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Our research methods help policy makers make fairer decisions with better health outcomes.

The problem. Existing analyses focus on a mythical average citizen.

The solution. We develop ways of analysing who gains and loses from health policies.

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Monitoring Fairness in the NHS

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Listen to the latest podcast (Jan 2020) from Professor Tim Doran - Looking beyond Horizons at the North South Divide, part of the series 'The Story of Things' hosted by the University of York in partnership with the York Festival of Ideas.


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Our brilliant network partner, Prof. Rowena Jacobs, and her team found that better primary care quality & continuity of care were associated with better outcomes & lower resource use in SMI. @CHEyork @HEU_unimelb via @YouTube

Pleased to have contributed to this paper in Medical Decision Making on the problematic use of general population values to inform patients' choices of hospitals. A collaboration with Nils Gutacker & Tom Patton of @CHEyork and @DrPanik.

Mapping clinical outcomes to generic preference-based outcome measures: Development and comparison of methods

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Years of Good Life Based on Consumption and Health: A Practical Well-Being Metric for Economic Evaluation

Cookson, R. A., Cotton-Barrett, O., Adler, M., Asaria, M. & T, O., Jul 2020, Measuring the Global Burden of Disease: Philosophical Dimensions. Eyal, N., Hurst, S. A., Murray, C. J. L., Schroeder, S. A. & Wikler, D. (eds.). Oxford: Oxford University Press

Research output: Chapter in Book/Report/Conference proceedingChapter

Publication details

Title of host publication Measuring the Global Burden of Disease: Philosophical Dimensions
Date Accepted/In press - Apr 2020
Date Published (current) - Jul 2020
Publisher Oxford: Oxford University Press
Editors N Eyal, S.A. Hurst, C.J.L Murray, S.A. Schroeder, D. Wikler
Original language English
ISBN (Print) 9780190082543

Fairer decisions, better health for all: Health equity and cost-effectiveness analysis

Mirelman, A., Asaria, M., Dawkins, B. R., Griffin, S. & Cookson, R. A., 1 Jun 2020, Global Health Economics: Shaping Healthcare Policy in Low- and Middle-Income Countries. Revill, P., Suhrcke, M., Moreno-Serra, R. & Sculpher, M. (eds.). World Scientific Publishing Co Pte Ltd, p. 99-132

Research output: Chapter in Book/Report/Conference proceedingChapter

Publication details

Title of host publication Global Health Economics
Date Published - 1 Jun 2020
Pages 99-132
Publisher World Scientific Publishing Co Pte Ltd
Editors Paul Revill, Marc Suhrcke, Rodrigo Moreno-Serra, Mark Sculpher
Original language English
ISBN (Print) 978-981-3272-36-1

Publication details

Journal Health Services and Delivery Research
Date Accepted/In press - 10 Jan 2020
Date Published (current) - Jun 2020
Issue number 25
Volume 8
Number of pages 158
Original language English


Background Serious mental illness (SMI), including schizophrenia, bipolar disorder and other psychoses, is linked with high disease burden, poor outcomes, high treatment costs and lower life expectancy. In the UK, most people with SMI are treated in primary care by general practitioners (GPs), who are financially incentivised to meet quality targets for patients with chronic conditions, including SMI, under the Quality and Outcomes Framework (QOF). The QOF, however, omits important aspects of quality. Objective(s) We examined whether better quality of primary care for people with SMI improved a range of outcomes. Design and setting We used administrative data from English primary care practices that contribute to the Clinical Practice Research Datalink GOLD database, linked to Hospital Episode Statistics, Accident & Emergency (A&E) attendances, Office for National Statistics mortality data, and community mental health records in the Mental Health Minimum Dataset. We used survival analysis to estimate whether selected quality indicators affect the time until patients experience an outcome. Participants Four cohorts of people with SMI depending on the outcomes examined and inclusion criteria. Interventions Quality of care was measured with: i) QOF indicators: care plans and annual physical reviews ;and ii) non-QOF indicators identified through a systematic review (antipsychotic polypharmacy and continuity of care provided by GPs). Main outcome measures Several outcomes were examined: emergency admissions for i) SMI and ii) ambulatory care sensitive conditions (ACSCs); iii) all unplanned admissions; iv) A&E attendances; v) mortality; vi) re-entry into specialist mental health services; vii) costs attributed to primary, secondary and community mental healthcare. Results Care plans were associated with lower risk of A&E attendance (Hazard ratio (HR) 0.74, 95%CI 0.69-0.80), SMI admission (HR 0.67, 95%CI 0.59-0.75), ACSC admission (HR 0.73, 95%CI 0.64-0.83), and lower overall healthcare (£53), primary care (£9), hospital (£26), and mental healthcare costs (£12). Annual reviews were associated with reduced risk of A&E attendance (HR 0.80, 95%CI 0.76-0.85), SMI admission (HR 0.75, 95%CI 0.67-0.84), ACSC admission (HR 0.76, 95%CI 0.67-0.87), and lower overall healthcare (£34), primary care (£9), and mental healthcare costs (£30). Higher GP continuity was associated with lower risk of A&E presentation (HR 0.89, 95%CI 0.83-0.97), ACSC admission (HR 0.77, 95%CI 0.65-0.92), but not SMI admission. High continuity was associated with lower primary care costs (£3). Antipsychotic polypharmacy was not statistically significantly associated with the risk of unplanned admission, death or A&E presentation. None of the quality measures were statistically significantly associated with risk of re-entry into specialist mental healthcare. Limitations There is risk of bias from unobserved factors. To mitigate this, we controlled for observed patient characteristics at baseline and adjusted for the influence of time-invariant unobserved patient differences. Conclusions Better performance on QOF measures and continuity of care are associated with better outcomes and lower resource utilisation and could generate moderate cost savings. Future work Future research should examine the impact of primary care quality on measures that capture broader aspects of health and functioning.

Bibliographical note

© Queen’s Printer and Controller of HMSO 2020. Uploaded in accordance with the publisher’s self-archiving policy. Further copying may not be permitted; contact the publisher for details


EQUIPOL is supported by the University of York, the Wellcome Trust (Grant No. 205427/Z/16/Z) and the NIHR (SRF-2013-06-015).

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