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Health Economics and Policy Group
 

With more than $90 billion spent in the Australian health sector each year, health economics is an increasingly important field of research used to inform policy makers on how best to spend the health dollar to improve services and health outcomes.

Established at the University of South Australia in 2007, the Health Economics and Policy Group (HEPG) conducts research, exploring how to effectively allocate resources to improve the health and wellbeing of the community.

Under the leadership of Professor Leonie Segal, the HEPG is working closely with the state government to increase health economics capacity in South Australia.

Professor Segal is a leading health economist in the areas of health system reform, priority setting and the evaluation of complex health policy initiatives, including those targeted at behaviour change. Professor Segal has over 15 years experience in health economic evaluation, gaining an enviable reputation as an evaluator of complex health policy and practice initiatives, including health reform experiments.

The group’s research can be classified into three areas – developing health economics research methods; applying health economics to important issues affecting health and wellbeing; and supporting the adoption of economics-informed policy and practice.
 

People

Staff
Professor Leonie Segal - founding research chair
Dr Duncan Mortimer - senior research fellow
Kim Dalziel - senior research fellow
Elena Gospodarevskaya - senior research fellow
Dr Matthew Leach - research fellow
Lesley Braybrook - research assistant
Liz Westwood - administration assistant/PA to Professor Segal

Research students
PhD Students:
Dr Jacqueline Amos
Ying Chen
Odette Gibson
Anna Gregory
Heidi Silverston

Honours Student:
Lesley Braybrook


Collaborators

Department of Health SA
Department of Families & Communities SA
Child, Youth & Women’s Health Service SA
Premier & Cabinet, Social Inclusion Unit
Department of Education SA
Australian Centre for Child Protection, University of South Australia
Australian Research Alliance for Children & Youth
Precedence Healthcare (Health IT)
Department of Psychology, Adelaide University
Department of General Practice, Melbourne University
Accident Research Centre, Monash University
Faculty of Business and Economics, Monash University
Public Health Information Development Unit, Adelaide University


Projects

Below is a selection of current and recent research projects involving members of the Health Economics and Policy Group.

Priority Setting in Child Protection: developing an evidence-based strategy to reduce child abuse and neglect and associated harms
Researchers: Prof Leonie Segal, Prof Dorothy Scott (Australian Centre for Child Protection UniSA) and Dr Paul Delfabbro (Adelaide University)
Funding: Australian Research Council; SA Dept of Families and Communities; Child, Youth and Women’s Health Service SA; SA Dept of Education; Premier and Cabinet; Social Inclusion Unit; SA Dept of Health
This project aims to inform state and national child protection policies by applying an evidence-based priority setting model to child maltreatment. Cost-benefit analysis will be applied to 30 interventions across education, health including mental health, child protection, drug and alcohol, justice and community renewal to determine where investment will yield greatest returns for society. An investment strategy will be developed with governments based on the results of the cost-benefit analysis and additional budget modelling. The methodology will be highly applicable to other complex social problems requiring whole of government strategies.

Development and implementation of an evidence-based primary healthcare workforce planning model to support best practice chronic disease management
Researchers: Prof Leonie Segal, Dr Mathew Leach, Prof Esther May, Prof Robyn McDermott, Dr John Glover (Adelaide University)
Funding: ARC Linkage Grant, SA Dept of Health
This project will apply an evidence-based health workforce-planning model to support best practice care delivery for people with chronic diseases. The model will be applied people with Type 2 Diabetes in Adelaide and Whyalla. It will inform government health workforce and health services planning, with the promise of improving access to best practice care for people with diabetes, and potentially other chronic conditions. It will also inform education and training of health professionals and support a more flexible response to health workforce needs.

Briefing paper 1: sub-populations with diabetes mellitus (PDF, 166kb)

Citizen Engagement: Listening to citizens views about Australia’s health system and prevention
Researchers: Prof B Oldenberg, V Lin, C Joyce, L Segal (associate investigator)
Funding: Queensland Department of Health, ACT Department of Health, SA Department of Health
The project will apply and evaluate innovative methods for engaging citizens in public policy debate. The project will use new methods to identify community perspectives about the future directions of the Australian health system. It will yield new and important perspectives from citizens on preventive health and health promotion, which can be used to develop better targeted and more effective prevention and promotion policies and strategies.

CDM-Net – A Broadband Health Network for Transforming Chronic Disease Management
Researchers: Prof Mike Georgeff, Prof Leonie Segal, Prof Leon Piterman, Monash University, Prof John Catford, Prof Trisha Dunning (Deakin University), Prof Bruce Rasmussen (Victoria University), Prof Colin Chapman (Victorian College of Pharmacy), et al.
Funding: Precedence Health Care, Australian Govt, Dept of Communications, IT & the Arts; Dept of Human Services, Victoria
This project is developing and implementing a broadband-based care planning tool to support best practice care in chronic disease management, applied as a case study to people with type 2 diabetes in the Barwon Region of Victoria. The health economic evaluation is designed to establish the performance of the CDM Net initiative in terms of ‘value for money’ – patient outcomes per additional cost – adjusting for any expected cost savings. The aim is also to estimate the impact of roll out beyond the trial population to the region, state or nation.

Building a cohort of Indigenous research leaders in community health development
Researchers: Prof Robyn McDermott, Prof Adrian Esterman, Prof John Buckley, A/Prof P d’Abbs, Dr K. Tsey, Prof Leonie Segal
Funding: NHMRC Capacity Building in Population Health Research
The project brings together a team of experienced health researchers supporting six indigenous health scholars to complete PhDs in areas of strategic importance for Indigenous health at the community level. Training received by the PhD students will provide them with the skills to address some of the most pressing Indigenous health issues and equip them to lead the next generation of health research and policy development.

Tai Chi for independent living: RCT of efficacy of Tai Chi in delaying disability among older people
Researchers: Dr Lesley Day, Prof Leon Flicker, A/Prof Keith Hill, A/Prof Damian Jolley, Prof Leonie Segal
Funding: NHMRC Project Grant
This project has three aims: to test the efficacy of Tai Chi in delaying disability among older people; to investigate the mechanisms by which Tai Chi intervenes in the disability pathway; and to determine the cost-effectiveness and cost-utility of the benefits of Tai Chi for older people. The primary outcome (disability) is being measured with the Late-Life Function and Disability Instrument. Secondary outcome measures include joint pain, stiffness and function, muscle strength, static and dynamic balance, life satisfaction, concentration and memory, falls and fear of falling, and anthropometric measures.

Modelling cost effectiveness of falls interventions in the elderly to inform a national falls strategy
Researchers: Dr Lesley Day, Prof Leonie Segal, James Harrison, Soufiane Boufous, Wendy Watson, Pam Albany, Caroline Finch
Funding: Commonwealth Govt contract, Falls Prevention & Injury Prevention Community Grants Program
This project will model the population level image in Australia of seven proven falls-prevention programs for community dwelling older people, incorporating costs and cost-effectiveness. It will also design and test formats for conveying model findings to policy officers and practitioners.

PEACH study – Patient Engagement and Coaching for health: An intensive treatment intervention for patients with type 2 diabetes in disadvantaged communities
Researchers: Prof Doris Young, Prof James Best, Dr Margaite Vale, Dr John Furler, Prof Leonie Segal, Prof Trisha Dunning
Funding: NHMRC GP Program Project Grant
This project will evaluate the effectiveness of a patient-focussed method for chronic disease self-management method (COACH program) for intensive diabetes treatment on health outcome measures in patients with type 2 diabetes, compared with usual care only, in order to achieve intensive treatment goals for T2D in a General Practice setting.

Methodological advancement in economic evaluation for the area of child protection
Researchers: Prof Leonie Segal, Ms Kim Dalziel
Funding: Australian Research Alliance for Children & Youth (2008)
This project brought together economic evaluation experts from around Australia to discuss methodological issues arising in child protection. Issues explored include measuring quality of life, intergenerational effects, benefits beyond individuals, combining disparate outcomes, evaluating complex interventions and use of cost benefit analyses. The project commenced dialogue and collaborative work between researchers of different disciplines and engaged methodologists in economic evaluations which has set a trajectory through research grants and joint publications that will advance the methods and make an impact on policy for child protection interventions.

Estimating the cost-effectiveness of alternative strategies to prevent neural tube defects
Researchers: Prof Leonie Segal, Kim Dalziel
Funding: Food Standards Australia & New Zealand
This research provided a framework for comparing the performance of alternative strategies to increase folate consumption and reduce the rate of neural tube defects. It provided cost-effectiveness input into Australian and New Zealand Government decision-making regarding an optimal strategy to reduce the rate of NTDs.

Validation of the ‘Transfer to Utility’ technique’ for mapping health status onto a utility score
Researchers: Prof Leonie Segal, A/P Graeme Hawthorne, A/P Anthony Harris, Dr Jonathon Sturm
Funding: NHMRC Project Grant
This research explored the TTU technique to i) establish the best method for estimating the regression equation between common health outcome measures and a utility score and validating that method; ii) test generalisability to other disease areas, for which quality of life is the primary objective of management (in stroke, drug dependence and depression); iii) develop and validate a method of translating the most commonly used measure of general health status, the SF-36, into a utility score, and iv) illustrate the application of the TTU in comparing interventions for the prevention and management of depression. The results will be of value to decision makers comparing the performance of medical/health care interventions across a range of diseases and modalities and to clinicians who practicing evidenced based health care. The potential health gains for the community are substantial, in supporting the redirection of resources to more effective and cost-effective.

Development of a value of life framework to assist priority setting decision making across sectors
Researchers: Prof Leonie Segal
Funding: ARC Discovery Grant
This research developed a framework for the adoption of a single value, or more realistically a single equation, for the value of life. It compared the value of life now incorporated into decision-making across several sectors, explicitly or implicitly, for which interventions are designed to reduce risk of death, and explored factors that might influence community views of the value of life. The research contributes to an understanding of how to incorporate risk of death into program and policy evaluation and provide evaluators with a consistent approach to be used across-sectors; as well as strengthening collaboration between various industry groups/government agencies, and exchange research skills and knowledge base.

Priority setting: How to reduce disease burden from: physical inactivity, poor nutrition, tobacco smoking, alcohol abuse and physical activity
Researchers: Prof Leonie Segal, Duncan Mortimer, Kim Dalziel
Funding: Commonwealth Department of Health & Ageing, Canberra
This research examined how best to reduce the burden of harm on the Australian community attributable to the four target lifestyle behaviours of physical inactivity, poor nutrition, alcohol misuse and tobacco smoking risk factors, by determining which interventions are most effective and cost effective.



Seminars and events

Publications

Below is a list of selected research publications involving members of the Health Economics & Policy Group (UniSA researchers are indicated in bold)

Peer reviewed publications

Accepted subject to revision

  1. Finch C, Day L, Donaldson A, Segal L, ‘Determining Policy – relevant formats for the presentation of falls research evidence’. Health Policy, provisional acceptance March 2009
     

  2. Mortimer D, Segal L, Sturm J. ‘Can we derive an ‘exchange rate’ between descriptive and preference-based outcome measures for stroke? Results from the transfer to utility (TTU) technique’ Health and Quality of Life Outcomes, provisional acceptance February 2009
     

  3. Segal L, Dalziel K, ‘Cost effectiveness of mandatory folate fortification versus other options for the prevention of neural tube defects: results from Australia and New Zealand’ Public Health Nutrition, provisional acceptance January 2009
     

  4. Watts J, Segal L, ‘Market failure, policy failure and other distortions in chronic disease markets’, provisional acceptance 20 January 2009

Published/in press

  1. Segal L, Dalziel K, Mortimer D, ‘Fixing the game: Are between-silo differences in funding arrangements handicapping some interventions and giving others a head-start?’ Health Economics, In press 2009
     

  2. Segal L, Bolton T, ‘Issues Facing the Healthcare Workforce: the importance of demand modelling’ Australia and NZ J of Health Policy, vol 6(12), May 2009
     

  3. Segal L, ‘The Place of Prevention in the Health Care System’, Public Health Bulletin, vol 6(1):22-26, March 2009
     

  4. Day L, C Finch, Segal L, ‘Reducing injuries from falls’, New England Journal of Medicine vol 359(15),1626, October 2008
     

  5. Hawthorne G, Densley K, Pallant J, Mortimer D, Segal L, ‘Deriving utility scores from the SF-36 health instrument using Rasch analysis’ Quality of Life Research, vol 17, 1183-1193, September 2008
     

  6. Watts J, Segal L, ‘Vouchers for chronic disease care’, Australian Health Review 2008, vol 32(3):451-458, August 2008
     

  7. Segal L, Dalziel K, ‘A Workforce model to support the adoption of best practice care in Chronic Diseases – A missing piece in clinical guidelines implementation’, Implementation Science, vol 3(35), June 2008
     

  8. Dalziel K, Segal L, Mortimer D, ‘Review of Australian health economic evaluation - 245 interventions: What can we say about cost-effectiveness?’, Cost Effectiveness and Resource Allocation 2008, vol 6(9), May 2008

  9. Mortimer, D, Segal, L, ‘Is the value of a life or life-year saved context specific? Further evidence from a discrete choice experiment’, Cost Effectiveness and Resource Allocation, vol 6(8), May 2008
     

  10. Mortimer D, Segal L, ‘Comparing the Incomparable? A systematic review of competing techniques for converting descriptive measures of health status into QALY-weights’ Medical Decision Making, vol 28(1) 66-89, February 2008
     

  11. Mortimer D, French S, McKenzie J, O’Connor D, Green S, on behalf of the IMPLEMENT study group, ‘Protocol for economic evaluation alongside the IMPLEMENT cluster randomised controlled trial’, Implementation Science, Vol 3(12), 2008
     

  12. Mortimer D, French S, McKenzie J, O’Connor D, Green S, on behalf of the IMPLEMENT study group, ‘IMPlementing a clinical practice guideline for acute Lower back pain Evidence based management in general practice (IMPLEMENT): cluster randomised controlled trial study protocol’, Implementation Science, Vol 3(11), 2008
     

  13. Leach, MJ. Gillham D, ‘Evaluation of the Evidence-Based practice Attitude and utilization SurvEy (EBASE) for complementary and alternative medicine practitioners’. Journal of Evaluation in Clinical Practice: In Press 2008,
     

  14. Leach, MJ, ‘Planning: a necessary step in clinical care’. Journal of Clinical Nursing: 17(3): 1728-1734, 2008.
     

  15. Leach, MJ, ‘Calendula officinalis for wound healing: a systematic review’. WOUNDS: 20(8): 236-243, 2008.
     

  16. Leach, MJ. Kumar, S, ‘The clinical effectiveness of Ginger (Zingiber officinale) in adults with osteoarthritis’. International Journal of Evidence-based Healthcare. 6(3): 311-320, 2008,
     

  17. Leach, MJ, ‘The naturopathic process: a framework for naturopathic practice’. Journal of the Australian Traditional Medicine Society. 14(1): 7-10, 2008
     

  18. Leach, MJ, ‘Natural wound care’. Journal of Complementary Medicine. 7, 32-35,65, 2008
     

  19. Mortimer D, Segal L. Hawthorne G, Harris A, ‘Item-based versus subscale-based mappings from the SF-36 to a preference-based quality of life measure’ Value in Health, vol 10(5):398-407, November 2007
     

  20. Dalziel K, Segal L, ‘Time to give nutrition interventions a higher profile: Cost-utility analysis of 10 nutrition interventions’, Health Promotion International, vol 22(4):271-283,October 2007
     

  21. Segal L, ‘Multidisciplinary care plans improve care for patients with type 2 diabetes: Is it the care plans or the multi-disciplinary care?’ Comment; Australian Family Physician, Vol 36(9) p.679, May 2007
     

  22. Young D, Furler J, Vale M, Walker C, Segal L, Dunning P, Best J, Blackberry I, Audehm R, Sulaman N, Dunbar J, Chondros P, ‘Patient Engagement and Coaching for Health: The PEACH study - A cluster randomised controlled trial using the telephone to coach people with type 2 diabetes to engage with their GPs to improve diabetes care: A Study Protocol’ BMC Family Practice, vol 8(20) (open access journal), April 2007
     

  23. Segal L, Dalziel K, ‘Economic evaluation of obesity interventions in children and adults’ International Journal of Obesity, vol 31:1183-1184, March 2007
     

  24. Segal L, Dalziel K, ‘Analysis and interpretation of child protection data: a comment on Ainsworth and Hansen (2006;11:33-41)’, Child and Family Social Work, vol 12(4): 434-35, 2007
     

  25. Hollingsworth BA, Harris A, Mortimer D, ‘The cost-effectiveness of intracytoplasmic sperm injection (ICSI)’ Journal of Assisted Reproduction and Genetics, Vol 24(12), 571-577, 2007
     

  26. Leach MJ, ‘Gymnema sylvestre for diabetes mellitus: a systematic review’. Journal of Alternative and Complementary Medicine. 13(9): 977-984, 2007
     

  27. Leach MJ, ‘Revisiting the evaluation of clinical practice’. International Journal of Nursing Practice. 13(2): 70-74, 2007
     

  28. Leach MJ, ‘Orthodox use, or misuse, of complementary and alternative medicine?’ Journal of Complementary & Integrative Medicine. 4(1): 1-5, 2007
     

  29. Dalziel K, Segal L, ‘Short Communication- Uncertainty in economic analysis of school based interventions to prevent obesity’ Obesity Research, vol 14(9):1481-1484, September 2006
     

  30. Gospodarevskaya E, Goergen S, Harris A, Chan T, deCampo J, Wolfe R, Gan E, Wheeler M, McKay J. ‘Economic evaluation of a clinical protocol for diagnosing emergency patients with suspected pulmonary embolism’, Cost Effectiveness and Resource Allocation, 2006 vol 4(12), 27 June 2006, http://www.resource-allocation.com/content/4/1/12
     

  31. McDermott R, Segal L., ‘Cost impact of improved primary level diabetes care in remote Australian Indigenous communities’ Australian Journal of Primary Health, vol 12(2):134-140, 2006
     

  32. Dalziel K, Segal L, ‘A Mediterranean diet is cost-effective for those with previous myocardial infarction’, Journal of Nutrition 2006, vol 136, 1879-1885, 2006
     

  33. Segal L, Mortimer D, ’A population-based model for priority setting across the care continuum and across modalities’ Cost Effectiveness and Resource Allocation, vol 4(6), March 2006
     

  34. Mortimer D, Segal L, ‘Economic Evaluation of Interventions for Problem Drinking and alcohol dependence: do within-family external effects make a difference? Alcohol and Alcoholism, vol 41(1): 92-98, 2006
     

  35. Dalziel K, Segal L, Elley R, ‘Cost utility analysis of physical activity counselling in general practice’, Australian and New Zealand J of Public Health, vol.30(1) 57-63, 2006
     

  36. Whitfield K, Buchbinder R, Segal L, Osborne R., ‘Parsimonious and Efficient Assessment of Health-related Quality of Life in Osteoarthritis: Validation of the Assessment of Quality of Life (AQoL) Instrument’ Health and Quality of Life Outcomes, vol 4(19), March 2006
     

  37. Dalziel K, Stein K, Round A, Garside R, Royle P, ‘Endoscopic Sinus Surgery for The Excision of Nasal Polyps: A Systematic Review of Effectiveness and Safety’, American Journal of Rhinology, Vol 20(5): 506-519, 2006
     

  38. Goergen SK, Fong C, Dalziel K, Fennessy G, ‘Can an evidence-based guideline reduce unnecessary imaging of road trauma patients with cervical spine injury in the emergency department?’ Australasian Radiology, Vol 50:563-569, 2006
     

  39. Mortimer D, ‘The value of thinly-spread QALYs’, Pharmacoeconomics Vol 24(9):845-853, 2006
     

  40. Mortimer D, Kelly J, ‘Economic evaluation of the Good Life Club intervention for diabetes self-management’ Australian Journal of Primary Health, Vol 12(1): 92-101, 2006
     

  41. Mortimer D, French S, ‘Can dissenting findings with respect to the comparative effectiveness of ICSI and IVF be explained by a learning curve?’ Journal of Assisted Reproduction & Genetics, Vol 23(1): 33-36, 2006
     

  42. Richardson J, Peacock S, Mortimer D, ‘Does an increase in the Doctor Supply Reduce Medical Fees? An Econometric Analysis of Medical Fees across Australia’, Applied Economics, Vol 38(1): 253-266, 2006
     

  43. Leach MJ, ‘Evidence-based practice: a framework for clinical practice and research design’. International Journal of Nursing Practice. 12(5): 248-51, 2006
     

  44. Leach MJ, ‘Wound management: using Levine's conservation model to guide practice’. Ostomy Wound Management. 52(8): 74-80, 2006,
     

  45. Leach MJ. Pincombe J. Foster G, ‘Using Horsechestnut Seed Extract in the treatment of venous leg ulceration: a cost-benefit analysis’. Ostomy/Wound Management.52(4): 68-78, 2006
     

  46. Leach MJ. Pincombe J. Foster G, ‘Clinical efficacy of horsechestnut seed extract in the treatment of venous ulceration’. Journal of Wound Care. 15(4): 159-167, 2006
     

  47. Leach MJ. ‘Integrative health care: a need for change’. Journal of Complementary & Integrative Medicine. 3(1): 1-11, 2006
     

  48. Dalziel K, Segal L, ‘Overstated cost effectiveness – comment on the Victorian Active Script Programme’ letter, British Journal of Sports Medicine Online, (comment on article by Sims et al BJSM 2004 (38):19-25), February 2005
     

  49. Mortimer D, Segal L, ‘Economic Evaluation of Interventions for Problem Drinking and alcohol dependence cost/QALY estimates’, Alcohol and Alcoholism, vol 40(6) 549-555, 2005
     

  50. Leach MJ, ‘Rapport: a key to treatment success’. Complementary Therapies in Clinical Practice. 11(4): 262-265, 2005

Edited publications including book chapters

  1. Dalziel K, Segal L, Ratcliffe J, ‘Economic Evaluation in Child Protection: What are the Special Challenges?’ Economic Evaluation in Child Health, Book chapter, Oxford Press, in press 2009

Other publications: research reports etc.

  1. Segal L, ‘A vision for Primary Care: Funding and other system factors for optimising the Primary Care contribution to the community’s health’, A paper for the National Health and Hospital Reform Commission (NHHRC), September 2008, www.nhhrc.org.au
     

  2. Day L, Hoareau E, Finch C, Harrison J, Segal L, Bolton T, Bradley C, Boufous S, ‘Modelling the impacts costs and benefits of falls prevention measures to support policy-makers and program planners, Ullah and National Injury Prevention Injury Working Group, Report to Department Health and Ageing, September 2008
     

  3. Dalziel K, Segal L, Ratcliffe J, ‘Economic evaluation in child protection – Past, Present and Future’, ARACY Briefing paper, April 200859. Segal L, Dalziel K, Katz R, ‘Informing a Strategy to Increase Folate Levels to prevent Neural Tube defects: A Cost-effectiveness Analysis of Options’, A Report to FSANZ (Food Standards Australia & New Zealand), May 2007, www.foodstandards.gov.au
     

  4. Gospodarevskaya E, Churilov L. ‘Linking the “social” and the “technological” together: a case study of a nursing information flow in the neurosciences ward of a public hospital’, Proceedings of the ISOneWorld 2007 Annual Conference, Las Vegas, NV, 11-13 April, 2007
    (PDF, 212kb)
     

  5. Gospodarevskaya E, Churilov L. and Wallace L. ‘Modelling the patient care process of an acute care ward in a public hospital’, Proceedings of the Thirty-Eighth Annual Hawaii International Conference on System Sciences (HICSS-38), Hawaii, 3-6 January, 2005. (ISBN 0-76952268-8; ISSN 1530-1605)

     

Contact

Health Economics and Policy Group
Phone: 61-8-8302 1422
Fax: 61-8-8302 2337
Email: liz.westwood@unisa.edu.au

 

 

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