Henry Lucas | Institute of Development Studies (original) (raw)

Papers by Henry Lucas

Research paper thumbnail of Research on the current state of PRS monitoring systems

Research paper thumbnail of What do we mean by 'major illness'? The need for new approaches to research on the impact of ill- health on poverty 1

Research paper thumbnail of New technology and illness self-management: Is the approach relevant for resource-poorpopulations?

Advances in technology have made it possible for many standard diagnostic and monitoring procedur... more Advances in technology have made it possible for many standard diagnostic and monitoring procedures, previously the preserve of qualified providers in medical facilities, to be undertaken by patients or carers in their own homes. The results can then be available over the internet for review, assessment and possibly timely response by service providers. It is suggested that this approach can both improve patient quality of life, by reducing the need for facility visits, and possibly quality of care, by engaging patients in the active management of their condition, for example encouraging lifestyle changes (McDermott and While 2013). It is also seen by many developed economies with aging population as a way to reduce the ever rising cost of providing medical care (Lindberg et al., 2013).

Research paper thumbnail of Introduction: Real Time Monitoring for the Most Vulnerable - Investing in Common Guidance for Equity and Quality

IDS Bulletin, Mar 1, 2013

Research paper thumbnail of The impact of increased reimbursement rates under the new cooperative medical scheme on the financial burden of tuberculosis patients

Infectious Diseases of Poverty, Aug 2, 2019

Research paper thumbnail of The RIM Initiative in Vietnam: ‘Prioritise Rapid Results rather than Publishable Results’

IDS Bulletin, Mar 1, 2013

The 2009 Rapid Impact Monitoring (RIM) initiative in Vietnam was one of a number of studies under... more The 2009 Rapid Impact Monitoring (RIM) initiative in Vietnam was one of a number of studies undertaken in East Asia and Pacific countries to assess the initial poverty and social impacts of the global economic crisis. In Vietnam, the exercise was undertaken by the Centre for Analysis and Forecasting (CAF) of the Vietnamese Academy of Social Sciences (VASS). A favourable response to the findings led to additional RIM exercises in 2010 and 2011. It has been suggested that it should become a permanent feature of the policy process in Vietnam, assessing the impacts of both external shocks and major policy initiatives. This case study was intended to assess the RIM as an RTM tool, and more generally to assess the potential value of qualitative RTM exercises. The key finding was that such exercises can play an important role in situations where current, reliable data from other sources is lacking.

Research paper thumbnail of Evaluation: Why, for Whom and How?

IDS Bulletin, Nov 1, 2010

The overall objective of this article is to discuss current theoretical debates in the evaluation... more The overall objective of this article is to discuss current theoretical debates in the evaluation literature to assess their relevance for agriculture. After noting the 'bad press' of monitoring and evaluation (M&E) in agriculture, the literature is selectively reviewed to see what light is shed from different evaluation paradigms and methodologies. Experiences in the health sector are then examined in greater depth, emphasising debates around randomised controlled trials (RCTs). The final section considers some possible ways forward.

Research paper thumbnail of New Information Technology - Old Information Habits?

IDS Bulletin, Apr 1, 1994

Research paper thumbnail of Household Structure, Left-Behind Elderly, and Rural Migration in China

Journal of Agricultural and Applied Economics, Aug 1, 2016

Research paper thumbnail of How and to What Extent Can Pensions Facilitate Increased Use of Health Services by Older People: Evidence From Social Pension Expansion in Rural China

Research Square (Research Square), Jun 16, 2020

Research paper thumbnail of Lessons Learned from Implementing E-Learning for the Education of Health Professionals in Resource-Constrained Countries

Electronic Journal of e-Learning, 2017

The growing global demand for tertiary education has led to the increased use of e-learning appro... more The growing global demand for tertiary education has led to the increased use of e-learning approaches around the world. Demand has increased most rapidly in low and middle income countries (LMICs), which account for half of the students currently enrolled in higher educational institutions (HEIs). But the implementation of e-learning programmes in resource-constrained settings faces many obstacles. This paper explores some of the key issues involved in implementation of e-learning in HEIs involved in the education of health professionals, given the resource constraints within which many institutions have to function. We present case studies of three such LMIC institutions of varying size and primary purpose. The paper suggests use of appropriate ICT infrastructure, both in terms of hardware and software, combined with effective access and bandwidth management policies is crucial to the successful implementation of e-learning courses on health within HEIs based in LMICs.

Research paper thumbnail of Utilisation of Health Services in Poor Rural China: An Analysis Using a Logistic Regression Model

Research paper thumbnail of Health Expenditure and Finance in Three Poor Counties of China

Research paper thumbnail of Distance- and blended-learning in global health research: potentials and challenges

Global Health Action, Oct 6, 2016

Research paper thumbnail of Impact of an innovative financing and payment model on tuberculosis patients’ financial burden: is tuberculosis care more affordable for the poor?

Infectious Diseases of Poverty, Mar 24, 2019

Background: In response to the high financial burden of health services facing tuberculosis (TB) ... more Background: In response to the high financial burden of health services facing tuberculosis (TB) patients in China, the China-Gates TB project, Phase II, has implemented a new financing and payment model as an important component of the overall project in three cities in eastern, central and western China. The model focuses on increasing the reimbursement rate for TB patients and reforming provider payment methods by replacing fee-forservice with a case-based payment approach. This study investigated changes in out-of-pocket (OOP) health expenditure and the financial burden on TB patients before and after the interventions, with a focus on potential differential impacts on patients from different income groups. Methods: Three sample counties in each of the three prefectures: Zhenjiang, Yichang and Hanzhong were chosen as study sites. TB patients who started and completed treatment before, and during the intervention period, were randomly sampled and surveyed at the baseline in 2013 and final evaluation in 2015 respectively. OOP health expenditure and percentage of patients incurring catastrophic health expenditure (CHE) were calculated for different income groups. OLS regression and logit regression were conducted to explore the intervention's impacts on patient OOP health expenditure and financial burden after adjusting for other covariates. Key-informant interviews and focus group discussions were conducted to understand the reasons for any observed changes. Results: Data from 738 (baseline) and 735 (evaluation) patients were available for analysis. Patient mean OOP health expenditure increased from RMB 3576 to RMB 5791, and the percentage of patients incurring CHE also increased after intervention. The percentage increase in OOP health expenditure and the likelihood of incurring CHE were significantly lower for patients from the highest income group as compared to the lowest. Qualitative findings indicated that increased use of health services not covered by the standard package of the model was likely to have caused the increase in financial burden. The implementation of the new financing and payment model did not protect patients, especially those from the lowest income group, from financial difficulty, due partly to their increased use of health service. More financial resources should be mobilized to increase financial protection, particularly for poor patients, while cost containment strategies need to be developed and effectively implemented to improve the effective coverage of essential healthcare in China.

Research paper thumbnail of Over‐ and under‐treatment of TB patients in Eastern China: an analysis based on health insurance claims data

Tropical Medicine & International Health, Jul 29, 2019

objective Poor compliance with existing guidelines for tuberculosis (TB) care and treatment is an... more objective Poor compliance with existing guidelines for tuberculosis (TB) care and treatment is an issue of concern in China. We assessed health service use by TB patients over the entire treatment process and compared it to the recommended guidelines. methods We collected insurance claims data in three counties of one province of Eastern China. Patient records with a diagnosis of 'pulmonary TB' in 2015 and 2016 were extracted. Treatment duration, number of outpatient (OP) visits and hospital admissions, as well as total cost, out-ofpocket (OOP) payments and effective reimbursement rates were analysed. results A total of 1394 patients were included in the analysis. More than 48% received over the 8 months of treatment that TB guidelines recommend, and over 28% received less. 49% of Urban and Rural Resident Basic Medical Insurance (URRBMI) TB patients were hospitalised while 30% of those with Urban Employee Basic Medical Insurance (UEBMI) had at least one admission. Median total cost for patients with hospital admission was almost 10 times that of patients without. By comparison, the average OOP was 5 times higher. UEBMI patients had a shorter treatment period, more outpatient visits but considerably fewer hospital admissions than URRBMI patients. conclusions We found an alarming extent of TB over-and under-treatment in our study population. There is an urgent need to improve compliance with treatment guidelines in China and to better understand the drivers of divergence. Extending the coverage of health insurance schemes and increasing reimbursement rates for TB outpatient services would seem to be key factors in reducing both the overall cost and financial burden on patients.

Research paper thumbnail of Impact of an innovative tuberculosis financing and payment model on health service utilization by tuberculosis patients in China: do the poor fare better than the rich?

Infectious Diseases of Poverty, Jun 11, 2019

Background: Tuberculosis (TB) prevalence is closely associated with poverty in China, and poor pa... more Background: Tuberculosis (TB) prevalence is closely associated with poverty in China, and poor patients face more barriers to treatment. Using an insurance-based approach, the China-Gates TB program Phase II was implemented between 2012 and 2014 in three cities in China to improve access to TB care and reduce the financial burden on patients, particularly among the poor. This study aims to assess the program effects on service use, and its equity impact across different income groups. Methods: Data from 788 and 775 patients at baseline and final evaluation were available for analysis respectively. Inpatient and outpatient service utilization, treatment adherence, and patient satisfaction were assessed before and after the program, across different income groups (extreme poverty, moderate poverty and non-poverty), and in various program cities, using descriptive statistics and multi-variate regression models. Key stakeholder interviews were conducted to qualitatively evaluate program implementation and impacts. Results: After program implementation, the hospital admission rate increased more for the extreme poverty group (48.5 to 70.7%) and moderate poverty group (45.0 to 68.1%), compared to the non-poverty group (52.9 to 64.3%). The largest increase in the number of outpatient visits was also for the extreme poverty group (4.6 to 5.7). The proportion of patients with good medication adherence increased by 15 percentage points in the extreme poverty group and by ten percentage points in the other groups. Satisfaction rates were high in all groups. Qualitative feedback from stakeholders also suggested that increased reimbursement rates, easier reimbursement procedures, and allowance improved patients' service utilization. Implementation of case-based payment made service provision more compliant to clinical pathways. Conclusion: Patients in extreme or moderate poverty benefited more from the program compared to a non-poverty group, indicating improved equity in TB service access. The pro-poor design of the program provides important lessons to other TB programs in China and other countries to better address TB care for the poor.

Research paper thumbnail of Monitoring progress towards the Millennium Development Goals at country level 1

Research paper thumbnail of Pension and Health Services Utilization: Evidence from Social Pension Expansion in China

SSRN Electronic Journal, 2020

Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch ge... more Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden. Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen. Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. Terms of use: Documents in EconStor may be saved and copied for your personal and scholarly purposes. You are not to copy documents for public or commercial purposes, to exhibit the documents publicly, to make them publicly available on the internet, or to distribute or otherwise use the documents in public. If the documents have been made available under an Open Content Licence (especially Creative Commons Licences), you may exercise further usage rights as specified in the indicated licence.

Research paper thumbnail of Introduction to the Three- County Study

12 A number of the articles in this volume are based on case studies in three counties: Donglan i... more 12 A number of the articles in this volume are based on case studies in three counties: Donglan in Guangxi province,' Shibing in Guizhou province and Xunyi in Shaanxi province. Fieldwork and data analysis were carried out in collaboration with a research institution in each province: Guangxi Health Management College, Guiyang Medical College and Xi'an Medical University The health bureaux of each province have also participated in the programme.

Research paper thumbnail of Research on the current state of PRS monitoring systems

Research paper thumbnail of What do we mean by 'major illness'? The need for new approaches to research on the impact of ill- health on poverty 1

Research paper thumbnail of New technology and illness self-management: Is the approach relevant for resource-poorpopulations?

Advances in technology have made it possible for many standard diagnostic and monitoring procedur... more Advances in technology have made it possible for many standard diagnostic and monitoring procedures, previously the preserve of qualified providers in medical facilities, to be undertaken by patients or carers in their own homes. The results can then be available over the internet for review, assessment and possibly timely response by service providers. It is suggested that this approach can both improve patient quality of life, by reducing the need for facility visits, and possibly quality of care, by engaging patients in the active management of their condition, for example encouraging lifestyle changes (McDermott and While 2013). It is also seen by many developed economies with aging population as a way to reduce the ever rising cost of providing medical care (Lindberg et al., 2013).

Research paper thumbnail of Introduction: Real Time Monitoring for the Most Vulnerable - Investing in Common Guidance for Equity and Quality

IDS Bulletin, Mar 1, 2013

Research paper thumbnail of The impact of increased reimbursement rates under the new cooperative medical scheme on the financial burden of tuberculosis patients

Infectious Diseases of Poverty, Aug 2, 2019

Research paper thumbnail of The RIM Initiative in Vietnam: ‘Prioritise Rapid Results rather than Publishable Results’

IDS Bulletin, Mar 1, 2013

The 2009 Rapid Impact Monitoring (RIM) initiative in Vietnam was one of a number of studies under... more The 2009 Rapid Impact Monitoring (RIM) initiative in Vietnam was one of a number of studies undertaken in East Asia and Pacific countries to assess the initial poverty and social impacts of the global economic crisis. In Vietnam, the exercise was undertaken by the Centre for Analysis and Forecasting (CAF) of the Vietnamese Academy of Social Sciences (VASS). A favourable response to the findings led to additional RIM exercises in 2010 and 2011. It has been suggested that it should become a permanent feature of the policy process in Vietnam, assessing the impacts of both external shocks and major policy initiatives. This case study was intended to assess the RIM as an RTM tool, and more generally to assess the potential value of qualitative RTM exercises. The key finding was that such exercises can play an important role in situations where current, reliable data from other sources is lacking.

Research paper thumbnail of Evaluation: Why, for Whom and How?

IDS Bulletin, Nov 1, 2010

The overall objective of this article is to discuss current theoretical debates in the evaluation... more The overall objective of this article is to discuss current theoretical debates in the evaluation literature to assess their relevance for agriculture. After noting the 'bad press' of monitoring and evaluation (M&E) in agriculture, the literature is selectively reviewed to see what light is shed from different evaluation paradigms and methodologies. Experiences in the health sector are then examined in greater depth, emphasising debates around randomised controlled trials (RCTs). The final section considers some possible ways forward.

Research paper thumbnail of New Information Technology - Old Information Habits?

IDS Bulletin, Apr 1, 1994

Research paper thumbnail of Household Structure, Left-Behind Elderly, and Rural Migration in China

Journal of Agricultural and Applied Economics, Aug 1, 2016

Research paper thumbnail of How and to What Extent Can Pensions Facilitate Increased Use of Health Services by Older People: Evidence From Social Pension Expansion in Rural China

Research Square (Research Square), Jun 16, 2020

Research paper thumbnail of Lessons Learned from Implementing E-Learning for the Education of Health Professionals in Resource-Constrained Countries

Electronic Journal of e-Learning, 2017

The growing global demand for tertiary education has led to the increased use of e-learning appro... more The growing global demand for tertiary education has led to the increased use of e-learning approaches around the world. Demand has increased most rapidly in low and middle income countries (LMICs), which account for half of the students currently enrolled in higher educational institutions (HEIs). But the implementation of e-learning programmes in resource-constrained settings faces many obstacles. This paper explores some of the key issues involved in implementation of e-learning in HEIs involved in the education of health professionals, given the resource constraints within which many institutions have to function. We present case studies of three such LMIC institutions of varying size and primary purpose. The paper suggests use of appropriate ICT infrastructure, both in terms of hardware and software, combined with effective access and bandwidth management policies is crucial to the successful implementation of e-learning courses on health within HEIs based in LMICs.

Research paper thumbnail of Utilisation of Health Services in Poor Rural China: An Analysis Using a Logistic Regression Model

Research paper thumbnail of Health Expenditure and Finance in Three Poor Counties of China

Research paper thumbnail of Distance- and blended-learning in global health research: potentials and challenges

Global Health Action, Oct 6, 2016

Research paper thumbnail of Impact of an innovative financing and payment model on tuberculosis patients’ financial burden: is tuberculosis care more affordable for the poor?

Infectious Diseases of Poverty, Mar 24, 2019

Background: In response to the high financial burden of health services facing tuberculosis (TB) ... more Background: In response to the high financial burden of health services facing tuberculosis (TB) patients in China, the China-Gates TB project, Phase II, has implemented a new financing and payment model as an important component of the overall project in three cities in eastern, central and western China. The model focuses on increasing the reimbursement rate for TB patients and reforming provider payment methods by replacing fee-forservice with a case-based payment approach. This study investigated changes in out-of-pocket (OOP) health expenditure and the financial burden on TB patients before and after the interventions, with a focus on potential differential impacts on patients from different income groups. Methods: Three sample counties in each of the three prefectures: Zhenjiang, Yichang and Hanzhong were chosen as study sites. TB patients who started and completed treatment before, and during the intervention period, were randomly sampled and surveyed at the baseline in 2013 and final evaluation in 2015 respectively. OOP health expenditure and percentage of patients incurring catastrophic health expenditure (CHE) were calculated for different income groups. OLS regression and logit regression were conducted to explore the intervention's impacts on patient OOP health expenditure and financial burden after adjusting for other covariates. Key-informant interviews and focus group discussions were conducted to understand the reasons for any observed changes. Results: Data from 738 (baseline) and 735 (evaluation) patients were available for analysis. Patient mean OOP health expenditure increased from RMB 3576 to RMB 5791, and the percentage of patients incurring CHE also increased after intervention. The percentage increase in OOP health expenditure and the likelihood of incurring CHE were significantly lower for patients from the highest income group as compared to the lowest. Qualitative findings indicated that increased use of health services not covered by the standard package of the model was likely to have caused the increase in financial burden. The implementation of the new financing and payment model did not protect patients, especially those from the lowest income group, from financial difficulty, due partly to their increased use of health service. More financial resources should be mobilized to increase financial protection, particularly for poor patients, while cost containment strategies need to be developed and effectively implemented to improve the effective coverage of essential healthcare in China.

Research paper thumbnail of Over‐ and under‐treatment of TB patients in Eastern China: an analysis based on health insurance claims data

Tropical Medicine & International Health, Jul 29, 2019

objective Poor compliance with existing guidelines for tuberculosis (TB) care and treatment is an... more objective Poor compliance with existing guidelines for tuberculosis (TB) care and treatment is an issue of concern in China. We assessed health service use by TB patients over the entire treatment process and compared it to the recommended guidelines. methods We collected insurance claims data in three counties of one province of Eastern China. Patient records with a diagnosis of 'pulmonary TB' in 2015 and 2016 were extracted. Treatment duration, number of outpatient (OP) visits and hospital admissions, as well as total cost, out-ofpocket (OOP) payments and effective reimbursement rates were analysed. results A total of 1394 patients were included in the analysis. More than 48% received over the 8 months of treatment that TB guidelines recommend, and over 28% received less. 49% of Urban and Rural Resident Basic Medical Insurance (URRBMI) TB patients were hospitalised while 30% of those with Urban Employee Basic Medical Insurance (UEBMI) had at least one admission. Median total cost for patients with hospital admission was almost 10 times that of patients without. By comparison, the average OOP was 5 times higher. UEBMI patients had a shorter treatment period, more outpatient visits but considerably fewer hospital admissions than URRBMI patients. conclusions We found an alarming extent of TB over-and under-treatment in our study population. There is an urgent need to improve compliance with treatment guidelines in China and to better understand the drivers of divergence. Extending the coverage of health insurance schemes and increasing reimbursement rates for TB outpatient services would seem to be key factors in reducing both the overall cost and financial burden on patients.

Research paper thumbnail of Impact of an innovative tuberculosis financing and payment model on health service utilization by tuberculosis patients in China: do the poor fare better than the rich?

Infectious Diseases of Poverty, Jun 11, 2019

Background: Tuberculosis (TB) prevalence is closely associated with poverty in China, and poor pa... more Background: Tuberculosis (TB) prevalence is closely associated with poverty in China, and poor patients face more barriers to treatment. Using an insurance-based approach, the China-Gates TB program Phase II was implemented between 2012 and 2014 in three cities in China to improve access to TB care and reduce the financial burden on patients, particularly among the poor. This study aims to assess the program effects on service use, and its equity impact across different income groups. Methods: Data from 788 and 775 patients at baseline and final evaluation were available for analysis respectively. Inpatient and outpatient service utilization, treatment adherence, and patient satisfaction were assessed before and after the program, across different income groups (extreme poverty, moderate poverty and non-poverty), and in various program cities, using descriptive statistics and multi-variate regression models. Key stakeholder interviews were conducted to qualitatively evaluate program implementation and impacts. Results: After program implementation, the hospital admission rate increased more for the extreme poverty group (48.5 to 70.7%) and moderate poverty group (45.0 to 68.1%), compared to the non-poverty group (52.9 to 64.3%). The largest increase in the number of outpatient visits was also for the extreme poverty group (4.6 to 5.7). The proportion of patients with good medication adherence increased by 15 percentage points in the extreme poverty group and by ten percentage points in the other groups. Satisfaction rates were high in all groups. Qualitative feedback from stakeholders also suggested that increased reimbursement rates, easier reimbursement procedures, and allowance improved patients' service utilization. Implementation of case-based payment made service provision more compliant to clinical pathways. Conclusion: Patients in extreme or moderate poverty benefited more from the program compared to a non-poverty group, indicating improved equity in TB service access. The pro-poor design of the program provides important lessons to other TB programs in China and other countries to better address TB care for the poor.

Research paper thumbnail of Monitoring progress towards the Millennium Development Goals at country level 1

Research paper thumbnail of Pension and Health Services Utilization: Evidence from Social Pension Expansion in China

SSRN Electronic Journal, 2020

Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch ge... more Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden. Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen. Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. Terms of use: Documents in EconStor may be saved and copied for your personal and scholarly purposes. You are not to copy documents for public or commercial purposes, to exhibit the documents publicly, to make them publicly available on the internet, or to distribute or otherwise use the documents in public. If the documents have been made available under an Open Content Licence (especially Creative Commons Licences), you may exercise further usage rights as specified in the indicated licence.

Research paper thumbnail of Introduction to the Three- County Study

12 A number of the articles in this volume are based on case studies in three counties: Donglan i... more 12 A number of the articles in this volume are based on case studies in three counties: Donglan in Guangxi province,' Shibing in Guizhou province and Xunyi in Shaanxi province. Fieldwork and data analysis were carried out in collaboration with a research institution in each province: Guangxi Health Management College, Guiyang Medical College and Xi'an Medical University The health bureaux of each province have also participated in the programme.