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  • Developing an International Sustainable Profile in Health Economics, Health Care Reform and Management and Public Health Policy: Measuring, Understanding and Explaining Health Outcomes in Russia

Developing an International Sustainable Profile in Health Economics, Health Care Reform and Management and Public Health Policy: Measuring, Understanding and Explaining Health Outcomes in Russia

Priority areas of development: economics
2016
Head: Gerry, Christopher
The project has been carried out as part of the HSE Program of Fundamental Studies.

Goal of research

The overall goal of this project and the research that it undertakes to develop a sustainable (in terms of publications, projects, funding, knowledge exchange, dissemination and impact) and internationally visible presence in Health Economics and Policy, operating through the Centre for Health Economics, Management and Policy (CHEMP). The basic operating apparatus and structure of CHEMP was established in the latter half of 2015 and helped to establish the framework within which CHEMP activity and outputs could rapidly develop in subsequent years.

During 2016, the overall goals of CHEMP’s research activity fall in to 4 categories: (i) to achieve the stated publication targets; (ii) to develop the research outputs and activities of young Russian researchers working in health economics for the first time; (iii) to establish cross-Russia, cross-sector relationships in specific spheres of health economics (e.g. cardiovascular disease, mental health and Health Technology Assessment (HTA)); (iv) to submit at least one application for external research project funding; (v) to develop an active internally oriented seminar series, alongside 2-3 one-off events; (vi) to develop knowledge exchange and dissemination activities through social media, a dual-language up-to-date website and the conduct of the first English-language Health Economics summer school.

As CHEMP has developed during 2016, there has been a further refinement of our research work themes. The following 5 work themes now shape the CHEMP research agenda (and are each described on the CHEMP website):

  1. Health Outcomes and HTA (http://scem.spb.hse.ru/en/chemp/health_outcomes)
  2. Applied Health Econometrics (http://scem.spb.hse.ru/en/chemp/health_behaviours)
  3. Cardiovascular disease in Russia (http://scem.spb.hse.ru/en/chemp/Chronic%20Diseases)
  4. Mental Health and Well-being (http://scem.spb.hse.ru/en/chemp/dynamics_of_ageing)
  5. Behaviours and Attitudes (http://scem.spb.hse.ru/en/chemp/behaviour_and_attitudes)

Methodology

Workstream 1 (Health Outcomes) : In 2016 we have begun data analysis from survey based studies (specifically the 2005 RLMS-HSE), and have also undertaken a pilot project in St. Petersburg and Moscow. In the case of the former the RLMS-HSE 2005 survey collected data on the 5 EQ-5D questions but without the visual analogue scale and with some, potentially important, changes in the structure and meaning of the questions. Notwithstanding this, we have been seeking to derive an experienced value set from these data (i.e. to recover a scoring set for Russia), using the corresponding 5-point questions on self-assessed health. This will provide for the first preliminary Russian value set for use in converting EQ-5D responses into a single index suitable for use in economic evaluation conducted by Russian healthcare decision-makers. 

In the pilot project, CHEMP’s research interns, based in Moscow and St. Petersburg conducted an overall scoping exercise to understand how different survey tools are understood and/or implemented in a non-representative Russian setting. The interns experimented with different forms of delivery (in-person / electronic / skype) as well as exploring the linguistic dimensions of the EQ-5D survey and different modes of preference elicitation. Preliminary results will be presented in December 2016.

Workstream 2 (Applied Health Econometrics):  Drawing on the RLMS – HSE longitudinal data (and the Ukrainian Longitudinal Monitoring Survey) we have employed leading edge econometric techniques (multinomial ordered probit; ordinary logit; heckman selection models; difference-in-difference, propensity score matching; and lifecourse analysis) to explore the determinants of: self-assessed health; smoking among adult Russians; labour market response to health shocks; willingness to contribute to potential health insurance schemes; and lifecourse smoking patterns for Russian males and females. 

Workstream 3 (Cardiovascular disease): The work in this stream is based on systematic literature reviews and a robustly developed qualitative fieldwork process. We have developed a strategy for implementing the project based on sampling from 2-3 CVD clinics, using 4 trained interviewers and are currently awaiting the approval of HSE ethics review board for our study protocol.   

Workstream 4 (Mental Health): This is a qualitative project based on in-depth interviews with key informants and mental health care consumers, focus groups and community mapping. The project is being developed in cooperation with the Bekhterev clinic of St. Petersburg and with the support of experts at LSE and King’s. During 2016 we have undertaken a review of the Russian based literature and, in cooperation with Bekhterev, developed a topic guide and are close to submitting our protocol for ethics approval.  

Workstream 5 (Behaviours and attitudes) : This workstream is largely qualitative in nature, employing focus groups to explore attitudes to smoking; in-depth semi-structured interviews to explore drug use and drug policy, but quantitative methods to develop a new theme in the sphere of obesity, based on the RLMS-HSE data set. The latter work has only recently begun, while the focus groups are now underway in the smoking project.

Empirical base of research

The empirical base for our research is as follows:

  1. RLMS-HSE: we have utilised the Russia Longitudinal Monitoring Survey of HSE across several of our research themes in work related to: health outcome measurement (EQ-5D); self-assessed health; health shocks and the labour market; life-course trajectories of smoking; and the determinants of tobacco consumption.
  2. ULMS: we have utilised the Ukrainian Longitudinal Monitoring Survey to analyse self-assessed health and socioeconomic inequalities in Ukraine.
  3. Levada omnibus: we have utilised a Levada omnibus survey to analyse the willingness to pay and the willingness to join drug insurance schemes in Russia.
  4. Rosstat and WHO data: we have drawn on data from Rosstat to complement cross-national data from the World Health Organisations Health for all database to analyse the evolution of health workforce policy in Russia.
  5. Focus groups: we have generated focus group data concerning attitudes to smoking.
  6. Pilot survey data: we have conducted a pilot survey experimenting with different methods of eliciting population health values and attitudes.

Results of research

The results of our research in 2016 are summarised in tabular form below, with bold type indicating work already published or accepted for publication and normal type indicating that the work is complete and has been submitted to the named journal for review:

Gender, Education and Russia's Tobacco Epidemic: a life-course approach

Social Science and Medicine

(published)

Q1

Time-distributed difference-in-differences approach: The case of wage returns to training

Applied Econometrics

(published)

Scopus

Motivation of Entrepreneurial Activity: Role of Institutes

Vestnik of Saint Petersburg University. Management Series (published)

Social inequalities in self-rated health in Ukraine: The role of psychosocial, material and behavioural factors

European Journal of Public Health (published)

Q1

Migration and sexual resocialisation: the case of Central and East Europeans in London

East European Politics and Societies (published)

Q1

Health Workforce policy in the Russian Federation: an international perspective

HSE Working Paper

(published)

Reforming voluntary drug insurance in Russian healthcare: does social solidarity matter?

Health Policy

(revised and resubmitted)

Q1

A Cross-National Study of Subjective Well-Being of Older People

Ageing and Society

(submitted)

Q1

Institutional determinants of necessity-driven entrepreneurship

Journal of Entrepreneurship

(submitted)

Q2-Q3

The effect of chronic conditions and multimorbidity on SAH in Russia

Journal of Community Health

(submitted)

Q1

Life expectancy patterns in Post-Communist countries, 1959-2009

Social Research Indicators

(submitted)

Q2

Entrepreneurial Intentions in Russia: An empirical study

International Journal of Entrepreneurial Behaviour and Research

(submitted)

Q1

Level of implementation, recommendations on implementation or outcomes of the implementation of the results

The Ministry of Health of the Russian Federation has created a ‘Center of Healthcare Quality Assessment and Control’ (ЦЭККМП) which is effectively intended to serve as Russia’s HTA agency. There are many obstacles to the introduction of HTA in Russia, ranging from stakeholder opposition to a shortfall of expertise and understanding in the field. The immediate priority for ЦЭККМП is to introduce HTA guidelines for Russian health-care decision makers.

Separately from, but related to this, CHEMP (through workstream 1) is exploring the use of EQ-5D in Russia to provide both background scholarly research to inform the future development of HTA, as well as seeking to provide more immediate technical assistance to ЦЭККМП. Thus there are three broad ongoing objectives:

  • to seek to inform, conceptually and through scoping exercises, how Russia decides to measure the value of health benefits;
  • to explore the conceptual legitimacy of different approaches to health value measurement in the Russian and international context;
  • to support the development of domestic Russian infrastructure and capacity among young health economists and practitioners and within the medical care sector itself.

Within (i), the role of CHEMP is to explore possible strategies concerning how to value health benefits, both through (in 2017) facilitating a Russian consensus on the measurement of social preferences (rather than utility) and also – in the first instance (by the end of 2016) – through providing a strategy and method for delivering weights (experienced values) to calibrate EQ-5D. Specifically, CHEMP is currently finalising the scoring of an experienced value set for Russia using the RLMS-HSE. By the end of December, a technical assessment, providing an overview of the potential use of the RLMS data in generating a value set for use in converting EQ-5D responses into a single index suitable for use in economic evaluation conducted by Russian healthcare decision-makers, will be made available to ЦЭККМП.

This work with, and for, ЦЭККМП represents the single most important impact of our 2016 results and will further develop during 2017. 

Publications:


Davis C. The Ukraine conflict, economic-military power balances, and economic sanctions // Post-Communist Economies. 2016. Vol. 28. No. 2. P. 167-198. doi
Gerry C., Quirmbach D. Gender, education and Russia’s tobacco epidemic: A life-course approach // Social Science & Medicine. 2016. No. 160. P. 54-66. doi
Gerry C., Mole R. C., Parutis V., Burns F. M. Migration and Sexual Resocialisation: The Case of Central and East Europeans in London // East European Politics and Societies. 2017. Vol. 31. No. 1. P. 201-222.