Working with dogs in India is the only way to tackle one of the most fatal diseases in the world

To mark the 17th World Rabies Day on September 28th, the authors discuss their research findings and explore the implications of strategies aimed at eliminating this life-threatening disease in India

The economics of health inequality in the English NHS : the long view

In this paper, I briefly outline some of the key milestones of health inequality policy in England. I describe how socioeconomic inequalities in health, government policy towards it, and the academic literature about it, have evolved over time and in relation to each other. Whilst this historical review is far from comprehensive, its aim is to provide sufficient context within which to interpret current NHS health inequality policy from the perspective of an economist

The economics of health inequality in the English National Health Service

This thesis explores the economics of health inequalities in the English National Health Service (NHS). It consists of five applied economic studies that explore different questions regarding socioeconomic inequalities and the NHS. It is bound together by an integrative chapter that provides the historical background to, and draws conclusions across, the body of work. The first of the five applied studies examined the financial costs that socioeconomic inequalities exact on the NHS, the second looked at socioeconomic inequalities in access to primary care, the third looked at socioeconomic inequalities in health outcomes attributable to the NHS, and the final two studies extended the established methods for the economic evaluation of health care programmes to explicitly value minimising socioeconomic health inequalities as well as maximising population health. These extended methods were termed distributional cost-effectiveness analysis. The studies found that dealing with the excess morbidity associated with socioeconomic inequalities cost the NHS approximately a fifth of its annual budget. Socioeconomic inequalities in access to and quality of primary care significantly improved from 2004 to 2011 in response to government policy to tackle these. However, socioeconomic inequalities in health outcomes stubbornly persisted over this period, by 2011 socioeconomic inequality was still associated with over 158 000 patients experiencing one or more preventable hospital admissions and almost 40 000 patients dying from causes amenable to health care. Distributional cost-effectiveness analysis methods were shown to be practically applicable in an NHS setting. This was demonstrated using a case study comparing population health programmes in which trading off between health maximisation and health inequality minimisation was necessary. The thesis provides an evidence base and practical new methods that should serve as a foundation to better understand the role of the NHS in tackling socioeconomic inequalities in health. In so doing, it also outlines an exciting programme of further research

The impact of management on hospital performance

There is a prevailing popular belief that expenditure on management by health-care providers is wasteful, diverts resources from patient care, and distracts medical and nursing staff from getting on with their jobs. There is little existing evidence to support either this narrative or counter-claims. We explore the relationship between management and public sector hospital performance using a fixed effects empirical econometric specification on a panel data set consisting of all 129 non-specialist acute National Health Service (NHS) hospitals in England for the financial years 2012/13 to 2018/19. Measures of managerial input and quality of management practice are constructed from NHS Electronic Staff Records and NHS Staff Survey data. Hospital accounts and Hospital Episode Statistics data are used to construct five measures of financial performance and of timely and high-quality care. We find no evidence of association either between quantity of management and management quality or directly between quantity of management and any of our measures of hospital performance. However, there is some evidence that higher-quality management is associated with better performance. NHS managers have limited discretion in performing their managerial functions, being tightly circumscribed by official guidance, targets, and other factors outside their control. Given these constraints, our findings are unsurprising

Health care costs in the English NHS : reference tables for average annual NHS spend by age, sex and deprivation group

This paper describes how to calculate average health care costs broken down by age, sex and neighbourhood deprivation quintile group using the distribution of health care spending by the English NHS in the financial year 2011/12. The results presented here can be used by costeffectiveness analysts to populate their extrapolation models when estimating future health care costs. The results will also be of interest to the broader community of health researchers as they illustrate how NHS spending is distributed across different subgroups within the population

Myopic self-interest restricts access to COVID-19 vaccines

COVID-19 vaccination presents a picture of inequality: about 51% of the world’s vaccines are in the hands of 14% of the global population. Between and within countries, the distribution of vaccines has reflected existing racial and socioeconomic hierarchies rather than allocations that would maximise collective social welfare. Many countries see this as a contest. As a result, ‘winners’ order many more vaccines than they need, leading to reduced supplies and higher prices for everyone else. Miqdad Asaria and Joan Costa-Font explain why this doesn’t make sense from a health security point of view and is likely to backfire economically

The costs of inequality: whole-population modelling study of lifetime inpatient hospital costs in the English National Health Service by level of neighbourhood deprivation : Whole-population modelling study of lifetime inpatient hospital costs in the English National Health Service by level of neighbourhood deprivation

BACKGROUND: There are substantial socioeconomic inequalities in both life expectancy and healthcare use in England. In this study, we describe how these two sets of inequalities interact by estimating the social gradient in hospital costs across the life course. METHODS: Hospital episode statistics, population and index of multiple deprivation data were combined at lower-layer super output area level to estimate inpatient hospital costs for 2011/2012 by age, sex and deprivation quintile. Survival curves were estimated for each of the deprivation groups and used to estimate expected annual costs and cumulative lifetime costs. RESULTS: A steep social gradient was observed in overall inpatient hospital admissions, with rates ranging from 31 298/100 000 population in the most affluent fifth of areas to 43 385 in the most deprived fifth. This gradient was steeper for emergency than for elective admissions. The total cost associated with this inequality in 2011/2012 was £4.8 billion. A social gradient was also observed in the modelled lifetime costs where the lower life expectancy was not sufficient to outweigh the higher average costs in the more deprived populations. Lifetime costs for women were 14% greater than for men, due to higher costs in the reproductive years and greater life expectancy. CONCLUSIONS: Socioeconomic inequalities result in increased morbidity and decreased life expectancy. Interventions to reduce inequality and improve health in more deprived neighbourhoods have the potential to save money for health systems not only within years but across peoples' entire lifetimes, despite increased costs due to longer life expectancies

Erring on the side of rare events? A behavioural explanation for COVID-19 vaccine regulatory misalignment.

The development of new vaccines against COVID-19 has triggered a debate about which of the vaccines should be chosen, and in some countries which vaccines to authorise. The choice of vaccines in Western countries seems to be largely driven by trust in the vaccine manufacturers, with safety concerns regarding potential rare side effects rather than relative efficacy playing the pivotal role in this choice [1]. So far, vaccines developed by China, Russia and India have largely been ignored in Western countries. Amongst the vaccine candidates currently in use in many western countries, access to the AstraZeneca (AZ) and Johnson & Johnson’s (JJ) vaccine has been restricted and, in some cases, suspended as they hav been perceived to be the least safe despite being approved by the European Medicines Agency (EMA) [2] and recommended by the WHO [3]. We argue that regulatory vaccine misalignment can be explained by an ‘erring on the side of rare events’ phenomena. That is, when rare events are heavily publicised, regulators tend to favour a precautionary approach, even when the fatalities from vaccine side effects are only 10% as likely to occur as the risks arising from COVID-19 infection [3]. Furthermore, we argue that such decisions have detrimental consequences for vaccine trust and the success phenomena logically follow not just from the overestimation of the risk of such events, but also from a combination of ambiguity aversion, joint risk, and benefit formation. All of which add to a background of limited trust in government decisions with regards to vaccines, which weaken the vaccination rollout. This note will provide a discussion of these arguments. The next section argues that vaccine regulation follows a clear regulatory misalignment resulting from some countries ‘erring on the side of rare events. We examine the erosion of public trust, followed by a discussion on different behavioural explanations for the ‘erring on the side of rare events’ phenomena. Finally, we conclude with suggestions for a way forward

COVID-19 has made us more averse to both income and health inequalities

Evidence from Italy, Germany, and the UK shows high levels of inequality aversion – a dislike for inequality and a preference for fairness – in both income and health, explain Miqdad Asaria, Joan Costa-Font, and Frank Cowell (LSE). In the UK in particular they find that people are more inequality averse, especially to health, but that the effect is stronger among those not directly affected by the pandemic

Homeless mortality data from East London

Background: The rate of homeless mortality is known to be significantly below the national average, with mortality rates varying geographically. This study aims to look at the rates and causes of homeless mortality within East London. Question: To characterise homeless mortality of patients registered in two specialist homeless practices, between 2001 and 2016 in the London boroughs of Tower Hamlets and Hackney, by age at death and cause of death. Study Design: A retrospective study of general practice electronic patient records. Methods: Electronic patient records across two general practice surgeries specialising in care for the homeless in East London were examined and their mortality data extracted. Results: Two hundred and three deaths recorded in the two general practice surgeries were examined. The average age at death was 47 years, with the highest numbers of deaths being attributed to substance misuse, liver disease and cardiac-related deaths. Those dying of cardiac-related causes died at an average of 51, those dying of liver-related causes died at an average age of 49 years and those dying from substance misuse died at an average age of 38. Conclusions: Those dying of substance misuse-related causes died much younger than the average homeless patient did