Health Services Research and Evaluation

The provision of affordable, sustainable healthcare without compromising patient outcomes is an increasingly difficult challenge for healthcare providers and policy makers. Health services research and evaluation incorporates a range of approaches to examine equitable access to care, funding mechanisms, healthcare costs, and outcomes of individuals and populations to generate evidence to guide effective and cost-effective evidence-based care.

Our health services and evaluation research spans a wide variety of areas across health and healthcare delivery in Australia and globally. This includes examining the distribution of government Medicare spending for Australian children, quantifying the direct and indirect expenditures among rheumatoid arthritis patients with comorbid conditions, assessing the impact of hospital-acquired complications on length of hospital stay and costs, evaluating models of care in managing infections in cancer, and demonstrating the use of inequality measures from describing to evaluating major policy changes, such as Medicare Part D in the United States. The broad scope of our projects also highlights the extensive cross-disciplinary collaborations between health economists, clinicians, healthcare professional and policy makers across the University and internationally.

Project highlights:

Economic burden of sepsis in cancer:

This study used population-linked administrative data to estimate the whole of system healthcare cost of cancer patients without and without sepsis. The cost of care of cancer patients who developed sepsis is substantial, resulting in a doubling of cancer care costs, particularly during the first year of cancer diagnosis. These estimates are helpful in improving our understanding of burden of sepsis along the cancer pathway and to support policy decisions to align appropriate resources for efficient care. The research paper can be found here.

Inequalities in child Medicare spending in Australia:

This study used the Longitudinal Study of Australian Children (LSAC) to assess the distribution of children’s out-of-hospital government Medicare spending according to household income. Income related inequalities were identified with children from poorer families most disadvantaged when aged 0-1 years in their use of specialist services. The research paper is found here and news article from The Conversation and ABC News are also available.

Impact of Medicare Part D on income-related inequality in pharmaceutical expenditure:

In this project, we outline the use of inequality measures to evaluate the impact of extending health insurance on income-related inequality in drug expenditure, using the example of Medicare Part D in the United States.  We use pooled cross-sectional samples from the Medical Expenditure Panel Survey to estimate income-related inequality in drug expenditures using the concentration index and generalised concentration index. This study demonstrates the usefulness of measuring the impact of health system changes on inequalities in health expenditure and provides a guide for future evaluations.

Selected publications:

2021

Saxon S, Dalziel K, Story D. Survey of hospital Chief Executive Officer research and translation priorities. Australian Health Review. 45(2):263-64. DOI:/10.1071/AH20115. This survey shows research priorities in evaluation, data linkage and patient reported outcome measurement and is being used to guide health services research priorities across Victoria and Australia.

2020

Tew, M., Dalziel, K., Clarke, P., Smith, A., Choong, P. F., & Dowsey, M. (2020). Patient-reported outcome measures (PROMs): can they be used to guide patient-centered care and optimize outcomes in total knee replacement?. Quality of Life Research, 29(12), 3273-3283. This research employed a statistical technique uncommon in health economics research to demonstrate the potential of translating routinely collected patient-reported outcomes measures to facilitate shared decision making and optimise patient outcomes by correlating quality-of-life trajectories with patient characteristics.

Vu M, Carvalho N, Clarke P, Buchbinder R, Tran-Duy A. Impact of comorbid conditions on health care expenditure and work-related outcomes in patients with rheumatoid arthritis. The Journal of Rheumatology 2020. This study is the first to demonstrate both the health and employment related direct and indirect expenditures associated with co-morbidities among patients with rheumatoid arthritis.

Liam Fernando-Canavan, Anthony Gust, Arthur Hsueh, An Tran-Duy, Michael Kirk, Peter Brooks, Josh Knight. Measuring the economic impact of hospital-acquired complications on an acute health service. Australian Health Review; DOI: 10.1071/AH20126. This study provides a template for other health services to assess the economic impact of hospital-acquired complications corresponding to their own casemix and to inform targeted patient safety programs.

2019

Dalziel K, Li J, Scott A, Clarke P. Accuracy of patient recall for self-reported doctor visits: is shorter recall better. Health Economics. 27(11):1684-1698. Top Health Economics journal as rated by Australian Business Deans Council. Awarded top 5 Australian Health Economics paper award by Australian Health Economics Society 2019. This methods research presents the first empirical data to guide the design of recall questions which are included in population surveys and health economic surveys. This research is guiding design of surveys worldwide (see The Database for Resource Use Measurement, DIRUM). Was awarded top 5 paper by Australian Health Economics Society 2019.

Carvalho N, Petrie D, Chen L, Salomon J and Clarke P. The impact of Medicare Part D on income-related inequality in pharmaceutical expenditure. International Journal for Equity in Health 2019; 18(57). This research looks at the equity implications of a major policy change in the United States and moves inequality research on from describing to evaluating.

2018

Dalziel KM, Huang L, Hiscock H, Clarke PM. Born equal? The distribution of government Medicare spending for children. Social Science and Medicine. 2018, 208:50-54. This research resulted in 8,000 views in 2 days when launched as a Conversation article, media attention via an ABC article and a call from Federal Health Minister Greg Hunt with follow up policy solutions provided to his advisors as requested.

2016

Hua X,Carvalho N, Tew M, Huang ES, Herman WH, Clarke P. Expenditures and Prices of Antihyperglycemic Medications in the United States: 2002-2013. JAMA. 2016;315(13):1400–1402. doi:10.1001/jama.2016.0126. This research letter has an Altmetric score of 1733, placing it in the top 5% of all research outputs. It has been mentioned by 192 news outlets including the New York Times, Washington Post, Time Magazine, Fortune and others. It was cited in a January 2019 letter by the U.S. Committee on Energy and Commerce to three major insulin manufacturers asking for an explanation for rising drug prices.