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Article ; Online: Measuring healthcare payor management practices in England.

Dorgan, Stephen J / Powell-Jackson, Timothy / Briggs, Andrew

Social science & medicine (1982)

2023 Volume 340, Page(s) 116415

Abstract: Good management practice in healthcare payors and providers is considered central to ensuring health systems respond to population needs, contain costs, and improve both quality and outcomes. However, the evidence to support this assertion is sparce. ... ...

Abstract	Good management practice in healthcare payors and providers is considered central to ensuring health systems respond to population needs, contain costs, and improve both quality and outcomes. However, the evidence to support this assertion is sparce. While a quantitative link between better management practice and improved patient outcomes has been demonstrated for healthcare providers, no such link has been identified for healthcare payors. The lack of a robust tool to assess the management practices of healthcare payors has impeded such quantitative assessments. We report upon a novel tool developed to measure and assess 11 management practices in all 152 healthcare payors within England's National Health Service in 2010. We have tested the acceptability, reliability and validity of this tool using rigorous analytic methods and present four key findings. First, performance of the tool is strong and comparable to management practice scorecards used in other settings. Second, exploratory factor analysis indicates the tool measures two distinct latent factors of healthcare payor management practice with high internal consistency and reliability. Third, there is evidence of assessment and score validity. Fourth, payor management practice variations are associated with the degree of supervisory oversight. While deploying such a tool is challenging, these results suggest that healthcare payor management practices can be measured and assessed robustly. This could enable governments, and others, to identify how payor management practices influence health system performance and to estimate what health system performance improvements they should expect from interventions designed to improve the management practices of their local healthcare payors.
MeSH term(s)	Humans ; Reproducibility of Results ; State Medicine ; Delivery of Health Care ; England
Language	English
Publishing date	2023-11-17
Publishing country	England
Document type	Journal Article
ZDB-ID	4766-1
ISSN	1873-5347 ; 0037-7856 ; 0277-9536
ISSN (online)	1873-5347
ISSN	0037-7856 ; 0277-9536
DOI	10.1016/j.socscimed.2023.116415
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Article: Determinants of government spending on primary healthcare: a global data analysis.

Erlangga, Darius / Powell-Jackson, Timothy / Balabanova, Dina / Hanson, Kara

BMJ global health

2023 Volume 8, Issue 11

Abstract: In 2018 global leaders renewed their political commitment to primary healthcare (PHC) ratifying the Declaration of Astana emphasising the importance of building a sustainable PHC system based on accessible and affordable delivery models strengthened by ... ...

Abstract	In 2018 global leaders renewed their political commitment to primary healthcare (PHC) ratifying the Declaration of Astana emphasising the importance of building a sustainable PHC system based on accessible and affordable delivery models strengthened by community empowerment. Yet, PHC often remains underfunded, of poor quality, unreliable and not accountable to users which further deprives PHC of funding. This paper analyses the determinants of PHC expenditure in 102 countries, and quantitatively tests the influence of a set of economic, social and political determinants of government expenditure on PHC. The analysis is focused on the determinants of PHC funding from government sources as the government is in a position to make decisions in relation to this expenditure as opposed to out-of-pocket spending which is not in their direct control. Multivariate regression analysis was done to determine statistically significant predictors.Our analysis found that some economic factors-namely Gross Domestic Product (GDP) per capita, government commitment to health and tax revenue raising capacity-were strongly associated with per capita government spending on PHC. We also found that control of corruption was strongly associated with the level of total spending on PHC, while voice and accountability were positively associated with greater government commitment to PHC as measured by government spending on PHC as a share of total government health spending.Our analysis takes a step towards understanding of the drivers of PHC expenditure beyond the level of national income. Some of these drivers may be beyond the remit of health policy decision makers and relate to broader governance arrangements and political forces in societies. Thus, efforts to prioritise PHC in the health agenda and increase PHC expenditure should recognise the constraints within the political landscapes and engage with a wide range of actors who influence decisions affecting the health sector.
MeSH term(s)	Humans ; Health Expenditures ; Delivery of Health Care ; Health Policy ; Government ; Primary Health Care
Language	English
Publishing date	2023-11-30
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2059-7908
ISSN	2059-7908
DOI	10.1136/bmjgh-2023-012562
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Article ; Online: Supply, then demand? Health expenditure, political leanings, cost obstacles to care, and vaccine hesitancy predict state-level COVID-19 vaccination rates.

Teperowski Monrad, Joshua / Quaade, Sebastian / Powell-Jackson, Timothy

Vaccine

2022 Volume 40, Issue 45, Page(s) 6528–6548

Abstract: Objectives: To examine predictors of state-level COVID-19 vaccination rates during the first nine months of 2021.: Methods: Using publicly available data, we employ a robust, iteratively re-weighted least squares multivariable regression with state ... ...

Abstract	Objectives: To examine predictors of state-level COVID-19 vaccination rates during the first nine months of 2021. Methods: Using publicly available data, we employ a robust, iteratively re-weighted least squares multivariable regression with state characteristics as the independent variables and vaccinations per capita as the outcome. We run this regression for each day between February 1 and September 21, the last day before vaccine booster rollout. Results: We identify associations between vaccination rates and several state characteristics, including health expenditure, vaccine hesitancy, cost obstacles to care, Democratic voting, and elderly population share. We show that the determinants of vaccination rates have evolved: while supply-side factors were most clearly associated with early vaccination uptake, demand-side factors have become increasingly salient over time. We find that our results are generally robust to a range of alternative specifications. Conclusions: Both supply and demand-side factors relate to vaccination coverage and the determinants of success have changed over time. Policy implications: Investing in health capacity may improve early vaccine distribution and administration, while overcoming vaccine hesitancy and cost obstacles to care may be crucial for later immunisation campaign stages.
MeSH term(s)	Aged ; Humans ; COVID-19 Vaccines ; Health Expenditures ; Vaccination Hesitancy ; COVID-19/prevention & control ; Vaccination/methods ; Vaccines
Chemical Substances	COVID-19 Vaccines ; Vaccines
Language	English
Publishing date	2022-09-08
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	605674-x
ISSN	1873-2518 ; 0264-410X
ISSN (online)	1873-2518
ISSN	0264-410X
DOI	10.1016/j.vaccine.2022.08.050
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Zs.MO 458: Show issues

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Article: Management Practices and Quality of Care: Evidence from the Private Health Care Sector in Tanzania.

Powell-Jackson, Timothy / King, Jessica J C / Makungu, Christina / Quaife, Matthew / Goodman, Catherine

Economic journal (London, England)

2023 Volume 134, Issue 657, Page(s) 436–456

Abstract: We measure the adoption of management practices in over 220 private for-profit and non-profit health facilities in 64 districts across Tanzania and link these data to process quality-of-care metrics, assessed using undercover standardised patients and ... ...

Abstract	We measure the adoption of management practices in over 220 private for-profit and non-profit health facilities in 64 districts across Tanzania and link these data to process quality-of-care metrics, assessed using undercover standardised patients and clinical observations. We find that better managed health facilities are more likely to provide correct treatment in accordance with national treatment guidelines, adhere to a checklist of essential questions and examinations, and comply with infection prevention and control practices. Moving from the 10th to the 90th percentile in the management practice score is associated with a 48% increase in correct treatment. We then leverage a large-scale field experiment of an internationally recognised management support intervention in which health facilities are assessed against comprehensive standards, given an individually tailored quality improvement plan and supported through training and mentoring visits. We find zero to small effects on management scores, suggesting that improving management practices in this setting may be challenging.
Language	English
Publishing date	2023-09-18
Publishing country	England
Document type	Journal Article
ZDB-ID	1473822-3
ISSN	1468-0297 ; 0013-0133
ISSN (online)	1468-0297
ISSN	0013-0133
DOI	10.1093/ej/uead075
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Article ; Online: Does increased provider effort improve quality of care? Evidence from a standardised patient study on correct and unnecessary treatment.

King, Jessica Julia Carne / Powell-Jackson, Timothy / Hargreaves, James / Makungu, Christina / Goodman, Catherine

BMC health services research

2023 Volume 23, Issue 1, Page(s) 190

Abstract: Background: Poor quality of care, including overprovision (unnecessary care) is a global health concern. Greater provider effort has been shown to increase the likelihood of correct treatment, but its relationship with overprovision is less clear. ... ...

Abstract	Background: Poor quality of care, including overprovision (unnecessary care) is a global health concern. Greater provider effort has been shown to increase the likelihood of correct treatment, but its relationship with overprovision is less clear. Providers who make more effort may give more treatment overall, both correct and unnecessary, or may have lower rates of overprovision; we test which is true in the Tanzanian private health sector. Methods: Standardised patients visited 227 private-for-profit and faith-based facilities in Tanzania, presenting with symptoms of asthma and TB. They recorded history questions asked and physical examinations carried out by the provider, as well as laboratory tests ordered, treatments prescribed, and fees paid. A measure of provider effort was constructed on the basis of a checklist of recommended history taking questions and physical exams. Results: 15% of SPs received the correct care for their condition and 74% received unnecessary care. Increased provider effort was associated with increased likelihood of correct care, and decreased likelihood of giving unnecessary care. Providers who made more effort charged higher fees, through the mechanism of higher consultation fees, rather than increased fees for lab tests and drugs. Conclusion: Providers who made more effort were more likely to treat patients correctly. A novel finding of this study is that they were also less likely to provide unnecessary care, suggesting it is not simply a case of some providers doing "more of everything", but that those who do more in the consultation give more targeted care.
MeSH term(s)	Humans ; Fees and Charges ; Private Sector ; Health Facilities, Proprietary ; Referral and Consultation ; Quality of Health Care
Language	English
Publishing date	2023-02-23
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	2050434-2
ISSN	1472-6963 ; 1472-6963
ISSN (online)	1472-6963
ISSN	1472-6963
DOI	10.1186/s12913-023-09149-5
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Article ; Online: Trading HIV for sheep: Risky sexual behavior and the response of female sex workers to Tabaski in Senegal.

Cust, Henry / Lépine, Aurélia / Treibich, Carole / Powell-Jackson, Timothy / Radice, Rosalba / Tidiane Ndour, Cheikh

Health economics

2023 Volume 33, Issue 1, Page(s) 153–193

Abstract: We use a cohort of female sex workers (FSWs) in Senegal to show how large anticipated economic shocks lead to increased risky sexual behavior. Exploiting the exogenous timing of interviews, we study the effect of Tabaski, the most important Islamic ... ...

Abstract	We use a cohort of female sex workers (FSWs) in Senegal to show how large anticipated economic shocks lead to increased risky sexual behavior. Exploiting the exogenous timing of interviews, we study the effect of Tabaski, the most important Islamic festival celebrated in Senegal, in which most households purchase an expensive animal for sacrifice. Condom use, measured robustly via the list experiment, falls by between 27.3 percentage points (pp) (65.5%) and 43.1 pp (22.7%) in the 9 days before Tabaski, or a maximum of 49.5 pp (76%) in the 7 day period preceding Tabaski. The evidence suggests the economic pressures from Tabaski are key to driving the behavior change observed through the price premium for condomless sex. Those most exposed to the economic pressure from Tabaski were unlikely to be using condoms at all in the week before the festival. Our findings show that Tabaski leads to increased risky behaviors for FSWs, a key population at high risk of HIV infection, for at least 1 week every year and has implications for FSWs in all countries celebrating Tabaski or similar festivals. Because of the scale, frequency, and size of the behavioral response to shocks of this type, policy should be carefully designed to protect vulnerable women against anticipated shocks.
MeSH term(s)	Female ; Humans ; Animals ; Sheep ; HIV Infections/epidemiology ; HIV Infections/prevention & control ; Sex Workers ; Senegal/epidemiology ; Sexual Behavior ; Safe Sex
Language	English
Publishing date	2023-11-02
Publishing country	England
Document type	Journal Article
ZDB-ID	1135838-5
ISSN	1099-1050 ; 1057-9230
ISSN (online)	1099-1050
ISSN	1057-9230
DOI	10.1002/hec.4756
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Article: Supply, then demand? Health expenditure, political leanings, cost obstacles to care, and vaccine hesitancy predict state-level COVID-19 vaccination rates

Teperowski Monrad, Joshua / Quaade, Sebastian / Powell-Jackson, Timothy

Vaccine. 2022 Aug. 22,

2022

Abstract: To examine predictors of state-level COVID-19 vaccination rates during the first nine months of 2021. Using publicly available data, we employ a robust, iteratively re- weighted least squares multivariable regression with state characteristics as the ... ...

Abstract	To examine predictors of state-level COVID-19 vaccination rates during the first nine months of 2021. Using publicly available data, we employ a robust, iteratively re- weighted least squares multivariable regression with state characteristics as the independent variables and vaccinations per capita as the outcome. We run this regression for each day between February 1 and September 21, the last day before vaccine booster rollout. We identify associations between vaccination rates and several state characteristics, including health expenditure, vaccine hesitancy, cost obstacles to care, Democratic voting, and elderly population share. We show that the determi- nants of vaccination rates have evolved: while supply-side factors were most clearly associated with early vaccination uptake, demand-side factors have become increas- ingly salient over time. We find that our results are generally robust to a range of alternative specifications. Both supply and demand-side factors relate to vaccination cov- erage and the determinants of success have changed over time. Policy Implications: Investing in health capacity may improve early vaccine distribution and administration, while overcoming vaccine hesitancy and cost ob- stacles to care may be crucial for later immunisation campaign stages.
Keywords	COVID-19 infection ; elderly ; health care costs ; issues and policy ; politics ; vaccination ; vaccines
Language	English
Dates of publication	2022-0822
Publishing place	Elsevier Ltd
Document type	Article
Note	Pre-press version
ZDB-ID	605674-x
ISSN	1873-2518 ; 0264-410X
ISSN (online)	1873-2518
ISSN	0264-410X
DOI	10.1016/j.vaccine.2022.08.050
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Article ; Online: A pragmatic way forward?

Powell-Jackson, Timothy

Science (New York, N.Y.)

2016 Volume 354, Issue 6308, Page(s) 34–35

MeSH term(s)	Communication ; Humans ; Patient Selection ; Research Design
Language	English
Publishing date	2016--07
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	128410-1
ISSN	1095-9203 ; 0036-8075
ISSN (online)	1095-9203
ISSN	0036-8075
DOI	10.1126/science.aai8652
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Article: Effectiveness of primary care gatekeeping: difference-in-differences evaluation of a pilot scheme in China.

Xu, Jin / Powell-Jackson, Timothy / Mills, Anne

BMJ global health

2020 Volume 5, Issue 8

Abstract: Introduction: This paper evaluates the effectiveness of a gatekeeping pilot in shifting resources and patient visits from hospitals to primary care facilities under the Chinese New Rural Cooperative Medical Scheme.: Methods: We applied a difference- ... ...

Abstract	Introduction: This paper evaluates the effectiveness of a gatekeeping pilot in shifting resources and patient visits from hospitals to primary care facilities under the Chinese New Rural Cooperative Medical Scheme. Methods: We applied a difference-in-differences regression analysis using claims data from a pilot district in northern China. The study covered 200 685 enrollees in 17 townships in 2012 and followed-up the townships over 12 year-quarters until the end of 2014. Results: The gatekeeping pilot led to significantly more patients visiting primary care facilities (55.3%, p=0.001), but there was little evidence of increased ambulatory spending on primary care (1.6%, p=0.884). The pilot reduced hospital visits by 23.9% (p=0.048) and ambulatory spending at the hospitals by 22.4% (p=0.011). Conclusions: This first impact evaluation of gatekeeping outside high-income countries found that gatekeeping policy did not seem to have expanded the care provided by primary care facilities, despite an increased volume of claimed visits. Although claimed patient visits and expenditure at hospitals reduced, we suspect this may have been because patients found it either cumbersome or difficult to obtain reimbursement for their care.
MeSH term(s)	China ; Gatekeeping ; Health Expenditures ; Humans ; Primary Health Care ; Rural Population
Language	English
Publishing date	2020-07-31
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2059-7908
ISSN	2059-7908
DOI	10.1136/bmjgh-2020-002792
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Article ; Online: Primary health care is not just a service delivery platform - Authors' reply.

Hanson, Kara / Balabanova, Dina / Powell-Jackson, Timothy / Brikci, Nouria / Erlangga, Darius

The Lancet. Global health

2022 Volume 10, Issue 8, Page(s) e1094

MeSH term(s)	Delivery of Health Care ; Humans ; Primary Health Care
Language	English
Publishing date	2022-07-14
Publishing country	England
Document type	Letter ; Research Support, Non-U.S. Gov't ; Comment
ZDB-ID	2723488-5
ISSN	2214-109X ; 2214-109X
ISSN (online)	2214-109X
ISSN	2214-109X
DOI	10.1016/S2214-109X(22)00282-0
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