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Research

Our research spans the field of health economics, covering the seven major themes of: economic evaluation and priority setting, policy evaluation, economics of health systems and organisations, and preference and behaviour.

Read more for overviews, areas of interest, relevant publications, and contact points for each theme:

Economic evaluation and priority setting

Overview of theme

The economic evaluation and priority setting group includes over 30 staff members and research degree students from different disciplines including economics, statistics, mathematical modelling and epidemiology. We work in close collaboration with research partners in the UK and several low and middle income countries.

Our work aims to improve health by informing policy, processes and approaches used to allocate resources across health systems in the UK and around the world. Our research draws on strengths in economic data collection, statistical analysis, valuation of health outcomes, and infectious disease modelling.

We value policy impact, and have long established partnerships with a wide range of both global and national policy makers. We regularly support and participate in advisory work, guideline development, national strategic planning and health technology assessment processes.

Theme leads

Areas of active research

We work across a wide range of health topics, addressing both non-communicable and infectious disease burden. We apply and develop methods in the following areas:

  • Improving the statistical analysis of trial and non-trial data
  • Incorporating behaviour, demand and health systems considerations into economic evaluation
  • Designing frameworks for the economic evaluation of multi-sectoral intervention
  • Understanding and estimating costs and resource use
  • Incorporating societal perspective, including the measurement of economic impact
  • Use of capability and well-being methods in global health
  • Incorporating equity in priority settings
  • Evaluation of complex interventions
    • Economic evaluation of a complex intervention to reduce bullying in schools
  • Evaluating disease models in priority setting
    • Cost-effectiveness of population genetic testing for cancer prevention
Policy evaluation

Overview of theme

Many of the big questions in health economics deal with cause and effect. Do sugar taxes reduce obesity? Does social franchising improve the quality of care? We aim to improve methods for policy evaluation and apply them in real-word settings, drawing heavily on approaches developed in economics, as well as related disciplines such as statistics and epidemiology.

The group has expertise across a wide range of evaluation approaches, including: quasi-experimental methods, randomised controlled trials, ex-ante evaluation modelling approaches, and machine learning techniques. Much of our work involves natural experiments and the application of matching, difference-in-differences, synthetical control, and instrumental variables methods.

We are interested in applying these approaches to large-scale observational and experimental data in the evaluation of health care policies and interventions. We work closely with research collaborators and policy-makers in many different countries, and their requirements motivate our interests in methods development, which takes place in collaboration with a cross-disciplinary network of methodological experts.

Theme lead

Areas of active research

  • Investigation of synthetic control methods versus difference in difference estimation
  • Instrumental variable and machine learning approaches for evaluating personalised effects of interventions
  • National evaluation of pay for performance in Brazil using quasi-experimental methods applied to linked administrative datasets
  • Large scale randomised controlled trial of a quality improvement and business intervention in private health facilities in Tanzania
  • Analysis of household scanner data on food and beverage expenditures to understand dietary behaviours and evaluation of likely health related food policy impacts
Economics of health systems and organisations

Overview of theme

The effective design and management of health systems poses many important economics questions, such as:

  • How should we finance health care?
  • What role should the government have in health care provision?
  • How should we regulate private providers?
  • How should we pay health care workers?

Our work involves the use of economic concepts, theories and insights to address these types of dilemmas. We use quantitative, qualitative and mixed methods to understand and analyse specific aspects of health system performance, and to support the design and evaluation of health system strategies and interventions. We study health care markets (e.g. competition and choice); non-market approaches (e.g. planning and regulation); healthcare financing (e.g. purchasing and provider payment), and resource allocation (e.g. rationing mechanisms). We draw on a wide range of economic theories, including principal-agency theory, transaction costs theory, new institutional economics, theory of yardstick competition, and theories of regulation.

Our work encompasses low, middle and high income countries and humanitarian settings. We investigate the variation across these health systems and their contexts, while also striving to identify common insights, and facilitate cross-country learning.

Theme members are also convenors of iHEA’s Special Interest Group on Financing for Universal Health Coverage.

Theme lead

Areas of active research

Healthcare markets and competition
Health system financing
  • Methods for tracking donor aid and domestic expenditure in low- and middle-income countries
  • Political economy of health system financing in low- and middle-income countries
  • Equity of health care financing in low- and middle-income countries
  • Evaluation of health systems’ financing impact on equity in Indonesia
Governance and regulation
Purchasing and provider payment
  • Evaluation of pay-for-performance for health facility staff in Tanzania
  • Health system effects of pay-for-performance in Zimbabwe, Mozambique, Tanzania, Zambia and Brazil
  • Social Impact Bonds to fund innovative services in England
  • Financial incentives to improve quality of care in English healthcare providers
  • Different methods of pricing and risk allocation in the English NHS
Intra-organisational issues
  • How senior managers instil appreciation of organisational goals in front line staff
  • Staff motivation in not-for-profit organisations in England
  • Intra-agency incentives
Economics of infectious disease

Overview of theme

The economics of infectious disease will crosscut the other themes to highlight the important and differentiating impact of the Centre’s work in this area.  Health economists at LSHTM have been heavily involved in the emergency work related to the current pandemic based on the extensive experience in this area over many years.  This theme will bring together health economists through LSHTM working on infectious disease, and incorporate the work on economic evaluation, behaviours and preferences and macroeconomic impacts of infectious disease currently ongoing in PHP.

Theme leads

Preferences, behaviour and outcomes

Overview of theme

Understanding people’s preferences as well as what determines the choices they make is critical for an efficient and effective healthcare system. This theme brings together researchers using classical and behavioural economic techniques to investigate and explain health decisions.

Discrete choice experiments (DCEs) are a method to understand preferences for products and services. They can be used to estimate user valuations and predict uptake prior to implementation. These experiments are being adapted for rapid application within the formative research phase, in order to optimise trials and programming. Their uptake predictions are also being incorporated into cost-effectiveness models, as an improvement on mathematical modelling which has traditionally relied on expert opinion to estimate uptake in projecting the impact of new technologies.

Our group is undertaking DCEs to estimate these parameters in order to improve projections of uptake, and better understand how product attributes such as efficacy affect epidemiological impact and cost-effectiveness directly, and indirectly through increasing attractiveness.

Behavioural economics combines theories from economics and psychology to investigate and understand how people make choices. We are undertaking research that examines how cognitive biases, such as overconfidence, affect decisions made by healthcare providers. We also make use of randomised experiments to study how behavioural interventions can be used to improve quality of care. In addition, we are using it to optimise implementation science research, through changing choice architecture in HIV self-testing.

We are also convenors of iHEA’s Special Interest Group on Health Preference Research.

Image map of research methods of preference and behaviour theme group.

Theme leads

Areas of active research

  • Using discrete choice experiments and revealed preference studies to design and evaluate interventions to improve health
    • Behavioural change interventions to reduce sexually transmitted infections
    • Taxes on sugar-sweetened beverages
    • HIV self-testing in the UK, Malawi, Zambia, and Zimbabwe
    • Comparison of stated and revealed preferences for blood donation using big data and data adaptive model estimation
  • Assessing the role of discrete choice experiments and revealed preference studies in parametrising user uptake in economic evaluations
The macroeconomics of health

Overview of theme

The macro-economics of health theme aims to explore economic evaluation from a macro-economic perspective, by employing both computational general equilibrium models and econometric methods. For example, this theme has recently contributed to estimates of the macro-economic impact of Covid-19 in the UK and Pakistan.

Theme leads

Health financing

Overview of theme

The health financing theme aims at understanding the effect of financing mechanisms, such as health insurance and payment for performance schemes, on the functioning of health systems in low and middle income countries.  This includes international aid and domestic financing for health, the determinants of financing levels and how funding is allocated and its effects health outcomes and equity.  There is also a focus on models for financing  health care for refugees.

Theme lead

 

Each of these seven themes operate as sub-groups within the Centre, and are led by LSHTM academics from across the School. Within them, researchers work on empirical and methodological developments, with particular interests in the following methods:

  • Causal inference approaches to provide accurate, relevant estimates of the effectiveness and cost-effectiveness of new health care interventions.
  • Novel preference elicitation methods and discrete choice experiments
  • Study of health care markets
  • Incorporating constraints in economic evaluations
  • Equity analyses using dynamic demographic and transmission modelling
  • Willingness to pay thresholds for multi-sectoral interventions
  • Cost functions in data scarce environments
  • Standards in global health costing
  • Use of behavioural economics and demand analysis to inform intervention and trial design and parameterise uptake in economic evaluation models
  • Methods for tracking global and domestic resource flows for health