Choice and Inequality in Public Service Access and Outcomes: The Case of Healthcare

Lead Research Organisation: Institute for Fiscal Studies
Department Name: IFS Research Team

Abstract

The previous Labour government introduced two policies that increased the choice that patients in England have over where to receive hospital treatment. First, GPs were required to offer their patients a choice over which hospital to attend for a first outpatient appointment. Second, new hospitals opened that treat NHS patients but are owned by private companies. This gives NHS patients a greater number of hospitals to choose between. Under the current government, patient choice is set to increase yet further. There are also moves to increase choice in other public services, such as education with the introduction of Free Schools. This research agenda will examine whether increased patient choice has lead to a change in inequalities in the use of NHS-funded services and, consequently, patient outcomes.
Successive governments have advocated choice for two reasons. First, because they believe that patients value the ability to choose for its own sake. Second, because choice can generate pressure for NHS hospitals to improve quality, so as to attract patients. There is evidence that offering patients a choice did indeed lead to improvements in average hospital quality. Much less has been written on how the policies affected different types of people or on the impact of the new privately owned hospitals. Even if choice leads to an average improvement in hospital quality, it is still important to understand who was affected by the policies. Equity in access to healthcare is a founding principle of the NHS. Moreover, if certain hospitals, particularly those that are privately owned, only treat particular types of patients, this may limit the competitive pressure needed to drive quality and could impact the cost-effectiveness of the policies.
The research programme will focus on three main questions. The first is whether some patient groups have responded to the choice policies more than others. Are younger and richer patients more likely to use the new private treatment centres? Have some groups received a greater than expected share in the increase in the number of operations performed over the past decade? What are the implications of any change in the inequality in use of NHS services on inequalities in patient health outcomes?
The second question is how choice operates for hospital treatments where the new privately owned hospitals do not operate. I will focus on the example of maternity care, or childbirth. As many women have more than one child, I can also test whether mothers use their own experiences when making decisions about where to give birth. In particular, whether a mother's experience during childbirth affects her decisions during subsequent pregnancies. Since some factors that make childbirth difficult, such as the mother's age or weight, might also affect future pregnancies, I will focus only on the impact of random factors that affect the quality of maternity care. One possible example is whether the birth occurred at the weekend, when there are likely to be fewer support staff. I will then compare the responses of mothers to their own experiences to their responses to public information, such as publicised scandals at local maternity units.
The final question is how future or potential policies to increase patient choice could affect the inequalities in where and whether patients are treated. The first two research questions will assess the impacts of past policies, but cannot predict the future. I will use a model of patient behaviour to illustrate the potential effects of alternative policies. This may help policy-makers to choose between policy options or make changes to the design of proposed reforms.
All the projects will use the NHS records on inpatients, which include information on all those patients that hospitals expected to stay overnight and all mothers who give birth in hospital. The first project will also make use of a biannual survey that follows a group of people aged 50 and over.

Planned Impact

The 6 main non-academic groups will benefit from my research agenda are as follows:
1.Policy-makers within government
This group includes government and opposition politicians, and civil servants. The results of my research will demonstrate the distributional impact of past policies to increase choice, and simulate the effects of possible policy scenarios. All political parties in the UK claim that they seek to reduce health inequalities. Governments and opposition parties may therefore employ my research to help evaluate past reforms and plan future policy in both healthcare and other public services.
2.Healthcare market regulators
The healthcare market regulators in England include Monitor and the Cooperation and Competition Panel (CCP). I intend for Monitor to use the results from my research to fulfil its future role in promoting competition and safeguarding the continuity of services. For example, the degree of segmentation by patient type might affect Monitor's judgment on the degree to which providers compete, and whether the premium paid to private providers is justified by higher start up costs. The CCP could invoke my findings when deciding on mergers between healthcare providers.
3.Individuals and bodies that implement healthcare policy
This group is comprised of healthcare workers, managers and civil servants, including GPs, NHS hospital managers, the new clinical commissioning groups and NHS Commissioning Board, and the Department of Health. For example, the NHS Commissioning Board state that they will seek to "improve outcomes and guarantee no community is left behind or disadvantaged" (NHSCB, 2012). I intend that results of my research will demonstrate how the implementation of policy can affect the distributional impact of a particular reform. These groups may use this evidence to evaluate the effectiveness of previous implementation strategies or to inform the design of future implementation. For example, my findings may indicate that commissioners need to devote more resources to encouraging and supporting choice amongst disadvantaged patients.
4.Patient advocates
Patient advocates include charities, such as the Patients' Association and Age UK, and MPs. These groups will use my findings in 2 ways. First, to help lobby government on behalf of those they represent. Examples may include a charity requesting more financial and logistical support to help facilitate choice, or an MP campaigning for or against a particular healthcare provider closing, opening or merging within their constituency. Second, to provide direct support and advice to those they represent. Charities may wish to launch information campaigns or support groups; MPs might provide advice to their constituents.
5.Private healthcare providers
Any observed variation in the willingness or ability of patients to choose private providers could be affected both by the preferences of those providers, or the behaviour of NHS commissioners. Private providers may benefit from widening access and lobby commissioners to recommend their services to patients. Alternatively, new entrants might use my results to calculate an expected rate of return from opening a new centre. It is the job of Monitor to ensure that the behaviour of private providers is of benefit to patients.
6.Patients and their families
Patients will benefit directly through a greater awareness that they have the right to choose. They benefit indirectly from any improvements in the content and implementation of healthcare policy.
Whilst the primary beneficiaries in each group will be those in the UK, I believe there is potential for substantive international impact. There are a number of countries with similar healthcare systems, such as Sweden and Denmark, where it would be possible to draw direct comparisons. For other countries, there is an interest in comparing how alternative systems operate and how patients behave when faced with common features, such as new providers.
 
Description 1) I have found that allowing private hospitals to treat patients has led to an increase in patient demand for NHS funded elective hip replacements. These additional patients that were funded by the NHS are not patients who would otherwise have paid for the treatment privately.

2) I have discovered that the cost of hospital care increases very rapidly after age 50. After age 50, this is entirely attributable to emergency inpatient admissions to hospital. The share of spending accounted for by those in the last year of life is approximately 10%. This is in line with a range of other developed countries. In follow up work, we compared the share of spending account for by those at the end of life across nine different countries. We found that approximately 10% of medical spending is accounted for by those in the final 12 months of life. This is substantial, given that fewer than 1% of the population die each year, but is much less than shares previous reported in the press. This is relevant, as there is concern in all countries at the rate of which medical spending is increasing. One proposed solution is to cut down on futile spending at the end of life. We show that although medical spending at the end of life is costly, the vast majority of medical spending is accounted for by those who are not close to death. Cutting spending on end of life care will therefore not "solve" the problem of ever rising medical costs.

3) I have found that those living in deprived areas, ethnic minorities and those with worse underlying health are less likely to choose a privately owned provider when they have an NHS funded hip replacement. Differences by local area deprivation can be explained by a combination of differences in health, proximity to providers, and GP referral patterns. Ethnic minority patients are less likely to choose a privately owned provider, even if they are in the same health, live in the same area, and are treated by the same GP as white patients.

4) My most recent findings show that maternity units are more likely to close on days where there are higher number of unplanned maternity admissions. However, they are also more likely to close on Thursday, Fridays and Saturdays. Given that there are no more unplanned admissions on these days, relative to Mondays-Wednesdays. This suggests that such closures are the result of either difficulties in rostering staff at the end of the week, or failures in the planning of elective case. Closures are also more likely to close in September, due to the higher birth rate 9 months after Christmas, but also during the summer and in December, when staff are more likely to take holiday. Acute Trusts where maternity units close more often are also more likely to breach their 4 hour A&E waiting time targets. This suggests some factors putting pressure on maternity units are Trust wide.
Exploitation Route Key finding (1) could be used by the Department of Health, NHS England and commissioners in order to understand how changes in the provision of elective health services could affect demand for health care.

Key finding (2) provides information on sources of medical spending for DH and NHS England. The finding that emergency hospital care drives the cost of treating older people could be used to target policy efforts to contain health care costs. We also find that although substantial, spending on those in the last year of life explains only a fraction of the growth in overall spending. This highlights the need for a multi-faceted approach to contain health spending. Results from other countries in the study highlight the importance of non-hospital care costs, and in particular the role of social care in the last three years of life.

Key finding (3), shows that certain types of patients have benefited less from choice policies could be used to share NHS policy in the future. This may include providing more information to GPs or more support to ethnic minority patients.

Key finding (4) on maternity unit closures have been discussed with the Royal College of Midwives and Royal College of Obstetricians and Gynaecologists. Both organisations were surprised by relationships between closures and days of the week. The Royal College of Midwives in particular were concerned about the weekly pattern, and will investigate why this is the case and whether anything can be done to prevent it.
Sectors Healthcare

URL https://www.ifs.org.uk/publications/9715
 
Description I have engaged with policy-makers to discuss the findings from my award. Three examples of this are as follows: 1) I contributed to a UK Statistics Agency Review of Health Statistics and attended the resulting summit. 2) I spoke with Maternity Commissioners from East London about work on Maternity unit closures that is at an early stage. This was in accordance with their beliefs, and after answering their questions and on that basis decided that it would not be beneficial to spend money contracting private consultancy firms to provide them with similar answers. 3) Met with the Royal College of Midwives to discuss research on pressures on maternity units. As a result of the discussions, we altered our analysis to incorporate projections of the impact of changing composition of patients on maternity unit activities. The RCM were surprised about our results which show that maternity units are more likely to close on Thursday, Friday and Saturday. They have communicated this information to the Heads of Maternity Units, who are investigating the causes.
First Year Of Impact 2016
Sector Healthcare
Impact Types Policy & public services

 
Description Collaboration with Coauthors at Dartmouth and Harvard 
Organisation Dartmouth College
Country United States 
Sector Academic/University 
PI Contribution I have worked with Jon Skinner (Dartmouth) and Amitabh Chandra (Harvard) on a project the examines the diffusion of Percutaneous Coronary Interventions in England and the US,
Collaborator Contribution My US partners worked with the US data to produce comparable results to those I produced for the UK. I participated in two work shops in the US run by Jon Skinner, where I presented results to a multi-disciplinary audience of academics, including economists, Medical Doctors, and Sociologists. My participation in the conference was funded by Jon Skinner. I also presented by results at a Health Economics conference in Rome, where my flight was paid for by Jon Skinner.
Impact We are currently working on two papers. As a result of the collaboration, both I and Jon Skinner have joined the NBER-IFS International Network on the Value of Medical Research. Jon Skinner has received 2,500 USD for research activities. I will receive 20,000 GBP for research activities.
Start Year 2014
 
Description Medical Spending in 9 Countries around the developed world 
Organisation Aarhus University
Country Denmark 
Sector Academic/University 
PI Contribution I have helped coordinate a 9 country project on patterns of medical spending across the developed world. This project resulted in a special issue of the IFS journal Fiscal Studies, which provided standardised characteristics of medical spending across the 9 countries. I guest edited the journal, co-authored a chapter for England, and co-authored an introduction that summarised the main findings. I am now co-authoring a piece that summarises and expands the work on end of life spending. This is expected to result in a publication in the Journal Health Affairs in July 2017.
Collaborator Contribution Eric French from UCL led the project. The remaining collaborators produced results for their countries.
Impact Fiscal Studies Special Issue: Medical Spending around the Developed World September-December 2016
Start Year 2015
 
Description Medical Spending in 9 Countries around the developed world 
Organisation Cornell University
Country United States 
Sector Academic/University 
PI Contribution I have helped coordinate a 9 country project on patterns of medical spending across the developed world. This project resulted in a special issue of the IFS journal Fiscal Studies, which provided standardised characteristics of medical spending across the 9 countries. I guest edited the journal, co-authored a chapter for England, and co-authored an introduction that summarised the main findings. I am now co-authoring a piece that summarises and expands the work on end of life spending. This is expected to result in a publication in the Journal Health Affairs in July 2017.
Collaborator Contribution Eric French from UCL led the project. The remaining collaborators produced results for their countries.
Impact Fiscal Studies Special Issue: Medical Spending around the Developed World September-December 2016
Start Year 2015
 
Description Medical Spending in 9 Countries around the developed world 
Organisation Dartmouth College
Department Department of Economics
PI Contribution I have helped coordinate a 9 country project on patterns of medical spending across the developed world. This project resulted in a special issue of the IFS journal Fiscal Studies, which provided standardised characteristics of medical spending across the 9 countries. I guest edited the journal, co-authored a chapter for England, and co-authored an introduction that summarised the main findings. I am now co-authoring a piece that summarises and expands the work on end of life spending. This is expected to result in a publication in the Journal Health Affairs in July 2017.
Collaborator Contribution Eric French from UCL led the project. The remaining collaborators produced results for their countries.
Impact Fiscal Studies Special Issue: Medical Spending around the Developed World September-December 2016
Start Year 2015
 
Description Medical Spending in 9 Countries around the developed world 
Organisation Erasmus University Rotterdam
Country Netherlands 
Sector Academic/University 
PI Contribution I have helped coordinate a 9 country project on patterns of medical spending across the developed world. This project resulted in a special issue of the IFS journal Fiscal Studies, which provided standardised characteristics of medical spending across the 9 countries. I guest edited the journal, co-authored a chapter for England, and co-authored an introduction that summarised the main findings. I am now co-authoring a piece that summarises and expands the work on end of life spending. This is expected to result in a publication in the Journal Health Affairs in July 2017.
Collaborator Contribution Eric French from UCL led the project. The remaining collaborators produced results for their countries.
Impact Fiscal Studies Special Issue: Medical Spending around the Developed World September-December 2016
Start Year 2015
 
Description Medical Spending in 9 Countries around the developed world 
Organisation HEC Montreal
Country Canada 
Sector Academic/University 
PI Contribution I have helped coordinate a 9 country project on patterns of medical spending across the developed world. This project resulted in a special issue of the IFS journal Fiscal Studies, which provided standardised characteristics of medical spending across the 9 countries. I guest edited the journal, co-authored a chapter for England, and co-authored an introduction that summarised the main findings. I am now co-authoring a piece that summarises and expands the work on end of life spending. This is expected to result in a publication in the Journal Health Affairs in July 2017.
Collaborator Contribution Eric French from UCL led the project. The remaining collaborators produced results for their countries.
Impact Fiscal Studies Special Issue: Medical Spending around the Developed World September-December 2016
Start Year 2015
 
Description Medical Spending in 9 Countries around the developed world 
Organisation Keio University
Department Graduate School of Science and Technology
Country Japan 
Sector Academic/University 
PI Contribution I have helped coordinate a 9 country project on patterns of medical spending across the developed world. This project resulted in a special issue of the IFS journal Fiscal Studies, which provided standardised characteristics of medical spending across the 9 countries. I guest edited the journal, co-authored a chapter for England, and co-authored an introduction that summarised the main findings. I am now co-authoring a piece that summarises and expands the work on end of life spending. This is expected to result in a publication in the Journal Health Affairs in July 2017.
Collaborator Contribution Eric French from UCL led the project. The remaining collaborators produced results for their countries.
Impact Fiscal Studies Special Issue: Medical Spending around the Developed World September-December 2016
Start Year 2015
 
Description Medical Spending in 9 Countries around the developed world 
Organisation National Bureau of Economic Research
Country United States 
Sector Public 
PI Contribution I have helped coordinate a 9 country project on patterns of medical spending across the developed world. This project resulted in a special issue of the IFS journal Fiscal Studies, which provided standardised characteristics of medical spending across the 9 countries. I guest edited the journal, co-authored a chapter for England, and co-authored an introduction that summarised the main findings. I am now co-authoring a piece that summarises and expands the work on end of life spending. This is expected to result in a publication in the Journal Health Affairs in July 2017.
Collaborator Contribution Eric French from UCL led the project. The remaining collaborators produced results for their countries.
Impact Fiscal Studies Special Issue: Medical Spending around the Developed World September-December 2016
Start Year 2015
 
Description Medical Spending in 9 Countries around the developed world 
Organisation National Graduate Institute for Policy Studies (GRIPS)
Country Japan 
Sector Academic/University 
PI Contribution I have helped coordinate a 9 country project on patterns of medical spending across the developed world. This project resulted in a special issue of the IFS journal Fiscal Studies, which provided standardised characteristics of medical spending across the 9 countries. I guest edited the journal, co-authored a chapter for England, and co-authored an introduction that summarised the main findings. I am now co-authoring a piece that summarises and expands the work on end of life spending. This is expected to result in a publication in the Journal Health Affairs in July 2017.
Collaborator Contribution Eric French from UCL led the project. The remaining collaborators produced results for their countries.
Impact Fiscal Studies Special Issue: Medical Spending around the Developed World September-December 2016
Start Year 2015
 
Description Medical Spending in 9 Countries around the developed world 
Organisation Organisation for Economic Co-operation and Development OECD
Country France 
Sector Public 
PI Contribution I have helped coordinate a 9 country project on patterns of medical spending across the developed world. This project resulted in a special issue of the IFS journal Fiscal Studies, which provided standardised characteristics of medical spending across the 9 countries. I guest edited the journal, co-authored a chapter for England, and co-authored an introduction that summarised the main findings. I am now co-authoring a piece that summarises and expands the work on end of life spending. This is expected to result in a publication in the Journal Health Affairs in July 2017.
Collaborator Contribution Eric French from UCL led the project. The remaining collaborators produced results for their countries.
Impact Fiscal Studies Special Issue: Medical Spending around the Developed World September-December 2016
Start Year 2015
 
Description Medical Spending in 9 Countries around the developed world 
Organisation University College London
Country United Kingdom 
Sector Academic/University 
PI Contribution I have helped coordinate a 9 country project on patterns of medical spending across the developed world. This project resulted in a special issue of the IFS journal Fiscal Studies, which provided standardised characteristics of medical spending across the 9 countries. I guest edited the journal, co-authored a chapter for England, and co-authored an introduction that summarised the main findings. I am now co-authoring a piece that summarises and expands the work on end of life spending. This is expected to result in a publication in the Journal Health Affairs in July 2017.
Collaborator Contribution Eric French from UCL led the project. The remaining collaborators produced results for their countries.
Impact Fiscal Studies Special Issue: Medical Spending around the Developed World September-December 2016
Start Year 2015
 
Description Medical Spending in 9 Countries around the developed world 
Organisation University Duisburg-Essen
Country Germany 
Sector Academic/University 
PI Contribution I have helped coordinate a 9 country project on patterns of medical spending across the developed world. This project resulted in a special issue of the IFS journal Fiscal Studies, which provided standardised characteristics of medical spending across the 9 countries. I guest edited the journal, co-authored a chapter for England, and co-authored an introduction that summarised the main findings. I am now co-authoring a piece that summarises and expands the work on end of life spending. This is expected to result in a publication in the Journal Health Affairs in July 2017.
Collaborator Contribution Eric French from UCL led the project. The remaining collaborators produced results for their countries.
Impact Fiscal Studies Special Issue: Medical Spending around the Developed World September-December 2016
Start Year 2015
 
Description Medical Spending in 9 Countries around the developed world 
Organisation University of Copenhagen
Department Novo Nordisk Foundation Center for Protein Research
Country Denmark 
Sector Private 
PI Contribution I have helped coordinate a 9 country project on patterns of medical spending across the developed world. This project resulted in a special issue of the IFS journal Fiscal Studies, which provided standardised characteristics of medical spending across the 9 countries. I guest edited the journal, co-authored a chapter for England, and co-authored an introduction that summarised the main findings. I am now co-authoring a piece that summarises and expands the work on end of life spending. This is expected to result in a publication in the Journal Health Affairs in July 2017.
Collaborator Contribution Eric French from UCL led the project. The remaining collaborators produced results for their countries.
Impact Fiscal Studies Special Issue: Medical Spending around the Developed World September-December 2016
Start Year 2015
 
Description Medical Spending in 9 Countries around the developed world 
Organisation University of Tilburg
Department Department of Economics
Country Netherlands 
Sector Academic/University 
PI Contribution I have helped coordinate a 9 country project on patterns of medical spending across the developed world. This project resulted in a special issue of the IFS journal Fiscal Studies, which provided standardised characteristics of medical spending across the 9 countries. I guest edited the journal, co-authored a chapter for England, and co-authored an introduction that summarised the main findings. I am now co-authoring a piece that summarises and expands the work on end of life spending. This is expected to result in a publication in the Journal Health Affairs in July 2017.
Collaborator Contribution Eric French from UCL led the project. The remaining collaborators produced results for their countries.
Impact Fiscal Studies Special Issue: Medical Spending around the Developed World September-December 2016
Start Year 2015
 
Description Better Statistics Better Decisions Health and Care Summit 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact I assisted Ed Humpherson in the UK Statistics Authority review of health statistics. This providing input into the review and attending the "Better Statistics Better Decisions Health and Care Summit" in July 2016.
Year(s) Of Engagement Activity 2016
 
Description Clinical guidelines in the real world of medicine: Evidence from the roll-out of Percutaneous Coronary Intervention Services in England 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Postgraduate students
Results and Impact Presentation of ongoing work on PCIs and clinical guidelines to the IFS-NBER network on Valuing Medical Research.
Year(s) Of Engagement Activity 2014,2017
 
Description Dartmouth College 
Form Of Engagement Activity Participation in an open day or visit at my research institution
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact I spent a month visiting Harvard and Dartmouth in the Autumn of 2016. This involved working with co-authors Amitabh Chandra and Jon Skinner to advance a paper, and talking with other faculty about my work. A direct benefit of this trip came from talking to Julie Bynum, who suggested submitting to a special issue of Health Affairs on end of life care. The abstract submission was successful, and we expect the article to be published in the summer of 2017.
Year(s) Of Engagement Activity 2016
 
Description Divided by Choice? Private Providers, Patient Choice and Hospital Sorting in the English National Health Service 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Other audiences
Results and Impact Presentation at the LSE International Health Policy Conference 2017
Year(s) Of Engagement Activity 2017
 
Description End-Of-Life Medical Spending In Last Twelve Months Of Life Is Lower Than Previously Reported 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact 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. Spending during the last twelve months of life made up a modest share of aggregate spending, ranging from 8.5 percent in the United States to 11.2 percent in Taiwan, but spending in the last three calendar years of life reached 24.5 percent in Taiwan. This suggests that high aggregate medical spending is due not to last-ditch efforts to save lives but to spending on people with chronic conditions, which are associated with shorter life expectancies.
Year(s) Of Engagement Activity 2017
 
Description Event: NHS services in the face of increasing demand - what does it mean for patients? 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact I organised an event for policy makers held at the Royal Institute for Chartered Surveyors, which had an audience of around 100 people, including policy-makers, patient groups, and practitioners. The event focused on three pieces of work by IFS authors on pressures on the NHS. Each presentation was followed by a policy response. Two policy responses came from NHS Improvement, and one from the Royal College of Midwives. Following the event, I was asked to write a blog for the Huffington Post. We are were also contacted by NHS England to ask about our future work in healthcare.
Year(s) Of Engagement Activity 2017
URL https://www.ifs.org.uk/events/1515
 
Description Huffington Post Blog on Maternity Unit Closures 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Media (as a channel to the public)
Results and Impact I wrote a short blog piece for the Huffington Post on maternity unit closures. The intention was to engage with the general public who might not read mainstream newspapers.
Year(s) Of Engagement Activity 2017
URL http://www.huffingtonpost.co.uk/elaine-kelly/maternity-unit-closures_b_17971684.html
 
Description Meeting to discuss results of maternity work with RCOG 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Meeting to discuss results of maternity work with Royal College of Obstetricians and Gynecologists
Year(s) Of Engagement Activity 2017
 
Description Meeting with Royal College of Midwives to discuss results 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact Meeting to discuss results from maternity work with the Royal College of Midwives and to ask whether they would be willing to be discussant at the September event.
Year(s) Of Engagement Activity 2017
 
Description NHS services in the face of increasing demand - what does it mean for patients? 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Other audiences
Results and Impact Event presenting three pieces of work about demand pressure in the English NHS, with policy responses.
Year(s) Of Engagement Activity 2017
 
Description Presentation at Economics Seminar at City University 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Other audiences
Results and Impact I presented at the City University Economics Seminar to an audience of 30 people.
Year(s) Of Engagement Activity 2016
 
Description Presentation at the Oxford University Applied Economics Seminar 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Other audiences
Results and Impact Presentation at the Oxford University Applied Economics Seminar.
Year(s) Of Engagement Activity 2015
 
Description Presentation at the Royal Holloway Applied Economics Seminar 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Other audiences
Results and Impact Presentation to academics at Royal Holloway, University of London
Year(s) Of Engagement Activity 2015
 
Description Presentation to the Department of Health on the Distribution of Health Spending 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Presentation to the Department of Health and NHS England on a cross country project comparing patterns of individual level health spending. Following the presentation, I received several emails asking for further information.
Year(s) Of Engagement Activity 2015
 
Description Presentation to the MSc Health Policy Students at LSE 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Postgraduate students
Results and Impact A presentation on patterns of individual health spending in England, with comparisons made to other countries. This presentation was a guest lecture as part of an MSc in Health Policy course.
Year(s) Of Engagement Activity 2015
 
Description Presentation: Medical spending at older ages in England: Evidence from National Health Service administrative records 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Other audiences
Results and Impact This presentation examined the distribution of spending of in patient health care for the elderly population in England, presented by Elaine Kelly, George Stoye and Marcos Vera-Hernandez on 27 March 2015.
Year(s) Of Engagement Activity 2015
URL http://www.ifs.org.uk/publications/7781
 
Description Presentation: Public payment and private provision: The changing landscape of healthcare in the 2000s 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Other audiences
Results and Impact "Public payment and private provision" was published in May 2013, as part of a joint work programme between IFS and Nuffield Trust, written by Elaine Kelly and George Stoye.
Year(s) Of Engagement Activity 2013
URL http://www.ifs.org.uk/publications/6793
 
Description Special Session at Royal Economic Society Conference: Discrete Choice Modelling - Applications to Helathcare 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Other audiences
Results and Impact I organised a special session at the Royal Economic Society Congress in Brighton in March 2016. This involved presentations from 4 authors on work that involved discrete choice models applied to healthcare. The audience was approximately 50-100 people.
Year(s) Of Engagement Activity 2016
 
Description Talk at a Fiscal Policy Conference (York) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact I presented at a conference on Fiscal Policy in York. The talk focused on patterns of individual medical spending, and in particular the cost of end of life care
Year(s) Of Engagement Activity 2016
 
Description Talk at a Fiscal Policy Conference (York) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact I presented at a conference on Fiscal Policy in York. The talk focused on patterns of individual medical spending, and in particular the cost of end of life care.
Year(s) Of Engagement Activity 2016
 
Description The Expansion Of Percutaneous Coronary Intervention Services In England: Impacts For Patient Care And Clinical Outcomes 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact Presentation at the Wennberg Collaborative, Oxford
Year(s) Of Engagement Activity 2017
 
Description Visit to the Health and Social Care Information Centre in Leeds to present and share knowledge 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact My research team and I travelled to HSCIC in Leeds for a day of knowledge exchange that included me and a member of our team presenting our research to HSCIC analysts and HSCIC analysts and senior leadership informing us about the work of HSCIC and providing a workshop on a specific use of HSCIC data.
During the meeting I offered suggestions about how to include economists in future work to improve data access and public engagement. I was asked for a copy of my presentation on patient choice of hospital from an analyst who had attended once we had returned home.
It is hoped that this visit will spur ongoing engagement between IFS and HSCIC. We will be having a "wash up meeting" in March to discuss ways forward.
Year(s) Of Engagement Activity 2016
 
Description Workshop on Medical Spending Across the Developed World 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact Co-organised a workshop on Medical Spending Across the Developed World, where academics from 8 countries presented work on patterns of individual medical spending. The aim was to understand the differences between health systems and the create a common set of statistics on patterns of individual medical spending.

In addition to academic participants, I invited policy makers from the Department of Health, NHS England and the CQC to attend. I spoke to the analysts from the Department of Health at the workshop and as a result we were invited to the Department of Health to present our results to NHS England and DH via teleconferencing.
Year(s) Of Engagement Activity 2015