Need, demand, supply in health care: working definitions, and their implications for defining access.

Effective policymaking in health care systems begins with a clear typology of the terminology - need, demand, supply and access to care - and their interrelationships. However, the terms are contested and their meaning is rarely stated explicitly. This paper offers working definitions of need, demand and supply.

Impact of prevention in primary care on costs in primary and secondary care for people with serious mental illness.

A largely unexplored part of the financial incentive for physicians to participate in preventive care is the degree to which they are the residual claimant from any resulting cost savings. We examine the impact of two preventive activities for people with serious mental illness (care plans and annual reviews of physical health) by English primary care practices on costs in these practices and in secondary care. Using panel two-part models to analyze patient-level data linked across primary and secondary care, we find that these preventive activities in the previous year are associated with cost reductions in the current quarter both in primary and secondary care.

Labor supply and informal care responses to health shocks within couples: Evidence from the UK.

Shocks to health have been shown to reduce labor supply for the individual affected. Less is known about household self-insurance through a partner's response. Previous studies have presented inconclusive empirical evidence on the existence of a health-related Added Worker Effect, and results limited to labor and income responses.

Exploring mental health disability gaps in the labour market: the UK experience during COVID-19.

People with long-term mental health problems that affect their daily activities are a growing proportion of the UK working population and they have a particularly low employment rate. We analyse gaps in labour market outcomes between mental health disabled and non-disabled people during the COVID-19 pandemic in the UK. We also decompose the outcome gaps in order to explore the relative importance of different factors in explaining these gaps.

Cuts to local government spending, multimorbidity and health-related quality of life: A longitudinal ecological study in England.

Background: Population health has stagnated or is declining in many high-income countries. We analysed whether nationally administered austerity cuts in England were associated with prevalence of multimorbidity (individuals with two or more long-term conditions) and health-related quality of life.

Methods: We conducted an observational, longitudinal study on 147 local authorities in England.

Multimorbidity combinations, costs of hospital care and potentially preventable emergency admissions in England: A cohort study.

Background: Patients with multimorbidities have the greatest healthcare needs and generate the highest expenditure in the health system. There is an increasing focus on identifying specific disease combinations for addressing poor outcomes. Existing research has identified a small number of prevalent "clusters" in the general population, but the limited number examined might oversimplify the problem and these may not be the ones associated with important outcomes.

Patterns of emergency admissions for ambulatory care sensitive conditions: a spatial cross-sectional analysis of observational data.

Objectives: To examine the spatial and temporal patterns of English general practices' emergency admissions for Ambulatory Care Sensitive Conditions (ACSCs).

Design: Observational study of practice level annual hospital emergency admissions data for ACSCs for all English practices from 2004-2017.

Participants: All patients with an emergency admission to a National Health Service hospital in England who were registered with an English general practice.

Does commuting mode choice impact health?

Governments around the world are encouraging people to switch away from sedentary modes of travel towards more active modes, including walking and cycling. The aim of these schemes is to improve population health and to reduce emissions. There is considerable evidence on the latter, but relatively little on the former.

Trends in and drivers of healthcare expenditure in the English NHS: a retrospective analysis.

Background: In England, rises in healthcare expenditure consistently outpace growth in both GDP and total public expenditure. To ensure the National Health Service (NHS) remains financially sustainable, relevant data on healthcare expenditure are needed to inform decisions about which services should be delivered, by whom and in which settings.

Methods: We analyse routine data on NHS expenditure in England over 9 years (2008/09 to 2016/17).

Impact of family practice continuity of care on unplanned hospital use for people with serious mental illness.

Objective: To investigate whether continuity of care in family practice reduces unplanned hospital use for people with serious mental illness (SMI).

Data Sources: Linked administrative data on family practice and hospital utilization by people with SMI in England, 2007-2014.

Study Design: This observational cohort study used discrete-time survival analysis to investigate the relationship between continuity of care in family practice and unplanned hospital use: emergency department (ED) presentations, and unplanned admissions for SMI and ambulatory care-sensitive conditions (ACSC).

Acute health shocks and labour market outcomes: Evidence from the post crash era.

We investigate the labour supply response to an acute health shock for individuals of all working ages, in the post crash era, combining coarsened exact matching and entropy balancing to preprocess data prior to undertaking parametric regression. Identification exploits uncertainty in the timing of an acute health shock, defined by the incidence of cancer, stroke, or heart attack, based on data from Understanding Society. The main finding implies a substantial increase in the baseline probability of labour market exit along with reduced hours and earnings.

Association Between Antipsychotic Polypharmacy and Outcomes for People With Serious Mental Illness in England.

Objective: Although U.K. and international guidelines recommend monotherapy, antipsychotic polypharmacy among patients with serious mental illness is common in clinical practice.

Do care plans and annual reviews of physical health influence unplanned hospital utilisation for people with serious mental illness? Analysis of linked longitudinal primary and secondary healthcare records in England.

Objective: To investigate whether two primary care activities that are framed as indicators of primary care quality (comprehensive care plans and annual reviews of physical health) influence unplanned utilisation of hospital services for people with serious mental illness (SMI).

Design, Setting, Participants: Retrospective observational cohort study using linked primary care and hospital records (Hospital Episode Statistics) for 5158 patients diagnosed with SMI between April 2006 and March 2014, who attended 213 primary care practices in England that contribute to the Clinical Practice Research Datalink GOLD database.

Outcomes And Analysis: Cox survival models were used to estimate the associations between two primary care quality indicators (care plans and annual reviews of physical health) and the hazards of three types of unplanned hospital utilisation: presentation to accident and emergency departments (A&E), admission for SMI and admission for ambulatory care sensitive conditions (ACSC).

Health care expenditures, age, proximity to death and morbidity: Implications for an ageing population.

This paper uses Hospital Episode Statistics, English administrative data, to investigate the growth in admitted patient health care expenditures and the implications of an ageing population. We use two samples of around 40,000 individuals who (a) used inpatient health care in the financial year 2005/06 and died by the end of 2011/12 and (b) died in 2011/12 and had some hospital utilisation since 2005/06. We use a panel structure to follow individuals over seven years of this administrative data, containing estimates of inpatient health care expenditures (HCE), information regarding individuals' age, time-to-death (TTD), morbidities at the time of an admission, as well as the hospital provider, year and season of admission.

End-Of-Life Medical Spending In Last Twelve Months Of Life Is Lower Than Previously Reported.

Although end-of-life medical spending is often viewed as a major component of aggregate medical expenditure, accurate measures of this type of medical spending are scarce. We used detailed health care data for the period 2009-11 from Denmark, England, France, Germany, Japan, the Netherlands, Taiwan, the United States, and the Canadian province of Quebec to measure the composition and magnitude of medical spending in the three years before death. In all nine countries, medical spending at the end of life was high relative to spending at other ages.

A quasi-Monte-Carlo comparison of parametric and semiparametric regression methods for heavy-tailed and non-normal data: an application to healthcare costs.

We conduct a quasi-Monte-Carlo comparison of the recent developments in parametric and semiparametric regression methods for healthcare costs, both against each other and against standard practice. The population of English National Health Service hospital in-patient episodes for the financial year 2007-2008 (summed for each patient) is randomly divided into two equally sized subpopulations to form an estimation set and a validation set. Evaluating out-of-sample using the validation set, a conditional density approximation estimator shows considerable promise in forecasting conditional means, performing best for accuracy of forecasting and among the best four for bias and goodness of fit.

Healthcare Cost Regressions: Going Beyond the Mean to Estimate the Full Distribution.

Understanding the data generating process behind healthcare costs remains a key empirical issue. Although much research to date has focused on the prediction of the conditional mean cost, this can potentially miss important features of the full distribution such as tail probabilities. We conduct a quasi-Monte Carlo experiment using the English National Health Service inpatient data to compare 14 approaches in modelling the distribution of healthcare costs: nine of which are parametric and have commonly been used to fit healthcare costs, and five others are designed specifically to construct a counterfactual distribution.

Methods for the estimation of the National Institute for Health and Care Excellence cost-effectiveness threshold.

Background: Cost-effectiveness analysis involves the comparison of the incremental cost-effectiveness ratio of a new technology, which is more costly than existing alternatives, with the cost-effectiveness threshold. This indicates whether or not the health expected to be gained from its use exceeds the health expected to be lost elsewhere as other health-care activities are displaced. The threshold therefore represents the additional cost that has to be imposed on the system to forgo 1 quality-adjusted life-year (QALY) of health through displacement.

The Influence of Cost-Effectiveness and Other Factors on Nice Decisions.

The National Institute for Health and Care Excellence (NICE) emphasises that cost-effectiveness is not the only consideration in health technology appraisal and is increasingly explicit about other factors considered relevant but not the weight attached to each. The objective of this study is to investigate the influence of cost-effectiveness and other factors on NICE decisions and whether NICE's decision-making has changed over time. We model NICE's decisions as binary choices for or against a health care technology in a specific patient group.

Do public smoking bans have an impact on active smoking? Evidence from the UK.

The literature on the effects of public smoking bans on smoking behaviour presents conflicting results and there is limited evidence on their impact on active smoking. This paper evaluates the impact of smoking bans on active smoking using data from the British Household Panel Survey and exploiting the policy experiment provided by the differential timing of the introduction of the bans in Scotland and England. We assess the short-term impact of the smoking bans by employing a series of flexible difference-in-differences fixed effects panel data models.

A person based formula for allocating commissioning funds to general practices in England: development of a statistical model.

Objectives: To develop a formula for allocating resources for commissioning hospital care to all general practices in England based on the health needs of the people registered in each practice

Design: Multivariate prospective statistical models were developed in which routinely collected electronic information from 2005-6 and 2006-7 on individuals and the areas in which they lived was used to predict their costs of hospital care in the next year, 2007-8. Data on individuals included all diagnoses recorded at any inpatient admission. Models were developed on a random sample of 5 million people and validated on a second random sample of 5 million people and a third sample of 5 million people drawn from a random sample of practices.

Does better disease management in primary care reduce hospital costs? Evidence from English primary care.

We apply cross-sectional and panel data methods to a database of 5 million patients in 8000 English general practices to examine whether better primary care management of 10 chronic diseases is associated with reduced hospital costs. We find that only primary care performance in stroke care is associated with lower hospital costs. Our results suggest that the 10% improvement in the general practice quality of stroke care between 2004/5 and 2007/8 reduced 2007/8 hospital expenditure by about £130 million in England.

Health systems' responsiveness and its characteristics: a cross-country comparative analysis.

OBJECTIVES. Responsiveness has been identified as one of the intrinsic goals of health care systems. Little is known, however, about its determinants.