D. (2014) 'Perceived need and barriers to continuing professional development among doctors', Health Policy, 117(2), 195-202.
Ikenwilo, D. and Skåtun, D. (2013) 'Job satisfaction and intentions to alter contracted hours among doctors in Scotland', Nordic Health Economists Study Group, Oslo, Norway, 14-16 August 2013.
- WOC1.5 - Payment by results: key outcomes and variations across HRGs providers and patients in 2006/07 and 2007/08
This project identified the medium-term consequences of activity-based funding for hospitals in the English NHS. It built on a completed project examining the implementation and early effects of the Payment by Results policy. Activity-based funding systems in other countries, similar to PbR, have been shown to have significant effects on the costs, quality and volume of care. Research on some of these payment systems shows the effects to be short-lived.
Using micro-econometric techniques we:
- (i) charted the evolving impact of the new financial regime on key indicators of activity, cost and quality;
- (ii) rolled forward previous work using Scotland (where the policy is not being implemented) as a comparator; and
- (iii) investigated the variability of the effects across three key dimensions:
- (a) patient group;
- (b) provider organisation; and
- (c) type of treatment.
Outcome and Translation
This research directly informed the Department of Health in England of the variation in impact of PbR, informing the future development of the policy.
HERU researchers involved in this research project: Shelley Farrar
External collaborators: M Chalkley (University of York)
Farrar, S., Yi, D., Chalkley, M., Ma, A. and Sutton, M. (2009) Interim report on the medium term consequences of payment by results, Department of Health
Farrar, S., Yi, D., Sutton, M., Chalkley, M., Sussex, J. and Scott, A. (2009) 'Has payment by results affected the way that English hospitals provide care? Difference-in-differences analysis', BMJ, 339:b3047.
Farrar, S., Chalkley, M., Yi, D. and Ma, A. (2010) Payment by results: consequences for key outcomes measures and variations across HRGs, providers and patients. Report for the Department of Health, Department of Health.
Farrar, S., Yi, D. and Boyle, S. (2011) 'Payment by results ' in Mays, N., Dixon, A. and Jones, L., eds., Understanding New Labour's Market Reforms of the English NHS, London: King's Fund.
Farrar, S. (2011) 'Using national tariffs to pay for hospital care', HERU Briefing Paper 36, Februarty 2011, University of Aberdeen
Yi, D., Farrar, S., Sutton, M., Scott, A. and Chalkley, M. (2007) ‘Do hospitals become more efficient under a new prospective payment system? Effects of Payment by Results on length of stay in English hospitals’, Health Economist’s Study Group, Brunel University, September 2007.
Farrar, S., Yi, D., Ma, A., Sutton, M. and Chalkley. M. (2009) ‘Behaviour of English hospitals in the early stage of implementing payment by results: difference-in-differences analysis using Scotland as control. Exploiting Existing Data for Health Research’, Scottish Health Informatics Programme, St Andrews, September 2009.
Farrar, S., Yi, D., Chalkley, M., Ma, A. and Sutton, M. (2009) ‘Impact of Payment by Results on providers and services: latest findings from the national evaluation. Department of HealthPRP Health Reforms and Evaluation Programme’, London School of Hygiene and Tropical Medicine, London, November 2009.
Farrar, S., Yi, D., Chalkley, M., Ma, A., Sutton, M. and Sussex, J. (2010) ‘Payment by Results: impact and policy implications. DoH PRP Health Reforms and Evaluation Programme’, Symposium on Policy Implications of Emerging Findings for the English NHS, King's Fund, London, February 2010.
Farrar, S., Yi, D., Ma, A., Chalkley, M. and Sutton, M. (2010) ‘Measuring the impact of activity based hospital financing across patient group’, ECHE, Helsinki, July 2010
- WOC2.1 - PhD: Developing a needs-based resource allocation model for health care expenditure in Bangladesh
This PhD addressed the counterfactual question of what would have been the allocation to each district had the needs of the population been accounted for. Two alternative approaches were considered.
The first used a simple capitation formula in which weights for the adjustment of the current allocation are generated directly based on the relative values of proxies for needs. The second approach predicted adjustment weights from the estimation of a standard econometric model of needs, controlling for a range of determinants including individual, household and district characteristics.
Important predictors of current allocation were found to be the number of hospital beds and health workers rather than need factors. Important predictors of needs include demographic and socio-economic characteristics. The findings suggest that a needs-based allocation can be developed for Bangladesh.
This research provides an alternative approach to generating weights showing systematic relationships between the need adjustment factors. The robustness of the methods used will be sensitive to the quality of the data and the assumptions of the models.
Outcome and Translation
As these approaches are based on sound economic analysis and are open to independent assessment, they will help to inform policy debate and can reduce the influence of politically motivated allocations. A gradual process of implementation and regular review of the methods used would be a way forward. Future areas of research may include: re-analysing data at smaller-area level and use of different components of allocations.
PhD Student: Zahid Quayyum
Supervisors: Dami Olajide (HERU), T Ensor, D Newlands (Economics, University of Aberdeen Business School (UABS)) and N Campbell (Division of Applied Health Sciences (DAHS), University of Aberdeen)
Quayyum, Z. (2012) ‘Developing a needs-based resource allocation model for health care expenditure in Bangladesh’, PhD Thesis, University of Aberdeen.
- WOC2.7 - PhD: Government purchasing of health care from Not-For-Profit providers: a review of service level agreements in Malawi
The Government of Malawi has entered into service level agreements (SLAs) with the CHAM healthcare facilities in order to expand access to a basic package of healthcare services.
The objectives of the package are to guarantee universal access and improve equity of access to healthcare. Under the SLAs, pregnant women, and children aged less than 5 years, are exempted from paying the user fees charged at the CHAM health centres. The government in turn reimburses the providers. It is, however, not known what the impact of the SLAs has been.
This study assessed the effect of the SLAs on utilisation – whether use of health services covered in SLAs increased; equity – who, between the poor and the better-off, has benefited from SLAs; and health outcomes for targeted populations. Health and healthcare indicators were compared before and after introduction of the SLAs for CHAM providers with and without SLAs.
The results of this study provided evidence on whether government investment in SLAs has yielded positive benefits.
Outcome and Translation
This research informed the proposal in the current health sector strategic plan (HSSP) 2011–2016 to increase the number of SLAs. The research received a prize from the African Health Economics & Policy Association (AfHEA) Scientific Review Committee to present at the AfHEA biennial conference in 2016. The prize included a substantial cash prize and a sponsorship package to attend the conference.
PhD Student: Gerrard Manthalu
Supervisors: Shelley Farrar (HERU)
Manthalu, G. (2014) 'The impact of user fee exemption on maternal health care utilisation and health outcomes at mission health care facilities in Malawi', PhD Thesis, HERU, University of Aberdeen.
Manthalu, G., Yi, D., Farrar, S. and Nkhoma, D. (2016) 'The effect of user fee exemption on the utilization of maternal health care at mission health facilities in Malawi', Health Policy and Planning, 31(9), 1184-1192.
- WOC2.3 - PhD: NHS staff skills mix and local labour markets: the role of reward structures, shortages and competition in determining the mix of the NHS workforce
The NHS has undergone rapid changes in recent years. These have had a significant impact on the pay and work of all major staff groups in the NHS including medical and nursing staff. The drivers of change include the new consultant contract and the introduction of Agenda for Change – the new system of pay for all non-medical staff. These changes come at a time when there are shortages of staff in some areas of the country. Research undertaken has revealed how local labour market conditions impact on the NHS workforce. Health providers faced with staff shortages but unable to adjust pay, as a means of alleviating the shortage, will find alternative ways of resolving the problem. One way is to adjust skill-mix, to change the relative contributions of health professionals by workforce restructuring.
Outcome and Translation
This research provided evidence on the use of alternative staff configurations by health providers as an instrument to resolve staff shortages as opposed to pay. In particular it extended the analysis to France where a significant private-hospital sector exists. The wage competition from this private sector does not have a significant impact on public-sector hospitals suggesting that it is non-wage competition that plays an important role between the public and private sector nursing labour market.
Phd Student: J-B Combes
Combes, J-B. (2012) 'An investigation of the impact of the local labour markets on staff shortages and staff mix of hospitals in England and France', PhD Thesis, HERU, University of Aberdeen.
Combes, J.-B., Delattre, E., Elliott, R. F. and Skåtun, D. (2015) 'Hospital staffing and local pay: an investigation into the impact of local variations in the competitiveness of nurses’ pay on the staffing of hospitals in France', European Journal of Health Economics, 16(7), 763-780.
Combes, J.-B., Elliott, R.F. and Skåtun, D. (2018) 'Hospital staff shortage: the role of the competitiveness of pay of different groups of nursing staff on staff shortage', Applied Economics, 50(60), 6547-6552.
Combes, J-B., Elliott, R. and Skåtun, D. (2009) ‘Skill mix and labour market competition: how hospitals adjust the nursing skill mix in response to local labour market conditions’, Health Economist’s Study Group, Sheffield, 2009.
Combes, J-B. (2010) ‘Nursing workforce skill mix and the competiveness of qualified nurses pay: a local labour market analysis. Ecole Nationale de la Statistique et de l'Analyse de l'Information’, Seminar Health Economics, Rennes, France, January 2010.
Combes, J-B., Elliott, R. and Skåtun, D. (2010) ‘Nursing workforce skill mix and the competiveness of qualified nurses pay: a local labour market analysis’, Econometrics of Healthy Human Resources, Rome, May 2010.
Elliott, R. (2011) ‘Local labour markets, nurse recruitment and retention and skill mix in English hospitals’, Melbourne Institute of Applied Economic and Social Research, Melbourne, April 2011.
Elliott, R. (2011) ‘Local labour markets, nurse recruitment and retention and skill mix in English hospitals’, Monash University, Melbourne, April 2011.
Combes, J-B. (2011) ‘The effect of the local labour force on the NHS workforce’, University of Aberdeen PhD Symposium, Aberdeen, June 2011.
Elliott, R., Combes, JB. and Skåtun, D. (2011) ‘Local labour markets and nursing skills mix in England’, iHEA, Toronto, July 2011.
Combes, J-B., Elliott, R. Delattre, E. and Skåtun, D. (2012) ‘Hospital staffing, skill mix and local pay: an investigation into the impact of local variations in the competiteveness of nursing-pay on the staffing of hospitals in France’, HESG/CES, Marseille, January 2012.
- WOC1.3 - PhD: Personal and professional motivation and the supply of health care
The project included a comprehensive review of the theoretical and empirical literature with the objectives (i) to identify different existing models of intrinsic motivation and consider their relevance to the healthcare sector and (ii) to review empirical analysis of applications of this theory and again consider what lessons can be learned from this for the design of future analysis. Models of intrinsic motivation with testable hypotheses for application to the healthcare sector were developed. Opportunities to test these models were identified within the changing policy and contractual environment of the UK NHS.
Outcome and Translation
Financial incentives are extensively used within healthcare to improve the performance of organisations and individuals. The outcomes of this research provided evidence of whether such incentives have unintended effects on motivation and hence performance. For instance, an increase in the rate of performance target payments was found to effectively motivate Scottish GPs' healthcare supply, but it also 'crowded out' GPs' intrinsic motivation. Further, a change in the level of target thresholds motivated low-performing GPs significantly more than their high-performing counterparts.
PhD student: Yan Feng
Supervisors:Shelley Farrar and Ada Ma (HERU); Matt Sutton (University of Manchester)
Feng, Y. (2010) 'An economic analysis of intrinsic and extrinsic motivation in the supply of health care', PhD Thesis, University of Aberdeen.
Feng, Y., Farrar, S., Ma, A. and Sutton, M.A. (2011) 'The effect of an increase in the rate of payment on General Practitioners' intrinsic and extrinsic motivation', OHE Research Paper 11/05,Office of Health Economics.
Feng, Y., Ma, A., Farrar, S. and Sutton, M. (2012) 'The tougher the better: the effect of an increased performance threshold on the performance of general practitioners', OHE Research Paper 12/02, Office of Health Economics.
Feng, Y., Ma, A., Farrar, S. and Sutton, M. (2015) 'The tougher the better: an economic analysis of increased payment thresholds on the performance of general practices', Health Economics, 24(3), 353-371.
Feng, Y. (2007) ‘Microeconometric analysis of health care datasets: an economic analysis of extrinsic and intrinsic motivation in the supply of health care. University of Aberdeen/Dundee.’ Scottish Institute for Research In Economics (SIRE) Health Economics PhD workshop, Arbroath, May 2007.
Feng, Y., Farrar, S., Sutton, M. and Ma, A. (2008) ‘The effect of a pay for performance system on GPs’ monetary and non-monetary motivations’, Joint Meeting of the UK HESG and the Nordic HESG, Aberdeen, August 2008.
Feng, Y. (2008) ‘An economic analysis of extrinsic and intrinsic motivation in the supply of health care’, University of Aberdeen IAHS PhD Symposium, Aberdeen, December 2008.
Feng, Y., Farrar, S., Ma, A. (2012) ‘The supply of unpaid work’, UK HESG, Oxford, June 2012.
- WOC1.1 - PhD: Studies of the job satisfaction and labour supply of hospital consultants
Consultants are part of a team of medical and non-medical personnel involved in the production of healthcare and are paid to deliver a specific minimum number of hours of their labour to the National Health Service (NHS) in the United Kingdom (UK). This thesis explored issues around motivation, and specifically looks at the effects of pay and non-pay factors on the labour supply of consultants in NHS Scotland, using data from two national surveys of consultants conducted in Scotland. It is written as three distinct empirical chapters looking at determinants of job satisfaction, and the supply of (usual and extra) labour by consultants in NHS Scotland before and after new consultant contracts were introduced.
Outcome and translation
PhD Awarded in November 2010. This research found that pay increases for consultants only result in small increases in hours worked. Those currently working above the median number of hours are much less responsive to changes in earnings.
PhD Student: Divine Ikenwilo
Ikenwilo, D. (2010)‘Studies of the job satisfaction and labour supply of hospital consultants, PhD Thesis, University of Aberdeen, 2010.
Ikenwilo, D., Scott, A. (2007) ‘The effects of pay and job satisfaction on the labour supply of hospital consultants’, Health Economics, vol 16 (12), 1303–1318.
PhD and internal HERU seminars and conference presentation (iHEA Beijing, 2009).
Ikenwilo, D. (2009) 'Longitudinal data analyses of normal and extra contracted hours among senior doctors following contractual reform', 7th World Congress of the IHEA. July 2009.
- WOC2.13 - Preferences for primary care delivery in Portugal
In the past few years there have been substantial changes to the delivery of primary care in many countries as healthcare reforms introduce new models of care. This began in Portugal in 2005 with the on-going reform of the primary healthcare. Although recent reforms have been accompanied by an effort to monitor the users’ satisfaction based on pre-defined attributes and scales, little is known about population preferences on primary healthcare services and its prioritization.
This study used a mixed methods approach to elicit the preferences of the general public for primary healthcare services in Portugal. The study developed valid and reliable measures of primary care attributes relevant to Portugal. These were used to develop a discrete choice experiment to examine preferences and priorities among these attributes among a sample of Portuguese patients. Public preferences were compared with the political choices necessitated by fiscal austerity.
Outcome and Translation
The structural reform of primary healthcare delivery in Portugal began in 2005 but political choices necessitated by fiscal austerity mean that the reform is incomplete. We found patients supported publicly provided primary care and were concerned about its future. They wished to keep the core principles of the Portuguese health service, mainly equity and solidarity. Although the reform was designed to improve efficiency and access in primary care delivery it has not substantially improved primary care delivery and has had a negative impact on equity. The incomplete nature of the reforms has led to a three-tiered model of care (patients with a Family Doctor (FD) and Family Health Unit (FHU), patients with a FD and Primary Care Health Unit (PCHU), patients without a FD and PHCU). This raises equity concerns that must be addressed.
External collaborators: P Viega and I Correia (University of Minho, Portugal)
Norwood, P., Watson, V., Viega, P. and Correira, I. (2013) What do patients want from primary care services? Final report, Ministério da Saude, INSA.
Norwood, P., Correia, I., Veiga, P. and Watson, V. (2019) 'Patients’ experiences and preferences for primary care delivery: a focus group analysis', Primary Health Care Research and Development, 20, e106.
Norwood, P., Correia, I., Heidenreich, S., Veiga, P. and Watson, V. (2021) 'Is relational continuity of care as important to people as policy makers think? Preferences for continuity of care in primary care', Family Practice, [Epub ahead of print].
Watson, V., Norwood, P., Benesch, P. V. and Correira, I. (2013) 'Population preferences in primary health care in Portugal' [Poster], Associação Portuguese de Economia da Saúde / Portuguese Health Economics Association, Braga, Portugal, 10-12 October 2013.
- WOC1.7 - The staff market forces factor component of the resource allocation weighted capitation formula
Previous research by HERU commissioned by the Advisory Committee on Resource Allocation (ACRA) led to important changes in the way the staff MFF was estimated. The MFF is an element of the formula that funds PCTs in England and Wales. More recent estimates were required, using the latest data and incorporating any refinements to method that would increase the reliability and robustness of the method. This research provided up to date MFF values and, within the general framework, reviewed and where appropriate suggested refinements to the method for estimating the MFF.
Outcome and Translation
ACRA recommended that the staff market forces factor (MFF) was updated in line with the figures provided by the study. This recommendation was accepted by the Department of Health and the updated staff MFF values were used in the PCT allocations from 2011–12. Two research reports were published by the Department of Health as Resource Allocation Working Papers to accompany the announcement of the PCT allocations.
External collaborators: M Sutton (University of Manchester); N Rice (University of York); S Morris (UCL) and A McConnachie (University of Glasgow)
Elliott, R.F., Ma, A., McConnachie, A., Morris, S., Rice, N. and Skåtun, D. (2010) The staff market forces factor component of the resource allocation weighted capitation formula: new estimates. Phase 1. Report to the Advisory Committee on Resource Allocation (ACRA), Advisory Committee on Resource Allocation (ACRA).
Elliott, R.F., Ma, A., Sutton, M., Skåtun, D., Rice, N., Morris, S. and McConnachie, A. (2010) 'The role of the staff MFF in distributing NHS funding: taking account of differences in local labour market conditions', Health Economics, 19(5), 532-548.
Ma, A., Elliott, R.F, Morris, S., Rice, N. and Skåtun, D. (2010) The staff market forces factor component of the resource allocation weighted capitation formula: refinements to method. Phase 2. Report to the Department of Health, Department of Health.
Elliott, R., Ma, A., McConnachie, A., Morris, S., Rice, N. and Skåtun, D. (2010) 'The staff market forces factor component of the resource allocation weighted capitation formula: new estimates', Technical Advisory Group (TAG), Department of Health, London, April 2010.
Elliott, R., Ma, A., McConnachie, A., Morris, S., Rice, N. and Skåtun, D. (2010) 'The staff market forces factor component of the resource allocation weighted capitation formula: new estimates', Advisory Committee Resource Allocation (ACRA), Department of Health, London, May 2010.
- WOC1.2 - A study of nurse labour markets: preferences for pecuniary and non-pecuniary rewards
This study investigated the importance of non-pay aspects within the reward structure for nurses in the UK. A crucial requirement of the current modernisation of the National Health Service (NHS) is the supply of an adequate number of nurses.
A key policy question is whether an increase in resources devoted to recruiting and retaining nurses is best spent on wages or upon improving working conditions. There is some evidence of the effect of wages on nursing labour supply, but little on the value placed by nurses on working conditions. Working conditions may become a more important policy instrument in the future with the introduction of the new, more uniform pay structures agreed in ‘Agenda for Change’.
The study distinguished the ‘price’ that nurses are willing to pay to improve their working conditions. It identified how nurses trade pay off against other working conditions.
Outcome and Translation
The research results have been disseminated to both the chief economist and statistician of the NHS Pay Review Body and the Head of Workplace Health, Employment Services at NHS Employers. The research provides evidence for the relationship between both pay and conditions for the nursing workforce and provides valuable information for policy-makers and employers. In particular, individual tastes for job characteristics such as the flexibility, predictability and the timing of hours have an important and significant impact on hours of work supplied. While it might be difficult to change individual tastes or preferences over job-specific characteristics, recognizing that these features are important determinants of the labour supply can be utilized to adapt management practices to take these tastes into consideration where possible. This can provide an important additional instrument apart from wages to influence labour supply.
External collaborators: A Scott (University of Melbourne)
Skåtun, D. and Elliott, R. (with Geue, C., Eberth, B. and Ikenwilo, D.) (2009) Nurse labour markets: preferences for pecuniary and non-pecuniary rewards. Economic and Social Research Council, Final Report.
Eberth, B., Elliott, R. F. and Skåtun, D. (2016) 'Pay or conditions? The role of workplace characteristics in nurses' labor supply', European Journal of Health Economics, 17(6), 771-785.
Skåtun, D., Elliot, R. and Geue, C. The role that working conditions play in the employment decisions of nurses. "Delivering better health services". Health Services Research Network and National Institute for Health Research Service Delivery and Organisation (NIHR SDO) Programme Annual Conference. Birmingham. June 2009.
Skåtun, D., Eberth, B. and Elliott, R. Pay or conditions? The role of workplace characteristics in nurses’ labour supply. Scottish Economic Society Conference. Perth. April 2010.
- WOC2.4 - Telemetric support self-monitoring of long-term conditions
Four different trials were conducted, one for each of the following conditions: uncontrolled high blood pressure in patients who do not have diabetes, kidney problems or previous stroke; uncontrolled blood pressure in patients who have had strokes; patients with chronic obstructive pulmonary disease (COPD); patients with several uncontrolled conditions (diabetes/blood pressure/obesity).
Outcome and Translation
Hypertension, COPD, diabetes and stroke directly and indirectly are responsible for a large proportion of morbidity and NHS costs in Scotland. Changing the way care is organised through the use of telemetry systems has the potential to improve the quality of control for patients with long-term conditions and release much-needed resources to be used in other ways for patient care.
HERU researchers involved in this research project: Marjon van der Pol.
External collaborators: B McKinstry, W MacNee, A Sheikh, C Pagliari, H Pinnock, S Wild, C Sudlow (University of Edinburgh); P Padfield, J McKnight (Lothian Health); J Hanley (Napier University); S Auld (Scottish Centre for Telehealth) and D Kelly (NHS Lothian)
Pinnock, H., Hanley, J. Lewis S., MacNee W., Pagliari C., Pol, M. van der., Sheikh A., McKinstry B. (2009) 'The impact of a telemetric Chronic Obstructive Pulmonary Disease monitoring service: randomised controlled trial with economic evaluation and nested qualitative study' [protocol], Primary Care Respiratory Journal, 18 (3): 233-235.
Pinnock, H., Hanley, J., McCloughan, L., Todd, A., Krishan, A., Lewis, S., Stoddart, A., Pol, M. van der, MacNee, W., Sheikh, A., Pagliari, C. and McKinstry, B. (2013) 'Effectiveness of telemonitoring integrated into existing clinical services on hospital admission for exacerbation of chronic obstructive pulmonary disease: researcher blind, multicentre, randomised controlled trial', BMJ, 347:f6070.
Stoddart, A., Pol, M. van der, Pinnock, H., Hanley, J., McCloughan, L., Todd, A., Krishan, A. and McKinstry, B. (2015) 'Telemonitoring for chronic obstructive pulmonary disease: a cost and cost-utility analysis of a randomised controlled trial', Journal of Telemedicine and Telecare, 21(2),108-118.
- WOC1.4 - Testing the validity of discrete choice experiment responses for predicting workforce behaviour
Using data on consultants’ behaviour from survey data in 2001 and 2006, we examined whether stated preference data eliciting valuations of job characteristics using discrete choice experiments are validated by changes in employment behaviour. Analysis was extended to explore the use of alternative econometric analysis to gain a deeper understanding of sources of preference heterogeneity in consultants’ preferences for contract characteristics.
Outcome and Translation
To understand further how DCEs can be used as an instrument to inform future contract negotiations with the NHS workforce.
HERU researchers involved in this research project: Diane Skåtun and Barbara Eberth
External Collaborators: M Sutton (University of Manchester)
Sutton, M., Eberth, B. and Skåtun, D. (2008) 'Really revealing? A follow up on the preferences stated by hospital doctors for hypothetical jobs', Health Economics Bergen, University of Bergen, April 2008.
- WOC2.9 - The use of global position satellite tracking in wandering patients with dementia: feasibility study
In people with dementia, wandering often triggers admission to long-term care, and causes harm and carer stress. There is no robust evidence that alternative community interventions can reduce wandering episodes safely. One potential solution is to use satellite tracking, which can locate users and inform carers if they have left a pre-defined ‘safe zone’. However, it is not clear what constitutes a ‘safe zone’, or whether satellite tracking reduces harm and carer stress or delays long-term admissions.
This pilot study explored the acceptability to patients and carers of satellite tracking, the suitability of instruments to measure outcomes such as carer stress, accidents and resource use, and recruitment feasibility.
The study found that although GPS tracking is perceived as both useful and acceptable to carers, the relative paucity of current deployment, variation in how it is used, difficulties in collecting social-care data and impracticality of current quality-of-life measures will challenge a RCT in this area.
Outcome and Translation
Dementia is a rapidly growing problem in Scotland. Wandering is a major cause of stress to carers and one of the main reasons why people with dementia are admitted to long-term care. GPS tracking offers a potential method of both relieving carer stress and potentially delaying admission to long-term care.
HERU researchers involved in this research project: Marjon van der Pol
External collaborators: B McKinstry, A Sheikh (University of Edinburgh); G Mead (Royal Infirmary Edinburgh); J Star (Royal Victoria Hospital Edinburgh); J Hanley (Centre for Integrated Healthcare Research); and P Corscadden (City of Edinburgh Council)
Milne, H., McKinstry, B., Flemming, D., Hanley, J., Mead, G., Pol, M.van der., Sheikh, A., Starr, J. and McCloughan, L. (2012) The use of global position satellite tracking in wandering people with dementia: feasibility study. Report to CSO, Edinburgh: Scottish Government Chief Scientist Office.
Milne, H., Pol, M. van der, McCloughan, L., Hanley, J., Mead, G., Starr, J., Sheikh, A. and McKinstry, B. (2014) 'The use of global positional satellite location in dementia: a feasibility study for a randomised controlled trial', BMC Psychiatry, 14, 160.