The interdisciplinary research programme Smarter Choices for Better Health has three goals. From these goals four action lines have emerged.
Help people to live longer healthier lives
Following major developments in molecular biology, computer science, micro-electronics, radio physics and many other areas, health care has acquired a much greater impact on the average person’s life over the past fifty years. There is still a lot of ground to make up, particularly among socio-economically deprived groups.
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Action Line: Prevention
Current developments in global health call for an increased focus on prevention. Preventive measures are vital to address the burden of non-communicable diseases and increase the sustainability of health care systems. The benefits of effective prevention are widely recognized, but how prevention efforts should be organized is hotly debated.
The goal of Action Line Prevention is to develop theoretical and evidence-based understanding of how to design impactful health interventions by considering the needs, preferences and context of individuals. We aim to increase scientific knowledge about the extent to which the effectiveness of interventions can be improved by tailoring them to (i) individual-level needs and preferences, including psychological traits and states, and (ii) environment-level contexts, such as economic, social, cultural, and institutional factors.
Keep health care affordable and accessible in the long term
Improved health care, an ageing population and financial incentive from health insurers mean rising costs. Without effective intervention, there is the risk that health care will become unaffordable in the long run. It is therefore vital that we examine how we can achieve the best results for the health of as many people as possible with limited resources.
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Action Line: Outcome based healthcare
Health care systems are under pressure and face significant challenges. In a context of rapidly expanding diagnostic and treatment options and growing concerns about the unsustainability of health spending growth, policymakers have been looking for methods and approaches to get more value for money, that is, to achieve the best possible outcomes for patients, delivered in a patient-centered manner at the lowest possible cost. Outcome-Based Health Care aims to contribute to the scientific basis for the pursuit of more effective health care.
Specifically, we focus on the following two main objectives:
- Development of methods for quantifying (between-provider differences in) outcomes, and assessment of the reliability (e.g., the role of random variation) and validity (e.g., the role of case-mix) of the resulting measures as indicators of quality of care.
- Development and testing of feasible methods for driving aggregate outcomes (both internal and external) and costs - including benchmarking and alternative payment models (e.g., bundled payment, pay-for-performance) - and assessment of their impact in terms of improvement of care processes, redesign of workflows, multidisciplinary collaboration, and quality and cost of care.
Action Line: Evaluation of healthcare
In recent years, the interest in valuing the benefits of health interventions has shifted from the common health-focused quality-adjusted-life-year (QALY) model towards capturing the full benefit of interventions by identifying additional dimensions of value beyond health, i.e. taking the quality of life into consideration. Based on literature and a theoretical framework, the Wellbeing Instrument Ten Domains (i.e. WiX) was developed in the Netherlands. A full-benefit Health Technology Application (HTA) decision making framework requires a rethink of policy-related preconditions.
Research is needed to determine when a HTA decision is sensitive to including other benefits than QALY as well as preferences. Research is also required to investigate whether an economic evaluation in terms of costs per WALY can act as a substitute for the costs per QALY evaluation and to determine the cut-off values (i.e. willingness to pay) for a WALY. Finally, existing economic evaluation and priority setting frameworks are insensitive to distributional considerations over QALY which likely matter more when incorporating more benefits such as WALYs. A unified welfare economics method could be used to guide decisions-makers to reach equitable distributions of QALYs and WALYs.
Increased equality in health
Although health care is becoming accessible to a growing number of people, there are still huge differences. To reduce these differences, it is important to examine what the main causes of the differences in health are.
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Action Line: Health equity
Despite efforts to reduce health inequalities, large health disparities by socioeconomic status remain. The Netherlands has a strong social safety net and relatively low financial barriers to preventive and curative health care, but the difference in life expectancy between the lowest and highest educated is about 4.5 years, while the difference in (self-perceived) healthy life expectancy is 13.5 years.
This Line of Action contributes in two ways to breaking down the barriers that prevent people of low social status from achieving better health. First, we document trends in inequalities in health across different parts of the life cycle and their relationship to and impact on inequalities in other social domains such as education, employment, and housing. Second, we will identify specific mechanisms underlying inequalities in health using (natural) experiments.