Donald S. Shepard Schneider Institute for Health Policy

      Homepage       Biography       Publications       Projects       Teaching       Downloads       Links

Projects

Dengue

Malaria

HIV/AIDS

Cardiovascular Diseases

Behavioral Health (Mental Health and Substance Abuse)

Nuisance Mosquitoes

Pneumonia

International Health Economics, Other

Other topics in the United States

Incentives (Pay for Performance, Results-Based Financing)
Current and recent projects follow.

Economic Analysis of Specific Conditions
Dengue

  1. The Global Economic Cost of Dengue.
    This study aims to enhance the current knowledge on dengue's economic impact on endemic countries and globally. A better understanding of the economic cost of dengue disease will help to mobilize national and international efforts and resources to mitigate its global impact. (Supported by Sanofi Pasteur, 2014 - 2016).

  2. Economic Evaluation of Dengue Control Program in Nicaragua and Mexico.
    Brandeis is conducting the economic evaluation of traditional, government run dengue control programs (based primarily on fumigation), and an innovative community program to reduce breeding sites to control the mosquitos that transmit dengue. Results were presented at a conference on community health workers in Accra, Ghana (Shepard et al., 2015).(Supported by UBS/UC Berkeley, 2014-2016)

  3. Economic Analysis of Dengue in Selected Countries.
    Brandeis used patient interviews; surveillance data; and a novel, hand-held data acquisition tool to study the cost of dengue in Puerto Rico (in cooperation with the US Centers for Disease Control),and in Malaysia, India and the Philippines (in collaboration with national investigators). The study extended findings to the Americas and South East Asia with secondary data analysis. Results were published in the Dengue Bulletin (Perez et al. 2010), the American Journal of Tropical Medicine and Hygiene (Shepard et al., 2011 and 2012; Halasa et al.,2012), and PLoS NTD (Undurraga et al. 2015). (Supported by Sanofi Pasteur, 2008 - 2015)

  4. Dengue Burden of Illness Studies.
    Selected as the Project Management Team, Brandeis assisted and managed investigators in eight countries studying the burden of dengue (a viral illness transmitted by mosquitoes) in their countries. Three of the countries (Cambodia, Malaysia, and Thailand) are in Southeast Asia, where dengue has long been established, while five (Brazil, Guatemala, El Salvador, Panama, and Venezuela) are in Central and South America, where dengue has re-emerged within the past three decades. Brandeis developed research capacity, a common core research protocol, and collaborated with national investigators to collect data in each country around this disease. These data have helped domestic policy makers in each country, and donors and vaccine producers internationally, in developing policy around the development, production, price, and implementation of a dengue vaccine. The work was supported by the Bill and Melinda Gates Foundation through the Pediatric Dengue Vaccine Initiative, a project under the International Vaccine Institute. (2011-2015).

Malaria

  1. Cost-Effectiveness Study of Durable Lining Compared to Indoor Spraying in Tanzania.
    This grant is supporting a cost-effectiveness analysis in Kenya and Tanzania as part of a controlled trial of a new technology to help prevent malaria--insecticide treated wall liners. Interim results were presented at international conferences in Washington, DC, Dar es Salaam, Kampala, and Washington, DC. (Shepard et al., 2013, 2014, 2015, respectively) (Supported by the Bill and Melinda Gates Foundation, 2011-2015).

HIV/AIDS

  1. Brief Interventions in the Emergency Department for Alcohol and HIV/Sexual Risk.
    This subcontract led the economic analysis of a randomized trial of motivational interviewing to reduce the substance abuse and sexual risk among emergency patients. (Brandeis subcontract from Brown University, Providence, RI. Supported by NIAAA, 2010-2015.)

  2. Application of Data Envelopment Analysis to Resource Estimation Addressing HIV/AIDS.
    Since the 1990s, the global initiative to control the HIV/AIDS epidemic has expanded beyond prevention to include widespread anti-viral treatment. Despite the growth in domestic and donor support, many developing countries still fail to provide sufficient services to meet their population's needs. Several costing tools have been developed to determine the amount of funding required to control HIV/AIDS. However, the estimates from the different models varied considerably. The objective of this study was to apply an innovative estimation method, Data Envelopment Analysis (DEA), to estimate the financial requirements for HIV/AIDS control among the roughly 20 low- and middle-income countries where data is available for analysis. This study is a first step in the application of this technique with available data. (Supported by the United Nations Programme on HIV/AIDS, UNAIDS, 2007-08.)

  3. Cost Effectiveness of Harm Reduction Strategies for Injecting Drug Users in Uzbekistan.
    With IV drug use as the major risk behavior behind Uzbekistan’s growing rate of HIV infection, a planning workshop sought to identify factors that promote and dissuade drug users from participating in preventive and harm reduction activities (e.g. condom use and syringe exchange programs). Workshop participants developed promising approaches to build on the strengths and overcame barriers, and designed a study to test the effectiveness, cost-effectiveness, and replicability of the most promising approach. A subsequently funded study evaluated substitution therapy and other approaches, such as peer-driven incentives, in syringe exchange programs in Uzbekistan. Retrospective analyses were performed for patients who received maintenance treatment with methadone or buprenorphine. Brandeis collaborated with a national partner, the Bukhara State Medical Institute, using client interviews, budget reviews, modeling, prospective data analysis, and literature review. Funded by the Civilian Research and Development Foundation.

  4. Impact of AIDS on Health Expenditures.
    The prevention and treatment of AIDS poses enormous challenges to health policy makers around the world. This study compiled and analyzed expenditures related to AIDS in five countries across four continents: Mexico in North America, Brazil in South America, Cote d'Ivoire and Tanzania in Africa, and Thailand in Asia. In each country, the study ascertained AIDS expenditures by object and source of funding, relating them to overall health expenditures, and identifying the determinants of the existing patterns of expenditures. The study was designed to give policy makers an empirical base for improving resource allocation. Funded by the World Bank and the European Commission.

  5. Costs of Anti-Retroviral Therapy in Botswana.
    At the time of this study (year 2000), the prevalence of HIV infection in Botswana was about 14% of the entire population, one of the highest rates in the World. Institute researchers examined alternative policies for anti-retroviral therapy. Results showed that treatment of pregnant women to reduce the risk of vertical transmission would be affordable, and under certain scenarios, even cost-saving. Treatment of the adult population generally with anti-retroviral therapy would be extremely costly, however. Funded by the Government of Botswana.

  6. Feasibility of Home-Based AIDS Care in Botswana.
    At the time of this study, AIDS was a growing problem in Botswana, with seroprevalence rates among pregnant women in sentinel sites averaging 33%. If present patterns of hospital-based treatment were not modified, then AIDS patients would exhaust all remaining hospital capacity by 1999, bringing hospital occupancy to 90% nationally. This study developed a model of home-based care, in which clinic staff would train family members to provide support at home. A spreadsheet model estimated the reductions in hospital care and resulting savings in costs. It showed how the share of the cost of home-based care offset by these savings depended on the design of the program. Funded by the World Bank.

  7. Economic Analysis of HIV/AIDS.
    Despite the growth in domestic and donor support for HIV/AIDS treatment, many developing countries failed to provide sufficient services to meet their population's needs. Several costing tools were developed to determine the amount of funding required to control HIV/AIDS. Estimates from the different models varied considerably, however. The objective of this study was to apply an innovative estimation method, Data Envelopment Analysis (DEA), to estimate the financial requirements for HIV/AIDS control among the low- and middle-income countries where data is available for analysis, and among health centers in Rwanda. The study's aim was to improve the efficiency of HIV/AIDS control programs in Rwanda and worldwide, and to examine how AIDS funding impacts other diseases. Funded by UNAIDS.

  8. Cost-Effectiveness of Dietary Interventions to Reduce AIDS Wasting.
    AIDS patients were randomly assigned to several interventions (nutrition counseling alone, exercise regimens, or appetite stimulants) to reduce AIDS wasting. Brandeis was responsible for the cost-effectiveness analysis. (Brandeis subcontract from Tufts University, Boston. Supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health, 1997-2000.)

Cardiovascular Disease

  1. Vermont Center of Behavior, Incentives and Health.
    Prof. Shepard serves as senior advisor on economics to this Center, helping to assess the cost-effectiveness of the approaches being evaluated through randomized trials. He is focusing on projects offering incentives to increase participation in cardiac rehabilitation among low-income persons with coronary disease and on incentives to promote smoking cessation among low-income pregnant women. (Brandeis subcontract from University of Vermont. Supported by NIH/NIGMS, 2013 - 2018)

  2. Evaluation of Medicare Lifestyle Modification Demonstration.
    Supported by the Centers for Medicare & Medicaid Services (formerly the Health Care Financing Administration) from 2000-2009, this evaluation studied national demonstrations for selected Medicare beneficiaries of lifestyle changes around diet, exercise, and stress reduction on cardiovascular disease. The evaluation examined implications to participants' health, health costs, and feasibility.

Behavioral Health (Mental Health and Substance Abuse)

  1. Reinforcing Therapist Performance.
    Under this 3-year study, Brandeis conducted the economic analysis of a randomized trial of incentives to counselors providing an evidence-based treatment to adolescents with substance misuse. Specifically, Brandeis researchers collected time utilization and financial data, leading to the economic analysis of the data, and collaborating on the preparation and delivery of scientific presentations and publications. (Brandies subcontract from Chestnut Health Systems. Supported by NIAAA.)

  2. Developing and Testing Intervention Costing Tools for Substance Abuse Treatment.
    Brandeis developed two tools (called Planner and Analyst) for the economic analysis of evidence-based practices of substance abuse treatment. Following developing the costing tool and the collection and analysis of data, a manuscript was be submitted to a peer-reviewed journal. (Supported by the Robert Wood Johnson Foundation Substance Abuse Policy Research Program.)
  3. Brief Interventions in the Emergency Department for Alcohol and HIV/Sexual Risk.
    This subcontract led the economic analysis of a randomized trial of motivational interviewing to reduce the substance abuse and sexual risk among emergency patients. (Brandeis subcontract from Brown University, Providence, RI. Supported by NIAAA, 2010-2015.)

  4. Enhanced Motivational Interviewing with Alcohol Positive Trauma Patients.
    The main goal of this study was to conduct a cost-effectiveness analysis as part of a randomized trial of two alternative treatments for alcohol-positive patients in a trauma unit or emergency department. The three treatments were "significant other" and motivational interviewing, individual patient motivational interviewing and standard care. (Brandeis subcontract from Brown University. Supported by NIAAA, 2005-2010.)

  5. Restructuring Services for Drug-Abusing TANF Women.
    Brandeis conducted the economic analysis of intensive case management (ICM) for women on public assistance with substance abuse disorder to determine whether interventions delivered in routine care settings lead to improved outcomes compared to usual care. A previous phase of the study showed that ICM delivered within a welfare setting increased access, engagement, and retention in substance abuse treatment, as well as improved outcomes for drug abusing TANF mothers when compared to usual care (UC). Under this part of the study, Brandeis conducted an economic evaluation of ICM including a cost of illness study and cost benefit study. (Funded by Center on Addictions and Substance Abuse (CASA). Supported by NIDA. 2007-2013).

  6. Profiling and Incentives in Behavioral Health Care - Research Center on Managed Care and Drug Abuse.
    This research evaluated the contribution of provider profiling and incentives to improving the quality of managed behavioral health care. Combining a quasi-experimental interrupted time series and randomized-controlled designs, the study used existing data from public sector general assistance (GA) clients who received substance abuse treatment under the state of Connecticut's managed behavioral health care (MBHC) program. In October 2001, the Connecticut Department of Mental Health and Addiction Services (DMHAS) initiated provider profiling. DMHAS incorporated four standards of care and effectiveness measures into the contracts of all 452 providers (sites) who provided substance abuse and mental health services. The profiles measured each provider's success in enhancing continuity of care, avoiding rapid readmissions to acute treatment services, documenting treatment plans, and referring high-risk clients appropriately.

  7. Organizational and Resource Assessments for Treatment Providers.
    The main goal of this "Roadmap" supplement was to extend a cost analysis workbook used in the parent grant beyond data entry. The enhanced version under this supplement, the on-line Treatment Cost Assessment Tool (TCAT) is a computerized cost-analyst interview and an Internet-based prototype of methods to conduct cost analyses in drug abuse treatment facilities. It checks the data automatically for consistency with other items, logical relationships, and industry norms. (Brandeis subcontract from Texas Christian University. Supported by NIDA, 2005-2007.)

  8. Long-Term Cost-Effectiveness of Drug Abuse Treatments.
    Funded by NIDA from 1993 through 2000, with related studies supported by NIDA and NIAAA on other populations, these studies were founded on randomized trials of alternative approaches to aftercare, one of the most important approaches to substance abuse treatment. In addition to measuring the effectiveness of each approach, the studies also assess costs to help policy makers better allocate resources across alternative modalities and services in substance abuse treatment.

  9. Aftercare for Cocaine Patients: Effectiveness and Costs.
    This study compared three approaches of varying cost for delivering aftercare to drug users: relapse prevention through individual sessions (most expensive); relapse prevention through group sessions (less expensive); and telephone-based aftercare counseling (least expensive). The study compared outcomes (through interviews and laboratory values) and costs over two years. (Brandeis subcontract from University of Pennsylvania, Philadelphia. Supported by NIDA, 1996-2002.)

  10. Efficacy and Cost-Effectiveness of Aftercare Plans for Alcoholic Patients.
    This study compared three approaches of varying cost for delivering aftercare to alcohol abusers: relapse prevention through individual sessions (most expensive); relapse prevention through group sessions (less expensive); and telephone-based aftercare counseling (least expensive). The study compared outcomes (through interviews and laboratory values) and costs over two years. (Brandeis subcontract from University of Pennsylvania, Philadelphia. Supported by NIAAA, 1996-2002.)

  11. Cost-Effectiveness of Substance Abuse Treatment in Connecticut Prisons.
    This 3-year study compared the four tiers, or intensities, of treatment provided to inmates in Connecticut prisons. They ranged from Tier 1, a 2-session orientation, to Tier 4, a residential program in a treatment cell block of at least 6 months. The study compared the costs of the approaches and evaluated the impact on problems while in prison (e.g. disciplinary tickets) and after release (e.g. recidivism). (Brandeis subcontract from Brown University, Providence, RI. Supported by the Robert Wood Johnson Foundation Substance Abuse Policy Program, 1996-2000.)

  12. Motivating Alcoholics to Quit Smoking.
    This study evaluated a program to motivate patients in treatment for alcohol abuse to consider smoking cessation. Brandeis was responsible for the cost-effectiveness component. (Brandeis subcontract from Miriam Hospital, Rhode Island. Supported by NIAAA.)

  13. Cost-Effectiveness of Extended Case Monitoring in Alcohol Abuse.
    This study evaluated telephone follow up for patients in a Health Maintenance Organization treated for alcohol abuse. The case monitor provided support to help patients remain abstinent, and provided detection and prompt referrals in the event of relapse. Brandeis was responsible for the cost-effectiveness component. (Brandeis subcontract from Brown University, Providence, RI. Supported by NIAAA.)

  14. Treatment Needs: Research and Evaluation Specialists.
    Under a contract with the Massachusetts Bureau of Substance Abuse Services (BSAS), a Brandeis team studied unmet need for substance abuse treatment in the state by region and level of care needed. The team collaborated with BSAS on the analysis and interpretation of data from the Behavioral Risk Factor Surveillance System (BRFSS) that assists in treatment service planning. Researchers also provided on-going technical assistance to BSAS Office of Statistics and Evaluation staff to assist the Commonwealth in policy development and economic analyses, and performed specialized analyses of the BRFSS and other measures compiled by BSAS.

  15. Review of the Massachusetts Behavioral Health Program.
    This conference award supported a scientific conference on February 5, 2004 at Brandeis to review and synthesize findings from the study of Managed Care in Michigan and Massachusetts and related studies. The organizers guest-edited the March 2005 issue of Administration and Policy in Mental Health summarizing the findings.

Nuisance Mosquitoes

  1. Asian Tiger Mosquito Area-Wide Project: Economic Analysis.
    Monmouth and Mercer counties in New Jersey implemented pest control against the Asian tiger mosquito (ATM). This aggressive, day-biting mosquito can be a vector for several diseases, including dengue fever. Brandeis, a member of a collaborative project that designed the study to (1) demonstrate a strategy for area-wide ATM control, (2) measure the public health and socio-economic benefits of the suggested area-wide mosquito control, and (3) transfer the strategy to end users. Brandeis conducted the economic analysis, including a willingness-to-pay survey. (Supported by the US Department of Agriculture. 2008-2013).

  2. An Economic Analysis of the Threats Posed by the Establishment of Aedes albopictus in Queensland.
    This study modeled the potential impact of this invasive mosquito species becoming established in a heavily populated area, and the type and cost of a control strategy that would need to be mounted in response in the state of Queensland, Australia. (Supported by State of Queensland, Australia, Queensland Institute of Medical Research, 2013)

Pneumonia

  1. Cost-Effectiveness Analysis of Pneumococcal Pneumonia Vaccination in Singapore.
    Pneumococcal pneumonia and other diseases caused by the pneumococcal organism are important causes of illness and death affecting children and elderly adults worldwide. At the time of this study, the vaccine for adults was long established and relatively inexpensive, but the pneumococcal vaccine for children was new and expensive. The cost-effectiveness of a pneumococcal vaccine for children, particularly in a country with good access to medical services, remain controversial. The purpose of this study was to conduct a cost-effectiveness analysis on pneumococcal vaccinations jointly with the Singapore Ministry of Health (MOH), and develop recommendations to build capacity within the MOH for economic analysis. (Supported by the Singapore Ministry of Health, 2007-2008).

International Health Economics, Other

International health activities focus on strengthening the financial health of public sector health activities in developing countries.
  1. Results-Based Financing: A Cost-effectiveness Application to Zimbabwe.
    This study is assessing the cost-effectiveness of results-based financing interventions to improve maternal and child health outcomes in Zimbabwe, making use of the impact evaluation, a controlled study across dozens of districts in the country. (Supported by the World Bank, 2015-2016).

  2. An Economic Analysis of the Threats Posed by the Establishment of Aedes albopictus in Queensland.
    This study modeled the potential impact of this invasive mosquito species becoming established in a heavily populated area and the type and cost of a control strategy that would need to be mounted in response in the state of Queensland, Australia. (Supported by State of Queensland Australia, Queensland Institute of Medical Research, 2013)

  3. Harmonizing Social Health Protection in East Africa.
    In collaboration with partners across all East Africa partner states (Republics of Burundi, Kenya and Rwanda, the United Republic of Tanzania, and Republic of Uganda) , Brandeis documented the current situation and options for harmonization around social health protection in East Africa and conferred with policy makers through national and regional workshops. Government delegations from all five East African states confirmed their support for the concept of social health protection at a final validation workshop. (Supported by East Africa Community/Deutsche Gesellschaft fur Internationale Zusammenarbeit (GIZ)/Global Health Issues and Solutions, LTD (GHIS), 2014)

  4. Toolkit for Cost-Effectiveness Analysis of Results-Based Financing and its Application to Zambia.
    The toolkit aims to support country programs to assess the cost-effectiveness of results-based financing (RBF) interventions and to facilitate cross-country comparisons of RBF programs to improve maternal and child health (MCH) health outcomes, as well as other conditions of high disease burden in many developing countries such as tuberculosis, human immunodeficiency virus (HIV) infection, and malaria. It is being applied in Zambia in conjunction with the impact evaluation of that country's RBF program. (Supported by the World Bank 2014-2015)

  5. Costing of Packages of Health Services in Afghanistan.
    This study compared the costs of packages of health services in Afghanistan under three donors: The European Union, The World Bank, and USAID. (Brandeis subcontract from AEDES. Supported by the European Union. 2011 - 2012).

  6. Cost and Value of Hospital Accreditation.
    This study addresses key elements of the need for a quantitative, economic assessment of hospital accreditation through a multi-year study of value and impact of selected standards. The pilot study selected two or three clinical and two or three management standards for which procedures and data for measurement appear feasible. In comparing accredited to non-accredited hospitals in several countries, the study hypothesized that the improvements in value and impact were greater in the accredited hospitals than the non-accredited comparison hospitals. Data gathering in Jordan was in conjunction with the Health Care Accreditation Council, Jordan. Results from Jordan were published in the Eastern Mediterranean Health Journal (Halasa et al., 2015). (Supported by the Joint Commission International. 2008-2011.)

  7. Exploratory Study of Health Financing in The Gambia.
    To help The Gambia design a system of community based health insurance, the PI conducted a site visit to the country, visiting facilities and conferring with stake holders. Options were developed with a particular emphasis on strengthening maternal health services Support from International Health Partners, 2010.

  8. Cost-Effectiveness of the Children's Vaccine Initiative.
    The Children's Vaccine Initiative, created by the UNDP, WHO, UNICEF, and the Rockefeller Foundation, seeks to foster the development and implementation of new and improved childhood vaccines worldwide. The Institute for Health Policy conducted cost-effectiveness studies to help the program set priorities among alternative vaccine candidates. Funded by the World Health Organization.

  9. Cost-Effectiveness of Vector Control against Lymphatic Filariasis (LF).
    Working with the LF Support Program, Brandeis conducted economic studies that documented the costs and benefits of vector control. In addition, we assessed the added value of vector control by comparing changes in the indicators of LF program effectiveness and helped define the most appropriate techniques, and most appropriate situations in which supplemental vector control strategies can be utilized most cost-effectively. This research was supported by the Bill and Melinda Gates Foundation through the Task Force for Global Health. 2009-2012.

  10. Cost-Effectiveness Analysis of Pneumococcal Pneumonia Vaccination in Singapore.
    Pneumococcal pneumonia and other diseases caused by the pneumococcal organism are important causes of illness and death affecting children and elderly adults worldwide. At the time of this study, the vaccine for adults was long established and relatively inexpensive, but the pneumococcal vaccine for children was new and expensive. The cost-effectiveness of a pneumococcal vaccine for children, particularly in a country with good access to medical services, remains controversial. The purpose of this study was to conduct a cost-effectiveness analysis on pneumococcal vaccinations jointly with the Singapore Ministry of Health (MOH), and develop recommendations to build capacity within the MOH for economic analysis. (Supported by the Singapore Ministry of Health, 2007-2008).

  11. Health Economics and Policy in Samoa.
    In collaboration with the Health Resource Planning Information Research and Development Division (HRPIRD) of the Samoa Department of Health since 2000, this project studied costs of health services in Samoa and overseas, and resource utilization and financing to strengthen the health sector in this small island nation. Supported by the World Bank and the Government of Samoa.

  12. Cost-Effectiveness of Regional versus Bilateral Approaches to International Assistance in West Africa.
    From 1994 to 1996, as the US Agency for International Development (USAID) closed 11 country missions in Subsaharan Africa due to budget constraints, it introduced a sub-regional approach in Burkina Faso, Cameroon, Côte d'Ivoire, and Togo. We related the cost-effectiveness of this sub-regional approach against the traditional approach in terms of the contraceptive prevalence rate (CPR) for women aged 14-45, adjusted for other factors. Funded by the US Agency for International Development in collaboration with Tulane University.

  13. Hospital Costs: A Manual for Managers.
    Hospitals consume the majority of resources in developing countries. Typically, however, the officials responsible for their management, both in the hospitals themselves and in provincial and national government offices, have little idea of the cost and efficiency of their services. Brandeis wrote a manual on estimating hospital costs and have used it for workshops for managers in both Bangladesh and Zimbabwe. The World Health Organization published the manual in English [Shepard, D.S., Hodgkin, D., Anthony, Y.E. Analysis of Hospital Costs: a Manual for Managers. Geneva, Switzerland, World Health Organization, 2000 (ISBN 92 4 154528 3). Shandong Medical University has published a translation in Mandarin Chinese. [Earlier version published in Mandarin Chinese under The Network for Training and Research in Health Economics and Financing (Bian Ying, translator). Jinan, Shandong Province, China: Shandong Medical University, National Institute of Hospital Cost Accounting, School of Public Health, 1998.] Funded by the World Health Organization.

  14. Health Insurance in Cote d'Ivoire.
    In the Cote d'Ivoire, public and private hospitals offer a wide array of hospital services. As 97% of the population lacked private health insurance at the time of this study (1998), financial access is more problematic than physical access. Subsidies to hospital care consume over half the government health budget, but still leave tertiary hospital care extremely expensive for ordinary citizens. This study helped the Government of Cote d'Ivoire develop options for health insurance both for people in the modern sector and in the rest of the country. Funded by the World Bank.

  15. Cost-Effectiveness of Disease Control Options.
    As part the World Bank's Health Sector Priorities Review, Brandeis provided the economic analysis and conceptual framework for control of two major diseases -- acute respiratory infections, one of the world' major killers, and dengue fever, a growing problem in Asia and South America. Both preventive and case management strategies were examined. With computerized models, sensitivity analyses were performed, combinations of strategies were considered, and the incremental cost-effectiveness of alternative strategies was compared. Funded by the World Bank.

  16. Health Financing in Sierra Leone
    Sierra Leone, an impoverished country of 4 million people in West Africa, enacted an innovative National Health Action Program in 1993 to strengthen the core services of its public health system. Although the government promised regular increases over its recent health spending of only US $0.80 per capita per year, additional sources of funding were required. This study assessed the potential of three other sources: higher fees for curative health services in government facilities, fees for drugs, and health insurance for the employed population. Funded by the World Bank.

  17. Health Economics Curriculum for CESAG.
    Institute researchers served as part of a design team for the first graduate degree program in health economics in sub-Saharan Africa. The program, conducted at the Centre d’Etudes Superieures Africaine de Gestion (CESAG) in Dakar, Senegal, admitted its first class in the fall of 1998. Funded by the U. S. Agency for International Development.

  18. Health Quality Indicators in Jamaica.
    Patient satisfaction surveys, used extensively by sophisticated health providers in the United States, were implemented in a sample of six hospitals in Jamaica. The data were used to monitor the impact of ongoing efforts to strengthen quality and management, such as the appointment of Chief Executive Officers and the divestment of selected hospital support services, such as laundry and portering. Funded by the U. S. Agency for International Development.

  19. Evaluation of the Health and Population Program of the Carvajal Foundation.
    The Carvajal Foundation is a private institution created to improve the welfare of low-income residents of Cali, Colombia. One of its innovative health programs is a network of "health volunteers," women who provide teaching, monitoring, and referrals to health and family planning facilities. Brandeis led an evaluation of the health and population programs of the foundation's health and population programs, which assessed the costs and effects of the system. The evaluation surveyed 1000 households and about 100 providers. Funded by the Rockefeller Foundation.

  20. Economic Analysis for Caribbean Regional Health Study.
    The Caribbean Regional Health Study for Caribbean Group for Cooperation in Economic Development was a diagnostic analysis of health problems of the Caribbean region. The study emphasized problems that are common to many countries in the region, or that would lend themselves to regional solutions. Brandeis was responsible for the portions of the study related to economic analysis. Funded by the Inter-American Development Bank.

  21. Cost Recovery in Jamaica.
    In the face of declining real resources, the Jamaican Ministry of Health had difficulty maintaining quality of care. To increase resources and to give more autonomy to hospitals, Brandeis researchers worked with the Ministry of Health to revise its fee schedule for care in public facilities. With a new fee schedule, hospital income more than doubled, while graduated fees and exemptions helped maintain access to the poor. Fees were developed to favor the most cost-effective services, reducing subsidies to tertiary care. Funded by the U. S. Agency for International Development.

  22. Cost-Effectiveness of Disease Control Options.
    As part the World Bank's Health Sector Priorities Review, the Institute provided the economic analysis and conceptual framework for control of two major diseases -- acute respiratory infections, one of the world' major killers, and dengue fever, a growing problem in Asia and South America. Both preventive and case management strategies were examined. With computerized models, sensitivity analyses were performed, combinations of strategies were considered, and the incremental cost-effectiveness of alternative strategies was compared. Funded by the World Bank.

Managed Care

  1. Impact of Managed Care for Medicaid Recipients with Alcohol Disorders in Michigan and Massachusetts.
    Michigan and Massachusetts, two industrial northern states, adopted contrasting approaches for managing substance abuse treatment for Medicaid recipients. For all recipients not in HMOs, Massachusetts carved out the services to a private managed care company which assumed partial risk for the cost services. Michigan also carved out substance abuse services, but used public agencies, each responsible for one or more counties, for this role. Initially, regional Centers for Diagnosis and Referral served as gatekeepers, but their successors, coordinating agencies, assumed a range of managed care functions in 1998 and 1999. This 6-year study had three specific aims: (a) To describe and evaluate how the introduction of public-sector managed care affects utilization, cost and outcomes of alcohol treatment; (b) To evaluate how managed care has affected outcomes, as judged by admissions, provider surveys, and key informants; and (c) To evaluate whether managed care impacts on alcohol treatment costs and utilization differ for subpopulations (e.g. women, adolescents, and people of color). The study analyzed claims data and surveying substance abuse providers in both states. (Supported by NIAAA, 1996-2002.)
Other Topics in the United States

  1. Economic Impact of Adult Oral Disease.
    This study aims to quantify the socio-economic impact of adult oral diseases based on its relationship to general health, work productivity and social problems, and to assess the impact of this disease on quality of life. (Brandeis subcontract from Denta-Quest Foundation, Supported by Medicaid State Dental Association, 2015).

  2. Medical Respite Care for People Experiencing Homelessness.
    This study is performing the economic analysis of an innovation funded by the Centers for Medicare & Medicaid Services through HCIA2 of providing medical respite services for persons experiencing homelessness. The service is expected to reduce hospital costs and provide better outcomes for participants. (Brandeis subcontract from Health Care for the Homeless Council, Supported by CMS - CMMI, 2014 - 2015).

  3. Increasing the Use of Donated Embryos: A Demonstration.
    This collaboration between Boston IVF and Brandeis designed, implemented and evaluated a demonstration to increase the use of donated frozen embryos as an additional option in infertility treatment. Based on the favorable trends, the sponsor implemented a complementary counseling service for certain clients with frozen embryos in storage. Brandeis was responsible for the evaluation and economic analysis. (Subcontract from Boston IVF. Supported by DHHS/OPA, 2011-2014.)

  4. Study of Frozen Embryo Donation and Adoption: Economic Analysis.
    Under this 18-month subcontract, Brandeis conducted the economic analysis related to the donation and adoption of frozen embryos as an additional alternative for infertile women to become a parent. In addition to general contributions to the study, Brandeis’ role related primarily to the delivery, costs, and financing of frozen embryo donation and adoption services. Support was from the US Department of Health and Human Services/QED Group LLC.

  5. High-Performing Community Health Centers: What It Takes.
    This two-year study examined the role of community health centers (CHCs) in the states of California, Massachusetts, and Texas, and in particular, the degree to which they provided high quality care to low income and racial/ethnic minority populations, and by extension, reduce disparities. Medicare claims allowed comparison of CHCs against other care settings to identify the highest performing CHCs and what factors make them successful. The results will help to inform policy makers, funders, and providers on ways to improve health system performance. The two sponsors are Commonwealth Fund and Texas Association of Community Health Centers.

  6. Evaluation of the Illinois and Wisconsin State Pharmacy Assistance Waivers.
    This evaluation examined the achievements as well as the difficulties inherent in the implementation of the Illinois and Wisconsin Pharmacy Plus programs. This five-year study included a descriptive evaluation of the program, a survey of a total of 2,200 program participants (1,200 in Illinois and 1,000 in Wisconsin), and analyses of prescription drug and medical claims to determine drug utilization and expenditures as well as the cost impact on the Medicaid and Medicare programs. This study provided a critical opportunity to evaluate how well such programs achieve their goals and provided lessons for other states and the federal government as a national policy evolved. (Supported by the Centers for Medicare and Medicaid Services, 2002-2007.)



Back to Top   |   Updated 25 August 2015 |   Created by Jeremy Maitin-Shepard