The major research areas within the Centre cover health policy and health economics with substantial overlap between these areas. The Centre emphasises a multidisciplinary approach to its work. LSE Health staff also collaborate with a number of other research centres and individuals in the UK and elsewhere. Currently there are major collaborations within the UK with, amongst others, various colleges of the University of London (including the London School of Hygiene and Tropical Medicine, UCL, and King's College), and the Universities of Cambridge, and York. On an International level, major collaborations with Stanford University and relationships with numerous European partners have been established.
This substantial research area is broadly defined and has both UK and international perspectives. While there is considerable overlap between analyses at national and international levels, the Centre has maintained its high reputation for feeding research into the policy arena. For example, within the UK, LSE was a contributor to the government-commissioned Wanless Review which undertook an in-depth look at the UK health expenditure requirements. There is also a long standing interest in health equity issues and this work is ongoing. Many LSE Health staff work on comparative aspects of health policy, particularly across Europe, reflecting the goals of the European Observatory's work. In line with the Centre's aim, the work on health policy has always maintained high standards of academic rigour while addressing issues of major policy concerns. Current specific areas of interest include:
Comparative health policy: This major research area has produced a number of outputs comparing, on both descriptive and analytical levels, various health care sectors. Work has been undertaken on health sector reforms across Europe, with a particular focus on the European Union's influence regarding the organisation, financing and delivery of health care.
UK health care financing and equity: A long-term programme of research documents recent funding issues in the UK and analyses the conceptual arguments for the public or private financing of health care. Work has concentrated on the issues dominating NHS funding debates over recent years. The impact of equity as a policy objective is also considered with a particular focus on the role of private health care insurance in the UK and its interaction with the NHS.
Health policy relating to the pharmaceutical industry: Given the specific pharmaceutical regulatory regimes in a number of countries, this research area deals with both comparative and EU-specific issues.
This research area covers methodological and applied topics. Staff are engaged in both theoretical and applied work over a range of areas. The aim is to maintain methodological advances while applying high quality research to specific areas. Current areas of interest include:
Economic evaluation in health care: A number of individual programmes contribute to this area. At a conceptual level, specific statistical approaches in economic evaluations, conducted alongside clinical trials, account for censored and missing data. Econometric modelling of trial data is a further interest. Individual projects have considered the methodological base of economic evaluation. Work is also proceeding on the relationship between expected utility theory and economic evaluation. On the applied side, work continues to assess the impact of regulatory bodies, such as NICE, on the application of economic evaluation. To date, various individual health care technologies have been evaluated.
Pharmaceutical economics: An ongoing research programme is concerned with the regulation of the pharmaceutical sector. In particular, the impact of regulation on pricing policies has been considered in a range of markets. This has been complemented by an analysis of how branded and generic pharmaceutical products interact.
Health care technology diffusion: Work continues to account for the variation in health technology up-take across different countries. A particular focus is on the area of coronary heart disease, part of the TECH project co-ordinated by Stanford University.
The economics of the hospital sector: Work in this area concerns the econometric specification of hospital cost functions and investigates optimal reimbursement contracts.
Health care workforce concerns: Work continues on the issues around the labour supply to the social care sector and on the nursing labour market.
Demography and health
Demography is the study of human populations, past, present and future. This science tracks how births, deaths, and migration determine change and therefore demonstrates key trends such as rapid population growth and population ageing. Research among the Population Group at LSE includes mortality forecasting, micro simulation, the demography of the Balkans, reproductive health in East Africa, the effects of childhood experiences on later outcomes in Britain and the evolutionary analysis of West African populations.
The European Observatory on Health Systems and Policies
TheEuropean Observatory on Health Systems and Policies supports and promotes evidence-based health policy-making through comprehensive and rigorous analysis of the dynamics of health systems in Europe. The Observatory is a partnership between the World Health Organization Regional Office for Europe, the Governments of Belgium, Finland, Ireland, the Netherlands, Norway, Slovenia, Spain, Sweden, and the Veneto Region of Italy, the European Commission, the European Investment Bank, the World Bank, UNCAM (French National Union of Health Insurance Funds), the London School of Economics and Political Science (LSE) and the London School of Hygiene & Tropical Medicine (LSHTM). It comprises a Steering Committee, a core management team, a research policy group and staff. The Observatory's Secretariat is in Brussels and there are research hubs in London and Berlin.
7th Framework Programme Projects
LSE Health coordinates the ECAB (Evaluating Care Across Borders) research project and Health Inc. (Financing Health Care for Inclusion), funded by the European Commission under its 7th Framework Programme.
Research at the LSE branch is focused around three core research programmes:
Commissioning and performance
The Commissioning and Performance programme endeavours to describe and evaluate the mixed economy of care in England, particularly focused on commissioning, providing, market development and choice. This work builds on the programme previously called 'the mixed economy of care' which sought to describe and evaluate the development, structure and performance of social care markets. There is a particular focus on:
the approaches and perspectives of purchasers;
the characteristics, motivations and behaviour of providers;
the key features of commissioning and their consequences for market structure and outcomes;
micro-commissioning by care managers and the participative roles of service users; and
commissioning of services by users, through direct payments and individual budgets.
Mental health economics and policy
The programme comprises research on mental health policy and practice, drawing particularly but not exclusively on economic approaches and associated empirical methods. Work covers the full age range and all mental disorders, and includes research on intellectual disabilities. Much of the work is conducted outside the UK.
Long-term care finance
The overall aims of the LTCF programme are to make projections of likely demand for long-term care for older people and associated expenditure to 2041 under different scenarios. The scenarios relate to changes in external drivers of demand, such as demographic pressures, and to potential changes in patterns of care or policies. A specific objective is to assess the likely impact of different policies and approaches to funding long-term care for older people on the balance of expenditure between sectors.
Work to date has been widely used by national and local policy-makers.
The School for Social Care Research's research is organised into five key programme areas:
Programme A: prevention and promotion
Core question: How can we best prevent or reduce the development or exacerbation of circumstances that lead to the need for social care?
Are there arrangements, circumstances, processes or interventions that can help to avoid individuals reaching a situation where social care is needed; or that respond early in order to lessen unwanted longer-term exacerbation of 'problems' or needs; or that help individuals to re-integrate themselves into their family, community and societal roles. Assessing the impacts of such interventions is methodologically challenging and a variety of projects might be needed to build up an understanding of 'what works', how it is experienced and with what resource implications.
Programme B: empowerment and safeguarding
Core question: How can we best empower and safeguard people who use social care services?
The success of personalisation lies in the achievement of a successful balance between choice, control and flexibility, on the one hand, and, on the other, security and safeguarding. This second programme of work will address areas of concern such as the balance of rights and risks in care and support; and the balance between flexibility and security. The roles of families, carers and formal support organisations in helping manage these balances will be of particular interest.
Programme C: care and work
Core questions: How can we best equip and support people - practitioners, volunteers, informal carers - to provide optimum social care? How can we ensure that people who use social care and their carers are enabled and supported in paid work and other types of meaningful activity?
The relationships between care and work are multi-faceted. Important features of this programme will be its breadth across the boundaries of formal and informal care work, including the employment of relatives and friends to provide care, and the employment outcomes for both social care users and those providing care.
Programme D: service interventions, commissioning and change
Core question: What interventions, commissioning and delivery arrangements best achieve social care outcomes?
Multiple simultaneous pressures are reshaping the commissioning and delivery of adult social care services. How can service commissioning and delivery processes adapt to meet new demands for services that are both personalised and integrated? What are the impacts of decommissioning services as a result of these and longer-term trends, and how is decommissioning best managed to minimise negative consequences and make best use of resources?
Programme E: resources and interfaces
Core question: How can social care and other public resources best be deployed and combined to achieve social care outcomes?
Historically, the resources allocated to individuals in adult social care have been a function of the costs of services they are assessed as needing. Personalisation has introduced new methods of allocating resources to individuals and made levels of allocated resources more transparent.
There is an extensive evaluation agenda on the impacts, outcomes and cost-effectiveness of more flexible resource use involving social care, health care, housing, social security and other systems, both contemporaneously and over time. There is a need for research into the methods and equity implications (between groups of social care users and between localities) of different approaches to allocating resources.