Monday, February 2, 2009

[EQ] Making an Impact: Framework and Indicators to Measure Returns on Investment in Health Research

MAKING AN IMPACT

A Preferred Framework and Indicators to Measure Returns on Investment in Health Research

 

Report of the Panel on the Return on Investments in Health Research

Canadian Academy of Health Sciences/Académie canadienne des sciences de la santé
January 2009

 

Available online PDF file [136p.] at: http://www.cahs-acss.ca/e/pdfs/ROI_FullReport.pdf

 

"……Twenty three different organizations sponsored this assessment. They all share an interest in defining the impacts of health research and learning how to improve the returns on investments in health research. Our remit from these sponsors was: Is there a "best way" (best method) to evaluate the impacts of health research in Canada, and are there "best metrics" that could be used to assess those impacts (or improve them)?

 

Based on our assessment, we propose a new impacts framework and a preferred menu of indicators and metrics that can be used for evaluating the returns on investment in health research. The CAHS impact framework demonstrates how research activity informs decision making, eventually resulting in changes in health and economic and social prosperity (left to right arrow). The framework also shows how research impacts feed back upstream, potentially influencing the diffusion and impacts of other research, and creating inputs for future research (right to left arrow).

 

This framework builds on the combined logic model and impacts approach of the "payback model" (Buxton, M.J., and Hanney, S.R., 1996 � adapted by CIHR in Canada in 2005 and 2008), revised by our panel into a "systems approach" to capture impacts (this is shown at the bottom of the Figure). It is designed to be used as a roadmap to track healthresearch impacts in five main categories:
1) advancing knowledge,
2) building capacity,
3) informing decision
making,
4) health impacts, and
5) broad socio
economic impacts………."

 

Content

 

Volume 1

The Chair's Perspective

Rationale (and CAHS Prospectus) for this Assessment

Executive Summary

Panel Recommendations

1. Chapter 1: Background

1.1. Defining Health Research

1.1.a. The Canadian Health Research Landscape

1.1.b. What Returns are Expected from Canadian Health Research?

1.1.c. Many Stakeholders, Many Views

1.1.d. Different Evaluation Purposes

1.1.e. Why Measure Returns on Investment for Health Research in Canada?

1.1.f. What Evaluation of "Returns" is Already Taking Place in Canada?

1.2. Are "Health Research Impacts" Already Defined Elsewhere?

1.3. Economic Evaluations to Date

1.4. Summary of the Landscape

2. Chapter 2: Frameworks

2.1. Rationale for a Framework to Understand Health Research

2.1.a. Definitions

2.1.b. Stakeholders Needs

2.2. A Review of Frameworks and Their Use

2.3. Developing a Health Research Evaluation Framework for Canada

2.3.a. Identifying What Should be Modelled

2.3.b. Building a Framework for R&D Uptake

2.3.c. Impact Categories

2.3.d. Impact Categories and the Logic Model

3. Chapter 3: Strategies for Using the Framework

3.1. Using the Framework Appropriately

3.1.a. Avoiding Misuse of the Framework

3.1.b. The Four Pillars and the Framework

3.2. Costs of Evaluation

3.3. Issues in Evaluation: Attribution, the Counterfactual, Timelags and Levels of Aggregation

3.4. Evaluation Methods

3.5. Data Collection

4. Chapter 4: Choosing Sets of Indicators and Metrics

4.1. Overview of Indicators and Metrics and Their Use

4.2. Defining "Appropriate Indicators"

4.3. Identifying Appropriate Indicators

4.3.a. Advancing Knowledge

4.3.b. Capacity Building

4.3.c. Informing Decision Making

4.3.d. Health Impacts

4.3.e. Broad Economic and Social Impacts

4.3.f. Theoretical examples of indicator sets for evaluation

5. Chapter 5: Conclusions

6. References

 

Volume 2

Appendices

The appendices present commissioned papers in areas where the report is not able to provide details, cover the background for the main report, and present the approach taken to the assessment process. The commissioned papers cover assessing the impacts of research in pillars II, III and IV but do not cover pillar I, since basic biomedical research is the area where most has been said on understanding the impacts of health research.

 

Appendix A: Commissioned Papers

- Pillar II: Clinical Research "How to Optimally Measure the Impact of Health Research Funding in Clinical Research" by Ralph M. Meyer

- Pillar III: Health Services Research "Estimating the Return on Investment from Health Services Research: A Theoretical and Empirical Analysis
   Steven Lewis, Patricia J. Martens and Louis Barre

- Pillar IV: Population and Public Health Research "Assessing the Return on Canada's Public Investment in Population and Public Health Research:
  Methods and Metrics" by Alan Shiell and Erica Di Ruggiero

- MesoLevel Metrics for Impact "Metrics for the Treatment Sector or Meso Level of the Canadian Health Care System" by Jerald Hage

- Ethics and Evaluating Health Research "The Return on Investments (ROI) in Health Research: Ethical Aspects" by Michael McDonald and Bartha Knoppers

- Public Perspective on Health Research Funding "Translating Science into Hope: The Public Perspective on Health Research Funding" by André Picard

- Health Research Evaluation Frameworks: An International Comparison by Philipp Bastian Brutscher, Steven Wooding and Jonathan Grant

Appendix B: The Canadian Landscape for health research

Appendix C: Evaluation frameworks and methods

Appendix D: Issues for research evaluation

Appendix E: Indicators

Appendix F: Glossary

Appendix G: Methods

Appendix H: External Interviewees

Appendix I: Prospectus for a Major Assessment � The Return on Investments in Health Research: Defining the Best Metrics

 

 

 

0Download the Appendices [pdf] 5.27 MB, (340 pages) ISBN: 978-0-9811589-1-4
0Download the Assessment Summary [pdf] 1.15 MB, 24 pages
0Pour Télécharger de « Résumé de l'évaluation » [pdf] 1.56 MB, 30 pages
0Menu of Preferred Indicators [pdf] 1.56 MB, 8 pages

 

Website: http://www.cahs-acss.ca/e/assessments/completedprojects.php

 

 

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]

"Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members".
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[EQ] Reducing health inequities in a generation: a dream or reality?

Reducing health inequities in a generation: a dream or reality?

 

Shankar Prinja a & Rajesh Kumar b

a. London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, England.

b. School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

 

Bulletin of the World Health Organization 2009;87:84-84. doi: 10.2471/BLT.08.062695

Volume 87, Number 2, February 2009

 

Available online at: http://www.who.int/bulletin/volumes/87/2/08-062695/en/index.html

 

“…..Inequalities in health are an indicator of distributional differences in the health status of populations. Low-income countries, which contribute 56% of global disease burden, account for only 2% of global expenditure on health.1 The WHO Commission on Social Determinants of Health has called for “closing the gap” – resolving health inequities between different groups – in the course of a generation. It aims to achieve this by improving conditions of daily living; tackling inequitable distribution of power, money and resources; and measuring and ascertaining the impact of interventions.2 However, there are several challenges to realizing this dream.

 

Health is generally not high on the political agenda. Policy and planning are heavily influenced by a few elite groups who are least affected by health inequalities. Powerful interest groups, such as the pharmaceutical industry, influence health policies in most countries. The revenue of the top 10 global pharmaceutical companies is more than the gross national income of the 57 lowest-income countries.3 Progressing towards the recommendations of the Commission would mean rejection of the biomedical model of disease causation and re-emphasizing the concepts of social medicine. None of this is in the interest of the power groups. Hence, the very step of agenda setting in the course of policy-making is laden with problems. It is difficult to convince politicians and bureaucrats about the long-term benefits of social interventions when they are focused on biomedical interventions that impact their status in the short term….” [au]

 

 

 

 

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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
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Equity List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html

 

 

    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.  

[EQ] Social Health Insurance vs. Tax-Financed Health Systems

Social Health Insurance vs. Tax-Financed Health Systems
Evidence from the OECD

 

Adam Wagstaff

The World Bank - Development Research Group

Human Development and Public Services Team - Policy Research Working Paper 4821

January 2009

 

Available online PDF file [39p.] at:

http://www-wds.worldbank.org/external/default/WDSContentServer/IW3P/IB/2009/01/21/000158349_20090121101737/Rendered/PDF/WPS4821.pdf

 

“…..This paper exploits the transitions between tax-financed health care and social health insurance in the OECD countries over the period 1960–2006 to assess the effects of adopting social health insurance over tax finance on per capita health spending, amenable mortality, and labor market outcomes. The paper uses regression based generalizations of difference-in-differences and instrumental variables to address the possible endogeneity of a country’s health system. It finds that adopting social health insurance in preference to tax financing increases per capita health spending by 3–4 percent, reduces the formal sector share of employment by 8–10 percent, and reduces total employment by as much as 6 percent.


For the most part, social health insurance adoption has no significant impact on amenable mortality, but for one cause—breast cancer among women—social health insurance systems perform significantly worse, with 5-6 percent more potential years of life lost.

 

 

 *      *     *

This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
------------------------------------------------------------------------------------
PAHO/WHO Website

Equity List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html

 

    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.