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Public financing of health services in low income countries was challenged by the World Bank's Agenda for Reform in 1987, which advocated increased roles for private sector, private insurance and user fees. This was followed by a wave of reforms implementing this approach. McPake has been involved in researching the implications of this shift since this period and has published a series of influential articles that have had a demonstrable impact on this debate. Removal of user fees for all, or selected, services or for selected population groups has occurred in many countries, including 28 of 50 countries with the highest maternal and child health mortality included in a recent survey (http://bit.ly/17FUiDM). Witter is the lead researcher who has examined country level experiences of removing fees and it is demonstrable that her work has been applied in specific countries to shape the details of policy and has also had a major influence on the global debate.
Research into cross-border patient care in Europe carried out by LSHTM has contributed substantially to shaping the 2011 EU Directive on Patients' Rights in cross-border health care. The research was cited in numerous policy documents and used extensively in consultations at EU and national level, feeding into the legislative process. Influential EU officials have explicitly acknowledged the importance of the research in the political process. The research team has also advised professional bodies in the health care sector as part of the consultation process.
There is an inherent tension between progress in the European Union's marketization agenda on the one hand, and the agenda for the development of European social citizenship on the other. Although markets internalise and manage many aspects of economic activity, the process of marketization also creates and ignores negative social and economic consequences. Focussing on uncertainty and insecurity in labour markets, the research by Crouch, Marginson and Meardi addressed the capacity of public and private employee relations and corporate governance arrangements, including collective bargaining and immigration, to offset these negative consequences. European policy makers are now gaining an interest in mitigating the effects of marketization. As a result, this timely research has challenged conventional wisdom that marketization promises unqualified gains and has stimulated significant ongoing policy and trade union debate across Europe.
Empirical evidence generated by UEL research has directly influenced the reform of health financing in two Indian states with total populations of 154 million through changes to provider behaviour, the organisation and use of funds, and treatment verification processes and package rates. The impacts of this work have been commended by the UK Department for International Development (DFID) and the World Bank, and attracted interest from states with similar healthcare schemes. More widely, it has helped policymakers in India and the UK recognise the importance of including high quality comprehensive primary care in India's strategic planning for universal health care, and the benefits to the UK in prioritising primary care collaboration with India.
Research carried out at the University of Aberdeen into the factors that influence the job satisfaction, health and well-being of employees has directly informed national and international policy reviews and reports. In the UK, recommendations from the research were incorporated into the Hutton Review of Fair Pay in the Public Sector; internationally, they were included in several EU Commission policy reviews and business press reports. The research was also presented direct to policy makers at EU forums and achieved considerable secondary reach through media coverage.
The Department of Health seeks to distribute the NHS budget to local commissioning organisations to achieve equal access for equal need and reduce health inequalities. The formula upon which it bases this distribution must be evidence-based, robust and up-to-date. We summarise four pieces of applied econometric research undertaken at the University of Manchester (UoM) and commissioned by the Department of Health that have developed the methodology for setting budgets fairly and determined the content of the formula in use in England from 2008-date. Adoption of the findings of this research by government has led to a substantial redistribution of NHS funding between areas.
The NHS spends about £11bn annually on pharmaceuticals, of which £8bn is on branded drugs, representing about 13% and 10% respectively of available NHS resources. Research at York has been central to the public and policy debate about how branded pharmaceuticals ought to be priced and has made a material contribution to the development of government policy to introduce a value based pricing (VBP) scheme for all new pharmaceuticals. VBP has significance for the prices that the NHS pays for pharmaceuticals, access to new drugs for NHS patients, and the return that manufacturers can expect from future research and development. There is also an international impact in two respects: UK prices are estimated to influence 25% of the world market and York has contributed to a wider policy debate about international pharmaceutical pricing and the potential role of value based pricing in European, North American, South American and South East Asian health care systems.
Methods for valuing quality of life developed by Professor Devlin at City University London are used internationally to help governments make healthcare decisions. Her research focuses on a widely-used questionnaire for measuring patient reported health, the European Quality of Life 5-Dimensions (EQ-5D). Government organisations routinely use the EQ-5D to judge whether new medicines work and are cost-effective. Over 15 countries are undertaking EQ-5D studies using Professor Devlin's methods to inform decisions on pricing and provision of new medicines. These developments have been achieved through active dissemination to the academic community and governments and through Professor Devlin's scientific leadership of the European Quality of Life (EuroQol) Group. The impact of this research is highly significant in improving health and health care decision-making and has had wide reach throughout the UK and in many other countries.
Swansea-led research on Thailand's universal healthcare coverage (UHC) reforms (1) helped change perceptions by showing researchers and policy makers in governmental and non-governmental organisations that UHC was viable in a lower-middle income country, (2) provided lessons about implementation challenges for other countries planning UHC reform, and (3) led to improved funding mechanisms in Thailand through the adoption of ring-fenced budgets for health centres and national priority services, and area-based commissioning. The study influenced the fine-tuning of Thailand's demand-side financing system to help develop a sustainable funding model that other aspiring UHC countries are emulating. Research recommendations were incorporated into the recent 10-Year Assessment of the Universal Coverage Scheme (UCS), which informed the Thai government health sector plan for 2013-15.
The ECuity Project was a European Union (EU) funded research network that provided rigorous quantitative evidence on the extent of socioeconomic inequalities in health and health care across countries and over time. The Project pioneered a set of measurement tools to help understand what drives international differences and trends in health inequality. The methods developed within the Project have had a direct impact on the way in which international organisations, such as the Organisation for Economic Cooperation and Development (OECD), World Bank (WB) and World Health Organisation (WHO), define and measure health inequality and inequity. The Project provided international agencies and governments with tools to develop and target policies to address inequity and the evidence generated by the Project has extended their understanding of the issue in developed and developing countries, informing and shaping their policy advice.