Who will care for you when you get old? A study of inequities in health and long-term care among the elderly in rural China

Lead Research Organisation: King's College London
Department Name: Social Science, Health and Medicine

Abstract

The proposed study seeks to address key questions concerning the health and LTC among rural elderly in China, bridging the research gap in this area, and offering policy suggestions. People above the age of 60 account for more than 15% of the Chinese rural population. This percentage is expected to increase in the next few decades. In rural China, elderly people are relying on family members to provide care. However, as more and more young people are migrating to big cities, the expectation that family members will be available to provide care for rural elderly is becoming unrealistic. Institutional LTC care is usually expensive in China, and although the government partially reimburses the costs through a social health insurance scheme or other mechanisms, service users are still responsible for a substantial amount of co-payments. These costs may be too expensive for the rural elderly living in poverty to afford, which exacerbates the issue of unequal access to care.

The proposed study seeks to examine inequities in health and LTC among rural elderly in China. This study will first examine whether the socioeconomic status of the rural elderly is associated with their health status. It will then assess the impact of a non-communicable disease prevention and control programme on rural elderly with different socioeconomic backgrounds, and also examine whether the needs of the rural elderly population can be sufficiently addressed with home-based care support. The study will simulate the population structure of the rural Chinese in the next few decades, and predict whether the New Cooperative Medical Scheme (NCMS) (the only financial support available to the rural elderly to finance their LTC) will be sustainable in the long term. It will draw lessons on LTC financing from other developed countries, and propose potential policy recommendations for decision makers.

The study results will benefit a number of stakeholders including policy makers who are designing ageing-related policies in China, organisations specialising in home-based LTC services, the rural elderly and their family carers. The study results will reveal how the current health status and patterns of health care and LTC use among the rural elderly differ across different socioeconomic groups. The intention is to inform the policy making process and encourage policy makers to re-examine existing health and LTC policies. Organisations specialising in home-based LTC will also benefit from this study, because this study aims to identify whether the current family care is able to meet the needs of the elderly and identify areas where there may be opportunities to develop formal home-based LTC care. Finally, this study will benefit rural elderly and their family members by engaging them in various dissemination activities and dialogues with policy makers and other relevant parties.

This study will employ sophisticated econometrics methods, such as the Concentration Index, Instrumental Variables (IV), and various other simulation models. Data will be drawn from the China Health and Retirement Longitudinal Study (CHARLS). This study builds on initial quantitative skills in health inequity research I have developed from my previous work (e.g. the Concentration Index and Panel Data Regressions), and is complemented by training opportunities that the Future Research Leaders Scheme provides (e.g. advanced quantitative courses and various knowledge exchange workshops). The scheme will put me in a position to deliver strong evidence-based policy research that can influence policies.

Planned Impact

The proposed study is designed to address key questions concerning the health and LTC among the rural elderly in China, bridging the research gap in this area and offering policy suggestions. This proposed study will benefit a wide range of audience members. Potential beneficiaries and stakeholders are listed as follows:
1. Policy makers
National level: National Health and Family Planning Commission (NHFPC; formerly the Ministry of Health) of the People's Republic of China, Ministry of Civil Affairs (MoCA)
Provincial level: Provincial MoCA and Committee of Ageing (CoA), Zhejiang Province
This proposed study aims to reveal issues relating to inequities in health and LTC systems among the rural Chinese elderly, provide evidence of current and future need and demands of health and LTC services among rural elderly in China, as well as offer policy recommendations. At a national level, the study results may be used to raise awareness and inform policy makers in the NHFPC about health and LTC policies in rural China. In particular, RQ4 seeks to use a probabilistic population projection model and possibly other related simulation methods to conduct population level projections, and this will inform policy makers on the sustainability of the current Chinese health and LTC system, and offer recommendations regarding LTC policies for the rural elderly. Policy makers will be invited to become members of the advisory group, participate in the project workshop and conference, as well as comment on the research papers and the plain language report.

2. NGOs and other related social care organisations
RQ3 in this proposed study focuses on family care and other types of home-based LTC in rural areas. The findings may be useful for related adult social care service providers or organisations as evidence for developing activities relating to home-based elderly care in rural China.

The proposed research plans to make contact with home-based LTC providers through the researchers at Zhejiang University. Using the CHARLS survey Zhejiang sub-survey, the proposed research will present results on the level of unmet needs for the rural elderly who receive home-based care and identify relevant areas that social care providers or organisations should focus on. Representatives from social care providers will also be invited to attend workshops and exchange opinions and knowledge with government officials, academic researchers and service users, in order to inform their practice.

3. Rural elderly, family members of rural elderly in China
Issues relating to inequities in health status and the utilisation of health and LTC among the rural elderly should be examined and should be recognised. It is important to note that the burden of family care of the rural elderly should not only be shared with the elderly and their families, but also with the wider society. The proposed study calls for attention to be paid by the government, to take responsibility for provision of publicly-subsidised social care for the rural elderly. This will also reduce the burden for the rural family. The proposed research plans to invite rural elderly and their family members to project workshops and other relevant events. These events will provide the rural elderly with opportunities to express their opinions, and engage in the policy dialogue with the decision makers and academics. They will also be invited to comment on the draft of the plain language report, which will be disseminated to relevant parties.

4. Academics
Limited research has been carried out in the field of LTC in rural China. This research will raise the awareness of health and LTC research among Chinese and international scholars, bridge the research gap, provide new findings and call for more engagement in the field of health and LTC research in China.

Related Projects

Project Reference Relationship Related To Start End Award Value
ES/N002717/1 11/01/2016 16/08/2016 £269,148
ES/N002717/2 Transfer ES/N002717/1 17/08/2016 31/07/2019 £227,206
 
Description We are in the process of finalising all academic deliverables of the project. Through the third year of the grant, this study has a number of key findings.
• The first finding relates to the current financing models for long-term care (LTC) in China. As the Chinese government is piloting new ways to finance its LTC sector, I have conducted a focused review of academic and grey literature, supplemented with qualitative interviews with government officials from relevant departments, care home staff and service users to assess different financing models that currently been used in China. Three emerging models are explored: Social Health Insurance (SHI) in Shanghai, LTC Nursing Insurance (LTCNI) in Qingdao, and a means-tested model in Nanjing. I find that, although SHI appears to be a convenient solution to fund LTC, this model has led to systematic bias in affordable access among participants of different insurance schemes, and has created a powerful incentive for the over-provision of unnecessary services. The means-tested method has been remarkably constrained by narrow eligibility and insufficiency of funding resources. The LTCNI model is by far the most desirable policy option among the three studied here, but the narrow definition of eligibility has substantively excluded a large proportion of elders in need from access to care, which needs to be addressed in future reforms.
• Using data from the China Health and Retirement Longitudinal Survey 2011, I investigated on inequity in LTC needs and access among the elderly in rural and urban China. I find that the rural elderly has significantly higher LTC needs and unmet needs compared with the urban elderly, and the rural poor are more likely to report poor health outcomes compared with the rural rich. The urban elderly, especially the urban rich, have started to use other types of LTC in addition to informal care, whereas LTC support in rural areas is still largely limited to informal care provided by family members.
• A paper entitled as Is informal care sufficient to meet the long-term care needs of older people with disability in China? Evidence from China Health and Retirement Survey is completed and is at R&R stage with Ageing and Society. Drawing data from the 2015 wave of the China Health and Retirement Longitudinal Survey, this paper explores the relationship between informal care provision and unmet long-term care needs among older people in China. We first examine the availability of informal care among older people with disabilities, we then look at whether a higher intensity of informal care leads to lower unmet needs. We further test the interaction effects between informal care intensity and cognitive function and their associations with unmet needs. Our findings suggest that the majority of older people with disabilities receive a low intensity of care, i.e., less than 80 hours per month. Besides, higher intensity of informal care has no association with unmet needs for the majority of the disabled older adults, except for a subgroup who are ADL dependent and have no cognitive impairment. We also find that the number of hours of informal care received has no significant effects on unmet needs. This means that even among the older people receiving a high intensity of care, the odds probability of them reporting having unmet needs, does not differ from those receiving a low intensity of care. Our study points out that informal care is insufficient to meet the growing needs and indicates a pressing need for the government to buttress the formal care provision and delivery systems to support these disabled older people in China.
• A paper entitled as Understanding non-medical costs for health care: Evidence from inpatient care for older people in China is also completed and is forthcoming at China Quarterly. This paper seeks to answer the third research question proposed in the grant - fairness in health and long-term care financing. This study seeks to examine the effects of non-medical costs (e.g. costs associated with travel, productivity lost, food, paying for carers) on catastrophic health payments and health payment-induced poverty among older people in rural and urban China. Using data from the China Health and Retirement Longitudinal Survey 2015, this study finds that inpatient costs account for a significant proportion of household expenditure, and non-medical costs can account for approximately 18% of total costs. That share is highest for those who belong to the lowest wealth groups. Non-medical costs increase the chances of older people incurring catastrophic health payments and suffering from health payment-induced poverty. Such effects are more concentrated among the poor than the rich. The results also show that the rural population are more likely to incur catastrophic health payments and suffer from health payment induced poverty compared to the urban population. This paper urges policy makers to consider reimbursing the non-medical costs of patient care, improving health care systems in general and for the rural populations specifically.
• A paper entitled as Care providers, access to care, and the Long-term Care Nursing Insurance in China: an Agent-based Simulation is published by Social Science and Medicine. In 2012, the Chinese government piloted one of the first publicly funded LTC nursing insurance (LTCNI) in developing countries with an aim to improve access to long-term care for older people in China. Although some early studies of the LTCNI showed that the scheme has been successful in meeting key objectives intended, most of these studies do not take into account the availability, price and quality of the local care providers, which may have significant effects on overall access to care. Using the LTCNI in Qingdao as a case study, this paper applies Agent-based Simulation approach to examine the effects of the LTCNI on access to care by considering factors associated with the local care providers. Our results show that there exist considerable discrepancies among the LTCNI beneficiaries in terms of access to services. Nursing home care use is more concentrated among the rich, whereas home-based care is more frequently used by the poor. We also find that the poor are more likely to choose nursing home with low costs albeit these services are often of poor quality. Despite a soaring demand for home-based services, our findings show that these services are often not distributed according to population needs in the localities. Unmet needs are high in districts with a large number of older people and limited services. We urge the policy makers to improve the overall design of the LTCNI, and to optimise the distribution of LTC services in districts with a high percentage of old population.
• We are also writing a perspective paper which is based on the 2nd Symposium on Ageing and Long-term Care in China was convened from 4 - 5th July 2019. The symposium is part of the deliverable of the grant. The symposium drew from a wide range of disciplines, including economics, public policy, demography, gerontology, public health and sociology. A total of 20 participants, spanning from 8 countries, sought to identify key issues and research priorities in the area of ageing and LTC in China. International lessons are also discussed in the symposium. In an era that witnesses an unprecedented pace of population ageing, it is essential for researchers to launch multidisciplinary research programs built on different disciplinary traditions that integrate a wide array of views, methods, and data to yield a better understanding on how to achieve an efficient and equitable LTC system in China as well as other developing countries. Lessons from the high-income countries, such as Germany, Japan, South Korea, in terms of understanding risk factors for age-related diseases, LTC service planning, financing as well as the application of technology in LTC, would be valuable for China. These top four research areas are proposed as key areas that could pave the way to many important inquiries, discussion, and future research priorities to examine challenging issues surrounding ageing and LTC development in China.
Exploitation Route Our impact strategy is informed by the principle of engaging and collaborating with different stakeholders at every stage. Potential beneficiaries and stakeholders of this research are listed as follows: Policy makers: This study provides evidence-based recommendations on the impacts and design of the health and LTC system to policy makers. Service providers: Study results from this research provide new evidence for service providers and help them to understand issues concerning health and LTC use and costs, as well as to identify areas on which they should focus. Older people and their family members: Older people and their family members will also benefit from this research as a health and LTC system with a thoughtful design is likely to have a positive impact on their use of LTC services and consequently their health outcomes.

I have started to disseminate the findings. A few activities have been implemented or planned:
• I attended a conference with Qingdao government official in December 2019. The conference includes a visit of a local care provider and a round table discussion with the provider, a conference and then discussion with government officials from Qingdao Civil Affairs and Social Security Bureau. The conference was organised by a member of the advisory group. I had chances to speak to the government officials and introduced the research project as well as to listen to their concerns on health and LTC system in Qingdao. We had fruitful discussions and agreed to continue to work together.
• Attended a forum organised by Zhejiang University and China Health Policy and Management Society (CHPMAS) in July. I have had meetings with the former and current president of the CHPMAS - Zhuo Chen and Xi Chen to discuss further opportunities for collaboration and disseminate activities. CHAPMAS is one of the most influential organisations that links the academics with policy makers in China. To collaborate with them will result in a greater impact of the project and also be beneficial for the PI's career.
• The 2nd Symposium on Ageing and Long-term Care in China was convened from 4 to 5th July 2019 to discuss these topics. While the 1st symposium focused on key drivers for population ageing, such as increased life expectancy and low fertility, the 2nd symposium drew research insights from a wider range of disciplines, including economics, public policy, demography, gerontology, public health and sociology. A total of 20 leading researchers and scientists from eight countries, sought to identify key issues and research priorities in the area of ageing and LTC in China. International lessons were also discussed in the symposium. The participants discussed these four priority research areas: Understand risk factors on healthy ageing, improve access to care, Address issues in long-term care financing and promote technology and innovation in LTC.
Sectors Communities and Social Services/Policy,Healthcare,Government, Democracy and Justice

 
Description We are in the process of disseminating our study results. I have listed a number of policy implications from this study and potential impacts as follows. For the paper on informal care and unmet needs, we think that even though having informal care support is able to lower the odds of unmet needs among disabled older adults, the fact that a higher intensity of informal care does not translate into lower odds of unmet needs suggests that LTC needs among disabled older people cannot be sufficiently addressed by informal care. The finding indicates a pressing need for the government to buttress the formal care institutions and delivery systems to support the 33 million incapacitated older people who need advanced care. Internationally, scholars have called for a recalibration of the interface between the formal and informal LTC systems. For instance, the deployment of professional caregivers from the formal health system such as home care nurses, rehabilitation therapists and social workers to the community is seen as a necessary move to support and supervise untrained informal carers in fast ageing nations like China. In European countries, changing governmental policy priorities in LTC to cut back on formal care provision and to promote deinstitutionalisation of older people who need intensive care to "age at home" or "age in place" have also given rise to the importance of informal caregiving. Second, the inability of the informal care support system in China to meet rising care needs for disabled older adults in China also implies that there is a need for policy makers and practitioners to rethink new strategies that could bridge the capacity deficit gaps among informal carers, especially those in home-based settings. In light of the pervasive caregiving burden, it would be necessary for more targeted community-based interventions to be tested and implemented to support informal carers, especially those who are experiencing a high care burden, in the future. There is also a need for the government to find a way to compensate informal carers or help older people to 'age in place'. Experiences from matured LTC systems in Europe suggest that cash benefits for recipients and informal carers for disabled older people who need care at home was more popular than direct service reimbursement. Nonetheless, closer to China, Japan and Korea have decided to reimburse eligible recipients for direct services such as home care, community-based care and institutional care only without handing out cash for various social cultural reasons. For paper on Agent-based modelling, we think the method is innovative in the sense that our paper is among the first to use agent-based modelling to simulate outcomes of an LTC financing policy by taking into account the availability and characteristics of the local care providers. It takes an interdisciplinary perspective to introduce a computational approach as policy evaluation tools and to offer evidence-based recommendations to policy makers in China. The method also assesses and suggests policy directions by incorporating the dynamics of the local care market characteristics, which are difficult to achieve using a regression model. Our model can be used to model equity in relation to access to care in difficult cities in China as well as in other developing countries. For the paper on long-term care Nursing Insurance, I suggest that the equity criterion of the LTC insurance should be addressed by the government. A key aspect of LTC financing based on equity criterion is that a care dependent person should not be denied access to care when the person is unable to meet the costs themselves. The study findings should have significant policy impacts on the LTC financing policies in China, and the government should direct the funding to be targeted to satisfy the needs of the lower socioeconomic groups who are in risk of incurring higher than expected costs. The findings also suggest a risk-adjusted payment mechanism for the LTCNI, whereby providers receive higher payments for patients with higher needs, can be potentially helpful in diminishing the incentives for risk selection. For paper on indirect costs for health care for older people in rural China, Indirect costs associated with receiving health care can present difficulties for many older patients from rural villages, and this needs to be recognised by the government. Some developed countries have already implemented health care travel cost programmes to help people from vulnerable groups to meet these costs. National Health Services in England reimburse travel and associated costs for those from low-income groups if they are referred to hospital or other health facilities for specialist treatment or diagnostic tests. Similar measures should be considered by the Chinese government. The government needs to address the issue of high health care costs. More comprehensive coverage with higher reimbursement rates for health services should be introduced so that the access to care can be improved among older people in rural areas. It is crucial to emphasise the need for long-term care and to enable better coordinated and more continuous care for the older population which has an increasing incidence of chronic diseases. International experience has demonstrated that these services also help to reduce the unnecessary use and spending of acute health services and help families to avoid catastrophic health payments.
Sector Communities and Social Services/Policy,Healthcare,Government, Democracy and Justice
Impact Types Societal,Policy & public services

 
Description PI incentivisation fund
Amount £3,000 (GBP)
Funding ID PI incentivisation fund 
Organisation King's College London 
Sector Academic/University
Country United Kingdom
Start 09/2018 
End 07/2019
 
Description PI incentivisation scheme
Amount £3,000 (GBP)
Organisation King's College London 
Sector Academic/University
Country United Kingdom
Start 01/2018 
End 07/2018
 
Title Developed an Agent-based model to simulate the effects of the long-term care insurance on equitable access to care 
Description My advisory group member and I have developed an Agent-based simulation module that can be used to predict the impact of the long-term care insurance on equitable access to care. In 2012, the Chinese government piloted one of the first publicly funded LTC nursing insurance (LTCNI) in developing countries with an aim to improve access to long-term care for older people in China. Although some early studies of the LTCNI showed that the scheme has been successful in meeting key objectives intended, most of these studies do not take into account the availability, price and quality of the local care providers, which may have significant effects on overall access to care. Using the LTCNI in Qingdao as a case study, we apply Agent-based Simulation approach to examine the effects of the LTCNI on access to care by considering factors associated with the local care providers. Our results show that there exist considerable discrepancies among the LTCNI beneficiaries in terms of access to services. Nursing home care use is more concentrated among the rich, whereas home-based care is more frequently used by the poor. We also find that the poor are more likely to choose nursing home with low costs albeit these services are often of poor quality. Despite of a soaring demand for home-based services, our findings show that these services are often not distributed according to population needs in the localities. Unmet needs are high in districts with a large number of older people and limited services. We urge the policy makers to improve the overall design of the LTCNI, and to optimise the distribution of LTC services in districts with a high percentage of old population. 
Type Of Material Improvements to research infrastructure 
Year Produced 2018 
Provided To Others? Yes  
Impact We think the tool can be used to predict the impact of the LTCNI on equity and efficiency locally using local demographic and socioeconomic data. As China is planning to rollout the LTCNI to 15 cities, this model can serve as a powerful policy tool for the policy makers in these 15 cities to make evidence based policy decisions on the design of the LTCNI. 
URL https://www.sciencedirect.com/science/article/pii/S0277953619306628
 
Description Collaboration on ageing and long-term care topic with Prof. Bei Wu from New York University 
Organisation New York University
Country United States 
Sector Academic/University 
PI Contribution Starting to do a literature review on integrated care in China with Prof. Bei Wu and her team from New York University. We found that integrated care is an important topic not only in the developed countries, but increasingly in the developing countries. Ample studies have found that investment in long-term care may eventually lead to cost saving in health care. Finding ways to integrated health and long-term care will be significant implications for policy makers in China and other developing countries with similar demographic structures.
Collaborator Contribution Prof. Bei Wu is a Dean's professor at College of Nursing at NYU. We will be working together on a manuscript on integrated care in China.
Impact We have just started working on this project, and hopefully there will be a working paper coming out by the end of the year.
Start Year 2019
 
Description Collaborations with Zhejiang University on Long-term Care Nursing Insurance in China 
Organisation Zhejiang University
Country China 
Sector Academic/University 
PI Contribution Zhejiang University has agreed to co-host the final grant conference in Hangzhou China in December 2018. The conference will invite a number of prestigious international speakers to and discuss issues surrounding ageing and long-term care in China. The conference will consist of two main parts, the first part will take place in Zhejiang University in Hangzhou and the second part will take place in Qingdao, where China's first long-term care insurance was launched. The second part of the conference will include local visits to care homes and meetings with government officials so that the academics can better understand the ageing issues and long-term care insurance in China.
Collaborator Contribution The partner has made substantial contributions to the grant, especially on impact activities. The conference mentioned above is expected to have significant policy impacts at the national and local level. Furthermore, Zhejiang University and I have co-submitted a funding proposal to Medical Research Council to analyse long-term care financing in China.
Impact Output of the collaborations: 1, Seminar entitled as "indirect costs and catastrophic health payments and health payments-induced poverty" at Zhejiang University in December 2017. 2, Grant final conference in December 2018.
Start Year 2017
 
Description The effectiveness of the home and community-based services in long-term care 
Organisation National Cheng Kung University
Country Taiwan, Province of China 
Sector Academic/University 
PI Contribution NCKU has recently signed a collaboration with us to look at how the role that social values plays in the setting of health care priorities and the implementation of evidence based cost effective care. The project will focus on the clinical effectiveness and cost-effectiveness of elders aged 65 and over who receiving long-term care services and their caregivers by following up their outcome trajectories. This is a two-year project and specifically the aims of the study are as follows: 1. To learn from the development and reform of long-term care system in the UK by comparing the demographic figures, needs and supplies of the long-term care system between UK and Taiwan. 2. From the prospective of clinical effectiveness, to analyze the physical and mental health outcome trajectories of elders receiving formal long-term care services in the different settings of the home and community-based care. 3. From the perspective of life course, to estimate the life expectancies and the health-adjusted life expectancies of elders who receiving different types of care services. 4. From the perspectives of cost-effectiveness, to estimate the lifetime medical and long-term care expenditures by using two major catastrophic illnesses (stroke, dementia) among elderly people as examples. 5. From the perspective of policy evaluation, to examine the effectiveness of long-term care service delivery by exploring viewpoints from multiple stakeholders-officials and service providers by mixed methods (combing quantitative mentioned above with qualitative methods). To achieve the quantitative aim, we developed a method by which to assess dynamic changes of dysfunction and estimate the lifetime duration of disability in long-term care recipients, for assessing their specialized healthcare needs and to account cumulative life-time cost. Our research team will have to conduct cost-effectiveness analysis on a long-term care intervention together with the NCKU team.
Collaborator Contribution The NCKU team will also participate in the project and co-author the papers.
Impact Two workshops held in London and Taiwan. The Taiwan team will fly over to London in July 2019 to attend a workshop here and discuss research ideas. The KCL team will fly over to Taiwan in Oct. 2019 for further collaboration and discussion. We aim to produce two papers based on the collaboration in the next two years.
Start Year 2019
 
Description A organised panel entitled as Long-term Care Financing in Asia at the International Public Policy Association Conference 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact Approximately 20 people attended the panel on long-term care financing in Asia. The audience came from ten different countries with various backgrounds. After the panel, further knowledge exchange and networking activities were agreed, and the study findings were further refined.
Year(s) Of Engagement Activity 2017
 
Description Conference on long-term care insurance held by the Qingdao government 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Policymakers/politicians
Results and Impact Invited to attend a conference held by the Qingdao city government. Qingdao is the first city in China that has piloted a long-term care insurance scheme. The conference includes a tour of local care providers, dialogue with the local providers, presentation and conversation with government officials from Qingdao's Civil Affair and Social Security Bureau. The event was fruitful and our research had been proved to be interesting and relevant to the policy makers.
Year(s) Of Engagement Activity 2019
 
Description Invited talk at Zhejiang University 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Postgraduate students
Results and Impact Approximately 20 postgraduates and academics attended my talk entitled as "Indirect health costs and catastrophic health payments among older people in rural China". During the talk, we spent more than one hour discussing the talk. The students were very engaged and some of them wrote emails to me asking further questions. The organiser reported increased interest in related subject areas.
Year(s) Of Engagement Activity 2017
 
Description Two presentations on long-term care financing and service delivery at International Health Economics Association conference in Boston in 2017 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Two papers were presented at the International Health Economics Association Conference in July 2017. The audience reached included health economists, health policy researchers, computer scientists, etc. The presentations helped me to build further research connections and refine study results.
Year(s) Of Engagement Activity 2017