Health Economics, capability approach, outcome measurement, end of life care, priority setting, organisation of care, antimicrobial resistance
The Capability Approach to Resource Allocation in Health Care
The major focus of Jo’s current research programme is around the operationalisation of Amartya Sen’s capability approach for health care decision making. She has led he development of the ICECAP-O and ICECAP-A capability indices, valued using best-worst scaling. She has also explored the use of the capability approach more broadly within health economics. The overall aim of her research programme is to improve the conduct of economic evaluation in complex settings, where a broader assessment of costs and outcomes is required, developing approaches to enable such assessment within a sound theoretical extra-welfarist (in its widest sense) framework. Current work, funded by a large European Research Council grant, is looking at applying the capability approach to evaluation of interventions at the end of life. Within this work, two new indices have been generated for use in economic evaluation of interventions at the end of life: the ICECAP Supportive Care Measure (ICECAP-SCM) and the ICECAP Close Person Measure (ICECAP-CPM).
Decision making in health care
A large part of Jo’s work has concerned the making of rationing decisions in the NHS. In 1996 she completed a book, Priority setting: the health care debate, in conjunction with colleagues. The book developed a framework for considering explicit priority setting and advanced a number of themes both theoretically and in terms of practical attempts to set priorities. Following the completion of this book she developed a theoretical model of the potential disutility which could result from implicit rationing. Between 1996 and 2000 she conducted empirical research into the commissioning of care in collaboration with colleagues in Avon Health and at McMaster University, Toronto. The research was concerned with the willingness of members of different kinds of community to undertake the purchasing of their own health and social services. Focus groups and semi-structured interviews were used to explore issues surrounding public participation in resource allocation decisions in the UK. Fieldwork was also carried out with health service informants to explore the process of decision making in relation to the economic theory of principal-agent relationships. Following the completion of this work, Jo has continued to focus on rationing decisions through ongoing supervision and mentorship of postgraduate students and post-doctoral fellows examining the use of economic evaluation at local level in the NHS, and exploring perceptions of implicit and explicit rationing. Current work is exploring decision making for end of life care, and Jo is also co-chair for the PRIORITIES 2016 conference to be held in Birmingham in September 2016.
Efficiency in the organisation of care
A large part of Jo’s work in the early 1990s concerned the appropriateness of acute hospital care. She led two research projects, conducted in Bristol and Cornwall, which aimed to go beyond previous “appropriateness” research by considering the potential for altering patterns of care. From these projects she developed a broader interest in the organisation of care and has been involved in the empirical evaluation of a number of innovatory organisational developments. Specific projects have included:
- a randomised controlled trial comparing discharge to a hospital at home scheme with continued acute hospital care for elderly patients. Here she was Principal Investigator for the entire project, leading both the RCT and the economic evaluation;
- An economic evaluation comparing follow-up in a community optometrist setting with such care provided in a hospital setting;
- An economic evaluation comparing the use of telemedicine in the Accident and Emergency setting with usual practice;
- A systematic review evaluating the evidence for innovatory organisational approaches to ensuring that elderly patients receive the care that they need, both from the health system and from social services, on discharge from the acute hospital setting;
- An economic evaluation comparing hospital outpatients appointments with appointments with General Practitioners with Special Interests (GPSI) for dermatology patients;
- An economic evaluation comparing PhysioDirect services with standard physiotherapy care – ongoing.
The economics of antimicrobial resistance
Since the mid 1990s Jo has worked on the economics of antimicrobial resistance with a variety of collaborators. One of the main aims has been to develop the relevant economic theory, conceptualising antimicrobial resistance as a negative externality that occurs as the result of the private decision by the patient/doctor that the patient should take antimicrobials. This work has considered both the value of empirical assessments of efficiency in this area and the possible organisational and policy responses that could be pursued. Later work has been more empirical with a systematic review of strategies to contain the emergence of antimicrobial resistance and modelling projects using both decision modelling and computable general equilibrium models. Recent funded research focused on the economics of antibiotic resistance in the context of lower respiratory tract infection, through the GRACE European network, and the writing of a policy report for the UK Department of Health.
Using qualitative methods in health economics
The conduct of health economics within the environment of a Department of Social Medicine gave Jo the opportunity to explore a number of methodological areas, but particularly, the use of qualitative methods in health economics. Jo has explored the use of qualitative methods in a number of areas within health economics, both in relation to developing grounded theory to enhance economic understanding, and in relation to the development of instruments for use in quantitative experiments and surveys. Throughout this work Joanna has had a keen awareness of the epistemological differences between economics and qualitative work and has published on this issue. She has recently been awarded a contract to write the first book on using qualitative methods in health economics, and her current research on end of life care makes extensive use of qualitative methods.
Research Group: Evaluative Spaces and the Capability Approach