BURA Collection: HERG's strategic focus is on the economic evaluation of a broad range of clinical and health service technologies and its dual aim is to provide applied, policy-relevant research whilst developing and refining methods to increase the rigour and relevance of such studies.

Characteristics of private health insurance enrollees and the association between health coverage type and outpatient service utilization in Saudi Arabia: Insights from the National Saudi Family Health Survey

2026-04-30T00:00:00Z

Title: Characteristics of private health insurance enrollees and the association between health coverage type and outpatient service utilization in Saudi Arabia: Insights from the National Saudi Family Health Survey Authors: Althabaiti, KS; Hunsberger, M; Khan, J; Ahmed, S Abstract: The Kingdom of Saudi Arabia (KSA) has a mixed health financing system consisting of governmental health coverage (GHC) and private health insurance (PHI). In 2016, KSA launched Vision 2030, which aims to reduce government spending and increase reliance on employer-sponsored PHI. This reform may affect the utilization of health services based on citizenship and the type of health coverage (PHI compared with GHC). The current study aimed to identify the characteristics of private health insurance enrollees and the association between different types of health coverage (GHC and PHI) and outpatient service utilization in the KSA. This study used data from the 2018 Saudi Family Health Survey (SFHS), which included 8,276 respondents aged 18 years and above and collected information on outpatient utilization during the previous 12 months. Statistical analyses were conducted using SPSS version 26. Bivariate analyses (chi-square and t-tests) were used to assess differences by nationality and coverage type. Binary logistic regression was used to examine the characteristics of PHI enrollment, and Poisson regression was used to evaluate the association between coverage type and outpatient utilization. This dataset provides a pre-reform baseline for assessing PHI enrollment and outpatient utilization prior to the implementation of the first phase of the reform in 2019. Most respondents were Saudi nationals (76.8%), and 54.9% were male. About 26.2% of respondents had PHI. Among non-Saudis, 72.8% were enrolled in PHI, compared with only 12.1% of Saudis. The logistic regression analysis revealed that having PHI was associated with factors such as a high monthly income, non-Saudi, male, being married, a high level of education, and a perception of good health. We found that having PHI was negatively associated with the utilization of outpatient services (coefficient −0.107; P < 0.001) compared with GHC. This finding may reflect barriers to access, a lower perceived need, or limitations in awareness of PHI benefits. In addition, this finding suggests that PHI may be associated with disparities in healthcare access, based on the observed lower utilization of outpatient services among its enrollees compared with those covered by GHC. Other factors associated with the utilization of outpatient services were being female, having a high monthly income, being never married, having chronic diseases, and the perception of poor health. The results of this study may inform future health reform efforts to enhance access to healthcare. These findings should be considered when planning the implementation and evaluation of the health system in KSA. Description: Data Availability: The data underlying the findings of this study are from the Saudi Family Health Survey (SFHS) and are owned by the General Authority for Statistics (GASTAT), Saudi Arabia. The dataset cannot be shared publicly, deposited in a public repository, or provided as supplementary material due to legal and ethical restrictions imposed by the data owner and the terms of access approval. Access to the data requires a formal request to GASTAT specifying the study objectives and the required variables. Researchers may request access by contacting GASTAT at cs@stats.gov.sa. The authors do not have the legal right to publicly share or redistribute the dataset.

Delivering the aims of the Collaborations for Leadership in Applied Health Research and Care: understanding their strategies and contributions

2015-05-01T00:00:00Z

Title: Delivering the aims of the Collaborations for Leadership in Applied Health Research and Care: understanding their strategies and contributions Authors: Soper, B; Hinrichs, S; Drabble, S; Yaqub, O; Marjanovic, S; Hanney, S; Nolte, E Abstract: Background: In 2008, the National Institute for Health Research (NIHR) in England established nine Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) to develop partnerships between universities and local NHS organisations focused on improving patient outcomes through the conduct and application of applied health research. Objectives: The study explored how effectively the CLAHRCs supported the ‘translation’ of research into patient benefit, and developed ways of doing applied research that maximised its chances of being useful to the service and the capacity of the NHS to respond. It focused on three issues: (1) how the NHS influenced the CLAHRCs, and vice versa; (2) how effective multistakeholder and multidisciplinary research and implementation teams were built in the CLAHRCs; (3) how the CLAHRCs supported the use of research knowledge to change commissioning and clinical behaviour for patient benefit. Methods: The study adopted an adaptive and emergent approach and incorporated a formative evaluation. An initial phase mapped the landscape of all nine CLAHRCs and the context within which they were established, using document analysis, workshops and interviews, and a literature review. This mapping exercise identified the three research questions that were explored in phase 2 through a stakeholder survey of six CLAHRCs, in-depth case studies of two CLAHRCs, validation interviews with all nine CLAHRCs and the NIHR, and document review. Results: (1) The local remit and the requirement for matched NHS funding enhanced NHS influence on the CLAHRCs. The CLAHRCs achieved positive change among those most directly involved, but the larger issue of whether or not the CLAHRCs can influence others in and across the NHS remains unresolved. (2) The CLAHRCs succeeded in engaging different stakeholder groups, and explored what encouraged specific groups to become involved. Being responsive to people’s concerns and demonstrating ‘quick wins’ were both important. (3) There was some evidence that academics were becoming more interested in needs-driven research, and that commissioners were seeing the CLAHRCs as a useful source of support. A growing number of completed projects had demonstrated an impact on clinical practice. Conclusions: The CLAHRCs have included NHS decision-makers in research and researchers in service decision-making, and encouraged research-informed practice. All the CLAHRCs (as collaborations) adopted relationship models. However, as the complexities of the challenges they faced became clearer, it became obvious that a focus on multidisciplinary relationships was necessary, but not sufficient on its own. Attention also has to be paid to the systems within and through which these relationships operate. Recommendations for research: Future research should compare areas with an Academic Health Science Network (AHSN) and a CLAHRC with areas with just an AHSN, to understand the difference CLAHRCs make. There should be work on understanding implementation, such as the balancing of rigour and relevance in intervention studies; systemic barriers to and facilitators of implementation; and tailoring improvement interventions. There is also a need to better understand the factors that support the explicit use of research evidence across the NHS, and the processes and mechanisms that support the sustainability and scale-up of implementation projects. Research should place emphasis on examining the role of patient and public involvement in CLAHRCs and of the relation between CLAHRCs and NHS commissioners. Description: Plain English Summary: Much of the health research that is produced is not used, and opportunities to improve patient care are missed. In 2008 the UK government funded nine collaborative partnerships between universities and local NHS organisations to address this problem. The Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) were asked to improve links between researchers and NHS managers and clinicians. The underlying idea was that, if NHS staff chose what research was done, it would be more useful to them, and they would use it. However, for this to work they needed to know how research could help them and how to get the research they needed. The CLAHRCs therefore encouraged the two groups to work together to achieve the common goal of getting research better used in practice. They also included patients, in whose interests this was being done. Our study explored what the CLAHRCs achieved. The CLAHRCs involved a large number of people from different academic disciplines and NHS backgrounds. We found evidence that mutual understanding increased, and that people found the new challenges exciting. The CLAHRCs provided research training and opportunities for people to learn about research, produced peer-reviewed publications and short evidence summaries for NHS staff, and developed a substantial portfolio of completed research projects, which prompted changes in practice locally and across the NHS. These partnerships built credibility and goodwill, and increased the capacity of academics to respond to the needs of the NHS and the service to absorb and act on research.

If health organisations and staff engage in research, does healthcare improve? Strengthening the evidence base through systematic reviews

2024-08-19T00:00:00Z

Title: If health organisations and staff engage in research, does healthcare improve? Strengthening the evidence base through systematic reviews Authors: Boaz, A; Goodenough, B; Hanney, S; Soper, B Abstract: Background: There is an often-held assumption that the engagement of clinicians and healthcare organizations in research improves healthcare performance at various levels. Previous reviews found up to 28 studies suggesting a positive association between the engagement of individuals and healthcare organizations in research and improvements in healthcare performance. The current study sought to provide an update. Methods: We updated our existing published systematic review by again addressing the question: Does research engagement (by clinicians and organizations) improve healthcare performance? The search covered the period 1 January 2012 to March 2024, in two phases. First, the formal updated search ran from 1 January 2012 to 31 May 2020, in any healthcare setting or country and focussed on English language publications. In this phase two searches identified 66 901 records. Later, a further check of key journals and citations to identified papers ran from May 2020 to March 2024. In total, 168 papers progressed to full-text appraisal; 62 were identified for inclusion in the update. Then we combined papers from our original and updated reviews. Results: In the combined review, the literature is dominated by papers from the United States (50/95) and mostly drawn from the Global North. Papers cover various clinical fields, with more on cancer than any other field; 86 of the 95 papers report positive results, of which 70 are purely positive and 16 positive/mixed, meaning there are some negative elements (i.e. aspects where there is a lack of healthcare improvement) in their findings. Conclusions: The updated review collates a substantial pool of studies, especially when combined with our original review, which are largely positive in terms of the impact of research engagement on processes of care and patient outcomes. Of the potential engagement mechanisms, the review highlights the important role played by research networks. The review also identifies various papers which consider how far there is a “dose effect” from differing amounts of research engagement. Additional lessons come from analyses of equity issues and negative papers. This review provides further evidence of contributions played by systems level research investments such as research networks on processes of care and patient outcomes. Description: Availability of data and materials: No datasets were generated or analysed during the current study.; Supplementary Information is available online at: https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-024-01187-7#Sec30 .

Impact upfront: novel format for Novo Nordisk Foundation funding

2025-09-02T00:00:00Z

Title: Impact upfront: novel format for Novo Nordisk Foundation funding Authors: Balling, GV; Fosse, HB; Iversen, KZ; Hanney, SR Abstract: Many retrospective assessments of the wider, societal impacts from health research funding use the Payback Framework or other frameworks. Much of this experience was collated in the 2018 Statement by the International School on Research Impact Assessment (ISRIA). Despite increased interest, especially in engaged research and a wider range of evaluation approaches, rarely do health and other research funders take a prospective approach and analyse the potential impact from a proposal to inform an impact management approach aimed at boosting impact. In this paper, experts from the Novo Nordisk Foundation, a leading philanthropic funder of research, describe how they are developing and applying such a pioneering approach. The five steps form a continuum from project inception to data collation and assessment. The first step entails preparing the project’s narrative in alignment with the project’s vision. The second, building the logic model, includes defining success factors and effect chains. The third is an early assessment of the initiative’s potential impact, conducted on a case basis. The fourth is implementing the data model by integrating specific indicators. The fifth focuses on monitoring, impact management and creating impact products, including developing a comprehensive plan for data reporting and assessment, with scope for adjustments based on experience. This approach aligns with ISRIA guidelines, but further steps are needed. Whilst the Foundation is driving innovation in impact assessment by successfully introducing a new approach that uses prospective impact analysis to inform impact management to enhance the levels of impact achieved, further progress is needed on stakeholder engagement expanding towards a more inclusive stakeholder involvement. Description: Data availability: No datasets were generated or analysed during the current study.