research topics in health economics

• Open access
• Published: 12 May 2023

Global trends in the scientific research of the health economics: a bibliometric analysis from 1975 to 2022

• Liliana Barbu   ORCID: orcid.org/0000-0003-0641-7483 1  

Health Economics Review volume  13 , Article number:  31 ( 2023 ) Cite this article

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Health science is evolving extremely rapidly at worldwide level. There is a large volume of articles about health economics that are published each year. The main purpose of this research is to explore health economics in the world's scholarly literature based on a scient metric analysis to outline the evolution of research in the field.

The Web of Science repository was used to get the data (1975–2022). The study explores 1620 documents from health economics. CiteSpace software was used to provide network visualisations. Four thousand ninety-six authors, 1723 institutions, 847 journals and 82 countries were involved in the sample. The current research contains a descriptive analysis, a co-authorship analysis, a co-citation analysis, and a co-occurrence analysis in health economics.

Drummond M.F (author), the USA (country), University of London (institution) and Value Health (journal) are among the most important contributors to the health economics literature. Co-authorship analysis highlights that cooperation between authors, institutions and countries is weak. However, Drummond M.F. is the most collaborative author, the USA is the most collaborative country, and University of York is the most collaborative institution. The study offers an image about the most co-cited references (Arrow K.J., 1963), authors (Margolis H.) and journals (British Medical Journal). The current research hotspots in health economics are “behavioural economics” and “economic evaluation”. The main findings should be interpreted in accordance with the selection strategy used in this paper.

All in all, the paper maps the literature on health economics and may be used for future research.

Introduction

The health economy is a branch of the economy that deals with concerns of the production and consumption of health services and healthcare that relate to efficiency, effectiveness, value, and behaviour. Applying economic ideas, concepts, and methods to institutions, actors, and activities that have an impact on people's health is known as health economics [ 1 ]. The health economy is studying how to allocate limited resources to meet human desires in the medical industry and disease care. The health economy often tries to meet the most pressing challenges facing the health system. Studies in health economics provide to decision-makers precious information about the effective use of resources that are available to maximize health benefits.

The health economics is a component of public health, a component that It can be used to examine health issues and medical treatment. Health economists consider the origin of their discipline to Petty W. (1623–1687) [ 2 ] who propose valuation of human life based on a person’s contribution to national production. Arrow K. is credited with creating the field of health economics in a work where he conceptually distinguished between health and other goods [ 3 ]. Since Arrow K.'s fundamental publication on health economics from 1963, the scale of the healthcare sector, the share of public budgets allocated to healthcare, and the body of research on health economics have all increased significantly [ 4 ].

The current pandemic context has proved the need for a functioning public health system capable of meeting any challenges. The World Health Organization report for 2020 presents an examination of 190 nations' global health spending from 2000 to 2018. The report shows that global health spending has increased consistently between 2000 and 2018, reaching $ 8.3 trillion, or 10% of world GDP [ 5 ]. At the level of OECD Member States, the latest estimates show an average increase in health spending of about 3.3% in 2019, whereas health spending as a percentage of GDP stayed about where it had been in prior years, at 8.8% [ 6 ]. These indicators rose sharply in 2020, as economies faced a pandemic. The increases were driven by an increase in the level of allocation of government resources for health, while private spending on health tended to decline. At EU level, the public sector plays a major role in funding health services. In 2/3 of Member States, more than 70% of health spending is funded by the public sector [ 7 ]. In 2020, the EU's overall public health spending was €1.073 billion, or 8.0% of GDP ( https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Government_expenditure_on_health ). For governments, public spending on health is one of the spending categories with the quickest growth.

Health economics is the application of economic theory, models, and empirical techniques to the analysis of decision-making by individuals, health care providers, and governments regarding health and health care. Even though the methodologies are distinct in terms of health care, health economics aims to apply the same analytical tools that would be applied to any good or service that the economy provides [ 8 ]. By offering a clear framework for decision-making based on the efficiency principle, health economics seeks to simplify decision-making [ 9 ]. Extensive government interference, insoluble uncertainty in many dimensions, asymmetric knowledge, barriers to entry, externality, and the presence of a third-party agent are all characteristics that set health economics apart from other fields [ 10 ].

Health economics is the field were interdisciplinarity bring additional value for society. Health economics development has not been without controversy. Health economics refers to a variety of elements that interact to affect the expenses and spending of the healthcare sector. Its controversy rises from the roles of people, healthcare providers, insurers, governmental bodies, and private companies in influencing the healthcare sector expenses. The parties that interact in this field have some conflicting goals. On the one hand, health care policymakers and public hospitals have as objective to provide real value to the patients, to balance public interest and economic restrictions. On the other hand, private hospitals, insurance companies aim to obtain profit for their shareholders. There are several weaknesses that should be rectified in the future. Among weaknesses it can be found deficiencies in the supply of health economists [ 11 ], a lack of financial resource independence between the local and central levels, the key macroeconomic variables' unfavourable behaviour, and the difficulty in developing new financing alternatives [ 12 ]. In addition to having too close relationships to national institutions and sponsors of health economics research, health economics also has excessively loose connections with general economic theory [ 13 ]. Considering increased demands in healthcare services and limited health care budgets, health economics faces real challenges in providing decision making frameworks and there will always be challenging healthcare decisions. Although it has not always been an impartial instrument, health economics does give useful information for policy [ 14 ]. Regarding how well economics integrates with promoting health, there is scepticism, and public health has mixed feelings on the subject. Health economics has been accused of focusing more on the consumption of healthcare services than the creation of healthcare [ 15 ]. Despite several methodological limitations, health economics can provide helpful concepts and principles that aid in comprehending the effects of resource allocation decisions [ 9 ]. All practitioners must have a elementary comprehension of some economic concepts to both understand the helpful ideas the field may provide and recognize its inadequacies.

The main purpose of the research is to examine the health economics literature published worldwide based on a scient metric analysis to outline the development of the field's research. The existence of a multitude of articles published on health economics determines the need to address and measure it quantitatively. Such an analysis is justified by the need must be aware of the current trends and future directions of research in the field of health economics. Health science is evolving extremely rapidly at worldwide level. There is a large volume of articles about health economics that are published each year. Another argument is that there several computer programs which allows for scient metric analysis of health economics publications. This article contributes to the bibliometric literature on health economics by offering answers to the subsequent research inquiries: How scientific production has evolved in health economics? Who are the most important authors and publications in health economics? What are the geographical and institutional hubs of knowledge production in health economics? What kind of collaboration between authors, organizations, and nations are there in the field of health economics research? Which are the most cited authors and the most cited papers, and which are the most attractive journals for publishing research results in health economics? What are the most debated conceptual approaches in health economics?

The remainder of the paper is structured as follows. The second section introduces a short literature review. Research methodology and data collection are presented in Sect. 3. Section 4 contains the quantitative and qualitative scient metric analysis on health economics by using CiteSpace software (descriptive analysis, collaboration analysis, co-citation analysis and keywords co-occurrence analysis). The last part concludes the analysis, presents the research limitations, and describes future directions of research.

Literature background

Although there are thousands of articles published on health economics, very few articles aim for bibliometric analysis of the field and use computer programs. A first article published by Rubin, R. M. and Chang, C. F. (2003) aims at the study of 5,545 indexed articles, in the period 1991–2000, in the EconLit database, in the Health Economics section [ 16 ]. The second study is published by Wagstaff, A. and Culyer, A. J. in 2012 and extends the previous bibliometric research done by Rubin and Chang also based on the articles indexed in EconLit on health, over 40 years [ 17 ]. The third study, published by Moral-Munoz J.A et all in 2020, focuses on articles indexed in the Web of Science, between 2010 and 2019, which have the word "health" and do not use scientometric software [ 18 ].

It would be worth mentioning a descriptive analysis of the field conducted by Jakovljevic M. and Pejcic A. in 2017, but without the use of bibliometric indicators. The authors quantitatively analyze health economics publications by querying the PubMed, Scopus, WoS and NHS economic evaluation Database between 2000 and 2016 and conclude with the existence of an upward flow of health economics publications [ 19 ]. In this context, the proposed research is characterized by focusing on WoS articles that refer strictly to "health economics" and their computer processing to obtain maps and connections between studies.

Research methodology

Research methods.

In the current paper two research methods were used: bibliometric analysis and knowledge mapping. Regarding the first one, it should be mentioned that bibliometric research methods are used delivering quantitative analysis of textual works, in this case publications about health economics. This method allows bibliographic overviews of scientific production in the field. In the scientific community, the technique is increasingly employed to provide details regarding relationships between various groups [ 20 ]. Bibliometric analysis uses statistical tools and different metrics as part of the analysis (frequency/ count, co-citation, co-authorship, co-occurrence, betweenness centrality, citation burst, modularity, centrality, sigma, Silhouette etc.). Bibliometric analysis naturally presents itself as a tool to qualify, then quantify, the study conducted [ 21 ].

Regarding the second one, bibliometric analysis uses a large quantity of information that should be transformed in knowledge. This is done by using data visualization and knowledge maps. An enormous and complex collection of knowledge resources can be more easily accessed and navigated by using knowledge mapping strategies [ 22 ]. Knowledge mapping is the process of making knowledge maps, it makes explicit knowledge graphic and visual. Knowledge maps are static, they are a “snapshot in time” that aids in understanding and organizing knowledge flow for researchers [ 23 ]. A process, method, or instrument called “knowledge mapping” is used to analyse knowledge to find traits or meanings and perceive knowledge in an understandable and transparent way [ 24 ]. One of the advantages of knowledge mapping includes the freedom to combine without restriction, i.e., without restrictions on the number of connections and concepts that can be established [ 25 ].

Data source and search strategy

For this analysis we decided to use one of the most reliable databases: Web of Science (WoS) because it contains a data for large period. The data was retrieved from the Web of Science Core Collection by using title search tool TI = (health economics). The primary literature data were downloaded on 7th of October 2022. The query objective was to integrate in this analysis all research papers related to health economics. We did not introduce any restrictions regarding the topic or time span for searching documents. We intend to have a comprehensive view of the research area and to see its evolution over time. As a result, 2340 documents were retrieved. Among publications about health economics, the most numerous documents are the articles (37.6%), followed by editor materials (19.8%), meeting abstracts (13.9%) and book reviews (13.3%). There are also review articles on the subject, proceeding papers, letters, books, and book chapters which were kept in the sample. The other types of documents were removed resulting a sample of 2305 publications. The language of almost all publications is English (91.4%), followed by German (4.3%). The percentage of publications produced in other languages, such as French, Spanish, Portuguese, Russian etc. is less than 1.5% for each of them. Publications in other languages than English were eliminated, remaining 2108 documents in the sample.

The next step is to identify and remove duplicates by using Excel function (Conditional Formatting – Highlight Duplicate Values), therefore 8 duplicates were removed. In the sample under analysis, a multitude of types of documents indexed in WoS and referring to the concept of health economics can be observed. During the step of checking for duplications, it was found that there are too many duplicates of documents’ title, most of them due to editorial materials or book reviews. This led to a thorough analysis of publication by type of document (eg there are more than 10 reviews for one book or more than 10 editorial materials signed by the same editor). We identified some publications which are irrelevant for the purpose of our analysis. One hundred eighty-six editorial materials without citations and all 286 book reviews were removed resulting 1628 publications. We kept the editorial materials with citation because some of them have more than 100 citations. We searched for anonymous publications, more exactly we looked for incomplete data (author’s name is missing) and we removed 8 documents.

For the remaining documents the "Full Record and Cited References" was downloaded on 13th of October 2022 (txt files) and used as original data for the proposed bibliometrics analysis and science mapping. The final data collection, which consists of 1620 publications, is supported by 16,755 citing articles (excluding self-citations) and has been cited 18,504 times (excluding self-citations), giving it an H-index of 59. The data are statistical analysed by using annual distribution of publications, authors, journals. Co-authorship analysis focuses on collaboration between authors, institutions, and countries. Cited references, cited authors, and cited journal are used in co-citation analyses, and finally, the co-occurrence will integrate keyword in this research.

The graphical representation of selection procedure can be seen in Fig.  1 .

Selection procedure flow chart. Source: Authors

Visualization tools

Bibliometric method needs a certain amount of data to be statistically credible. This is the reason for that computerized data treatment is needed. Moreover, databases contain hundreds or thousands of entries which are analysed by using computer software. There is many bibliometric software, each of them has particularities and weaknesses. CiteSpace was chosen in this study because it is very user friendly, intuitively, and easy to use. CiteSpace 6.1.R2. available for free download at https://citespace.podia.com . A variety of networks created from scientific publications, such as collaboration networks, author co-citation networks, and document co-citation networks, are supported by structural and temporal analysis in CiteSpace. CiteSpace can produce knowledge domain X-rays. The CiteSpace parameters for this investigation were as follows: time-slicing was from 1975 to 2022, years per slice was 1 year, Look Back Years (LBY) = -1, Link Retaining Factor (LRF) = -1. For text processing and links, we preserved the default settings. We used several nodes (authors, institutions, journal, references, keywords) and metrics (such as citation burstiness, Sigma, Silhouette, rad Q, betweenness centrality) depending on the study that was done. Top N% is set to be equal to 100%, Top N is set to be 50, and g-index is set to be 25.

Statistical analysis

The first step to follow in the scient metric analysis is to analyse the evolution of publications’ number in the researched field. The way in which they are distributed over the years indicates the attention that the field of health economics has benefited from and the speed at which its conceptual development took place. The first 3 papers about health economics were published in 1975, indicating the lowest number of annual publications, but also a concept that has existed for over 4 decades. From Fig.  2 , a general upward trend of health economics publications can be observed, but with numerous upward and downward fluctuations, generating sinusoidal cycles with an average duration of 3–4 years. The period 1975 – 1986 is characterized by a very low number of publications, 98 publications written by 110 authors in 12 years, representing 6% of the total sample. The next two decades (1987 – 2006) are characterized by a slightly increasing trend in the number of publications, with an annual average of approximately 23 publications on health economics, reaching a total of 454 publications written by 826 authors and representing 28% of the total number of analysed publications. Cyclical evolution is highlighted by booms in 1987, 1990, 1995, 1999, 2001.

Literature production related to health economics between 1975 and 2022. Source: Authors

The following period, 2007 – 2022 (16 years) is characterized by an upward evolution of the number of health economics publications, 1068 publications with an annual average of 67 articles (3261 authors involved), meaning 2.3 times more numerous as in the previous two decades and representing 66% of the total sample. In 2017, 86 studies on health economics were published, reaching the highest value in the analysed period. The quantitative evolution of publications in health economics it is explained by a higher interest of the researchers and policymakers to explore the benefits of health economics. The need to identify the ways in which health economics contributes to the healthcare system development represent a solid motivation to continue intensive research in the field.

The evolution of the citations’ number follows, like a shadow, the evolution of publications’ number. The upward trend is maintained, also respecting the previously presented temporal distribution, but without cyclical and sinusoidal fluctuations. The evolution of the citations’ number indicates the growing interest of specialists in researching the field, especially after 2000 when a constant and galloping annual increase in citations begins. The last 5 years show a very high interest of researchers and academics in health economics research, with a maximum point in 2021, with over 2000 citations, an evolution argued by the emergence of the global pandemic. All the figures and observations indicate a constant interest in the conceptualization of health economics and foresee a deeper development in the future.

Geographical analysis allows a better understanding of the field. The 1620 publications involved the work of authors from 82 countries. Among them, the first 10 states with significant contributions in the field of health economics stand out: the USA (605 papers), England (400), Canada (115), Australia (103), Netherlands (75), Scotland (64), Germany (59), Switzerland (57), France (47) and Italy (43). 96.8% of all publications were produced by top-10 countries. According to statistics, the USA is the top nation. 37% of all analysed documents are written by American authors, which is 1.5 times more than values recorded by England (rank 2) and 5.2 times more than Canada, rank 3. There are 49 nations where there are fewer than or equal to 5 publications during entire period.

In our study, a sum of 4096 different authors were identified, and they individually published between one and 16 papers, but only 170 persons are co-authors of more than 3 papers. Table 1 lists the top 10 authors with publications about health economics. Drummond M.F. is the leader, even if he published Essentials of Health Economics with his co-author, Mooney G.H., in 1982. He is affiliated to University of Yor (the UK). The top ten most productive authors published 107 articles, which represents 6.6% of the total publications. The most authors (95.8% of all authors) contributed to the health economics research with less than two papers. It should be noted that the number of authors is 2.5 times over the number of papers., which means that publications are made by cooperation between researchers.

From the point of view of affiliation, the 4096 authors belong to 1723 institutions. The top 10 organizations with many health economics articles are University of London (91 publications), University of California System (54), University of York (51), Harvard University (45), University of Birmingham (41), University of Pennsylvania (34), University of Oxford (30), University of Aberdeen (28), University of California Los Angeles (28) and University of Washington (28). The list is dominated by institutions from the UK and the USA. The top-10 institutions contributed to health economics research field by 230 papers which represents 26.5% of total publications.

It is very important to see which journals have published the most articles about health economics. Regarding the publication’s titles, 847 distinct journals published all 1620 documents related to health economics. It should be mentioned that 782 journals (92.3%) published from one to three articles on health economics during 1975 – 2022. Table 2 lists the top 10 most prolific journals, and together they have published 364 articles, which means 43% of all publications in the sample. The leading journal is the Value in Health (Impact Factor = 5.156) with 160 papers meaning 9.8% of all publications from the sample.

Co-authorship analysis

Co-authorship networks and social network analysis are becoming more and more effective techniques for evaluating collaboration patterns and locating top scientists and institutions [ 26 ]. The author collaboration network can help identify authors with high contributions and reveal the co-operative relationships between the authors. By using CiteSpace, the co-authorship network was created without pruning the sliced networks. Co-authors network has 1028 nodes and 1166 links. Figure  3 presents the network between the most collaborative authors in health economics, all of them published 4 or more publications as co-authors. As indicated by the node name, each node represents a different author, and the font size corresponds to the number of publications for each author. The connections made by the co-authorship of researchers are represented by the interconnections between each pair of nodes. The degree of cooperation between the two authors is indicated by the thickness of the link.

The network of authors’ collaboration in health economics. Source: Authors

Co-authors’ map shows that there are not strong collaboration relationships between authors, the network density level is 0.0022. Moreover, they are divided in small research groups and cooperation for research in health economics is insignificant. Top five collaborative authors are Drummond M. (20 publications), Mooney G. (16), Trosch R. (8), Marchese D. (8) and Fuchs V. (8). They are followed by Basu A. (7), Edwards R. (7), Coast J. (7), Peeples P. (7) and Comella C. (6).

In Fig.  3 it can be seen the cooperation between two research teams. These research teams are formed around key authors in health economics and integrated as most collaborative ones. First research team is created around Drummond M. and Mooney G. They published in 1982 and 1983, in British Medical Journal, 9 papers about different aspects of health economics [ 27 , 28 ]. The second research team is created around Trosch R. and Marchese D., who participated between 2012 and 2015 at several annual meeting, conferences, and congresses to present their work about clinical and health economics outcomes registry in cervical dystonia [ 29 , 30 ]. There are 72 scholars as co-authors in at least 3 publications showing a weak cooperation in health economics. From the perspective of citation burst, there are 5 bursting authors with a burst duration between 2 and 8 years: Drummond M. 1981–1999, Mooney G. 1982–1986, Marchese D. 2012–2015, Trosch R. 2012–2015, and Peeples P. 2018–2020. Bust analysis confirms the existence of the two research teams and their period of activity.

We continue exploring the co-authorship analysis by studying the level of cooperation between institutions. For this purpose, we generated a network where the nodes are the institutions, and we did not used pruning methods. The level of cooperation is revealed by the thickness between institutions’ nodes. The network contains 751 nodes, 944 links, and a density of 0.0034. In Fig.  4 are labelled the institutions with more than 4 collaborative papers, the label size is depending on the number of collaborative publications. No institution has a large value of centrality, meaning that cooperation among the analysed institutions is weak, the links are very transparent because of an insignificant number of publications written by collaboration between organizations or universities.

The network of institutions’ collaboration in health economics. Source: Authors

As seen in Fig.  4 , the top-10 most collaborative institutions in health economics area are: University of York (28 publications), University of Oxford (23), University of Pennsylvania (21), University of Washington (20), University of Birmingham (17), Erasmus University (16), Harvard University (16), Bangor University (15), University of California Los Angeles (13) and University of Toronto (12). There are six institutions for which there was identified citation burst as follows: University of Oxford 2016–2020, University of Pennsylvania 2017–2022, University California Los Angeles 2013–2016, King’s College London 2006–2011, London School of Hygiene & Tropical Medicine 2008–2010, University of Washington 2015–2018. Cooperation among institutions is depending on cooperation among authors. It is understood that poor collaboration at the individual level is followed by an identical one at the organizational level.

Progress in any field can be achieved only by communication. Analysing country co-authorship may lead to identification of leading states in health economics research. The visualisation map for country collaboration reveals a network of 202 nodes, 710 links and 0.035 density. It should be noted that country co-authorship network has a density 10 times larger than institutions co-authorship network. The map was generated in CiteSpace without pruning parameter. In Fig.  5 are displayed the countries having more than 5 collaborative health economics-related publications.

The network of countries’ collaboration in health economics. Source: Authors

As can be observed, the biggest nodes correspond to the most prominent and cooperative nations. The collaboration between institutions from these nations is shown by the links between the nodes. The discrepancies between the first two countries and the other states are obvious. The network of the most collaborative country, the USA, consist in 521 publications. It is followed by England with 344 publications. It is obvious that these two nations played a crucial part in worldwide academic exchanges in health economics area. The third and the fourth most collaborative countries are Canada (105 publications) and Australia (100 publications), which shows a degree of cooperation 5 times lower than that of the leading country. The top-10 most collaborative countries continue with the following nations: Netherlands (74 publications), Germany (58), Switzerland (56), Scotland (48), France (46) and Italy (43). Citation burst was identified for 4 countries: the USA 1975–1981, Scotland 1982–2003, Switzerland 1999–2006, and China 2020–2022. Citation burst analysis reveals that China, which stated to published research in health economics in 2006, faces an upward trend in the last two years.

Co-citations analysis

The following step of our current analysis is to find the most frequently cited publications in health economics sector. Co-citation reference analysis help to identification of the most important references in health economics. 16,755 references are linked to our sample. We obtain a co-citation network of 1550 nodes and 7240 links with a density of 0.0060. The network map was obtained without pruning parameter. In Fig.  6 are labelled the papers with more than 5 co-citations. Table 3 lists the top 10 articles in the field of health economics by the number of citations.

Visualization of reference co-citation networks for health economics research. Source: Authors

As we expected, the most influential paper is published by Arrow K.J. in 1963. In his paper, the author investigates and studies the unique distinctions between medical care and other goods and services in normative economics. He focuses on medical-care industry and its efficacy by rethinking the industry from economics perspective. This publication is the basic brick in the conceptualization of health economics. Unfortunately, this part of analysis reveals some basic limitation in bibliometric analysis: incomplete and compromised database because of incorrect data filled by authors. As it can be seen in Fig.  6 , the second most influential paper belongs to an anonymous author who wrote in 1996 a paper about cost effectiveness. A manual search in references database revealed the possibility to correlate the anonymous publications to a book written by Gold M.R., Siegel J.E., Russell L.B. and Weinstein M.C. The authors published in 1996 a book about cost effectiveness in health and medicine and there are several book reviews about it. The third and the fourth most co-cited publications are signed by Drummond M.F. and his co-authors. In fact, it is about a book entitled “Methods for the Economic Evaluation of Health Care Programmes”, first published in 1987 at and then renewed in the following editions: 1997 (2nd), 2005 (3rd) and 2015 (4th). Regardless the edition number, the book is a worldwide bestseller and it very cited in health economics research. It should be mentioned that the 2nd edition of the book appears twice in the database because some authors incorrectly cited Drummond. There are many book reviews for this book because it describes techniques and tools for evaluation of health care programs. It provides syntheses of new and emerging methodologies, and it is less concerned with the theoretical and ethical foundations of the methodologies (Drummond M.F et all, 2005). The book promotes basic health economic concepts and theories.

The citation burst was checked to see the period when a document citation increases sharply in frequency. There are 12 cited papers with citation burst fluctuating from 3.95 for Volpp K.G (2008) and 9.58 for Arrow K.J. (1963). Ten of twelve papers with citation burst are the ones from Table 3 , the most co-cited documents in health economics. The top-10 papers by burst are Arrow K.J. 1963 (period 2012–2018, citation burst 9.58), Drummond M.F. 1997 (2000–2008, 8.76), Anonymous 1996 (1999–2011, 8.86), Drummond M.F 2005 (2008 – 2019, 8.42), Kahneman D. 2011 (2013–2022, 5.03), Williams A. 1985 (1986–1998, 4.44), Lakdawalla (2018–2022, 4.44), Kahneman D. 1979 (2019–2022, 4.38) and Grossman M. 1972 (2016–2019, 4.35).

Two of Kahneman D.’s works stands out. One of them is represented by a book, another worldwide bestseller, entitled “Thinking, Fast and Slow” published in 2011 in London. His psychological book is appreciated because it aids in the public understanding of issues related to engineering, medicine, and behavioural science. The second paper is written by Kahneman D. and Tversky A. in 1979 and presents opponents of the anticipated utility theory as a framework for risky decision-making and introduces an alternative model called prospect theory.

We can find highly cited authors whose work is well known in the health economics research community by using author co-citation networks. CiteSpace configurations are the same. The network of co-cited writers has 1422 nodes, 12,462 linkages, with a density of 0.0123. The node size reflects the number of co-citations by author. In Fig.  7 the nodes with co-citations over 14 are labelled by the corresponding first author. Once again there are incomplete data in the database. We face with an anonymous person as the most cited author in health economics research. This author without name was 300 time co-cited. We manually checked the database to find additional information about this anonymous author. According to the findings we assume it is about Margolis H. who published in 1982 a book about selfishness, altruism, and rationality. Margolis H. is a professor at the University of Chicago and in his book about social choice propose and argue a distinction between self-interest and group-interest for a person, and he also develop an equilibrium model for his theory [ 41 ].

Visualization of authors co-citation networks for health economics research. Source: Authors

Drummond M.F. is on the second position, positioning himself with two publications in the top-10 most co-cited authors. Once again it is about his publication with Mooney G.H. about Essentials in Health Economics which was already mentioned in the paper. Williams A. is the third co-cited author, followed by Culyer A.J and Arrow K.J. It should be noted that World Health Organization’s (WHO) publications are ones of the most co-cited document in health economics research. Unfortunately, it is hard to identify the titles of WHO’s publications from 1993 and 2009 (see Table 4 ) because there is more than one publication per year for this international organization. However, we assume that it is about an anonymous publication focused on tuberculosis as a worldwide problem [ 42 ] (published in 1993) and a publication about health risk at the global level [ 43 ] (published in 2009).

There are no scholars who have a betweenness centrality greater than zero. This indicates that there is no author more influential than other scholars, and no one exert a significant influence on the evolution of health economics research. The evolution of health economics theory was influenced by all the authors discussed in this paper.

In terms of burstiness, there are 35 cited authors with citation burst between 9.26 and 3.90. It means that their papers were intensively cited during a specific period. The top-10 cited authors by bursts is Drummond M. 1988 (bursts of 9.26, period 1995–1999), Maynard A, 1982 (8.60, 1998–2003), WHO 2009 (8.09, 2009–2015), OECD 2013 (7.77, 2013–2022), Williams A. 1982 (7.63, 1986–2003), Johannesson M. 1996 (7.59, 1996–2003), Kahneman D. 2000 (7.55, 2016–2022), WHO 1993 (7.02, 2011–2022), Cutler D.M. 2007 (6.97, 2012–2016) and Donaldson C. 1995 (6.94, 1995–2003). Even if they are not included in the previous ranking, the following cited authors should be mentioned because their burstiness periods exceeds 10 years: Fuchs V.R. 21 years (bursts of 4.54, period 1977–1998), Williams A. 17 years (7.63, 1986–2003), Mooney G. 14 years (5.29, 1995–2009), Dolan P. 14 years (4.84, 2003–2017) and Weinstein M.C. 13 years (4.14, 1999–2011).

The same way as previous maps, the cited journal visualization map for health economics research (Fig.  8 ) was created in CiteSpace, but this network has 1273 nodes (cited journals), 25,008 linkages, and a density of 0.0309. The cited journals with more than 38 citations are labelled in the network.

Journal co-citation network visualization for health economics research. Source: Authors

The top ten journals by citations in health economics are presented in Table 5 . The BMJ – British Medical Journal (381 citations) is the journal published by British Medical Association and the most prominent cited journal in health economics area. It is followed by the New England Journal of Medicine (306 citations) and The Lancet (257 citations). The journal published by American Medicinal Association ranks on the fourth place. A journal that receives a lot of citations and has a high citation burstiness score has garnered the interest of academics recently.

The citation surge affects 70 cited journals. The cited journal with the strongest citation bursts is Plos One (21.79, 2014–2022), which is not the most cited one. It is followed by British Medical Journal (20.22, 1982–2006), Value Health (13.15, 2018–2022), BMJ Open (12.48, 2017–2022), Applied Health Economics and Health Policy (10.38, 2017–2022), BMC Health Services Research (10.16, 2019–2022), Frontiers in Public Health (9.99, 2020–2022), Cost Effectiveness and Resource Allocation (9.66, 1998–2005), JAMA Internal Medicine (9.24, 2019–2022) and BMC Public Health (8.71, 2016–2022). It should be noted that 8 cited journals of the ranking are bursting to the present. British Medical Journal (24 years), American Journal of Psychiatry (15 years), The Journal of Health Services Research and Policy (14 years), The New England Journal of Medicine (13 years) and Medical Care (12 years) are the cited journals with the longest periods of bursting, even if the interest in these journals is currently low. It must be added that four of the most cited journals in health economics research are on a top-10 list of journals with the highest JIF in 2021. All these journals are one of the most influential journals in health research.

Co-occurrence analysis

In this section of the analysis, we can pinpoint the key ideas and areas of interest in health economics research. To discover the primary study subjects in many scientific research domains, keywords are generally regarded as one of the most crucial elements of any research paper [ 44 ]. Co-occurrence analysis is used to identify the conceptual structure of the field. Without any pruning, the network of related keywords is shown in Fig.  9 . The network of co-occurred keyword has 694 nodes (keywords), 2823 links (connections), and a density of 0.0117. One percent of all keywords, those with a frequency greater than or equal to five, are labelled.

Keywords co-occurrence network for health economics research. Source: Authors

Table 6 presents the top 30 keywords which are used and connected in the 1620 analysed papers. “Health economics” and “cost effectiveness” are the most co-occurred items in health economics research, they have been connected for 121 times. “Care” follows them as the second high-count keyword with a frequency of 115. One crucial statistic used in the analysis of the keyword co-occurrence network is centrality. Centrality shows a keyword's strength, influence, or other specific characteristics. In this analysis all the keywords have a null betweenness centrality.

By using bursts detection, we tried to identify research hotspots in health economics. Surprisingly, there are only two keywords with citation bursts during 1975–2022: “behavioural economics” and “economic evaluation”. The keyword with the strongest bursts is “behavioural economics” (5.57) and it caught scholars’ attention between 2019 and 2022. The second keyword by citation bursts is “economic evaluation” (4.62). This item is bursting from 2020 to 2022. It can be observed that both research themes have short periods of bursts, and they continue bursting to present.

CiteSpace allows a cluster analysis of keywords to identify topics that have captured the attention of researchers. By applying clustering tool, the keywords network has been divided in 14 clusters, labelled by keywords. Table 7 presents the top 10 keywords clusters, in descending order of their size, and the most used keywords in the analysed sample of publications. There are 14 clusters with different sizes, from 80 research topics in health economics to 4 research topics. Their Silhouette values varies from 0.757 to 0.995 which means that keywords match well to their own cluster. Figure  10 show that the clustering configuration is appropriate.

Keywords clusters. Source: Authors

The largest cluster (#0) is labelled “Health economics” and has 80 components. It contains publications about health economics, cost effectiveness, quality of life, and management. Cost effectiveness analysis and health technology assessment are subjects in the second largest cluster (#1). It is labelled “Value framework” and has 78 topics. The third cluster (#2) “Economic evaluation” contains 75 topics and the most important are care, economic evaluation, outcome, and benefits. Other research topics refer to behavioural economics, demand, cost, quality of life, risk, cancer, public heath, financial incentives, therapy, etc.

The evolution over time of the keywords can be seen in Fig.  11 , structured by cluster. CiteSpace restricts the time pane analyses to the period 1990 – 2022. Figures  11 and 12 present how interest of researchers in health economics has evolved over time. In Fig.  12 are labelled the keywords with a frequency larger than 10. In the 1990s the hot topics of research in health economics were “care”, “impact”, “health economics”, “cost”, “cost effectiveness”, “quality of life”, “outcome”, “economic evaluation”. The most debated research topics in the 2000s were “children”, “air pollution”, “patient”, “management”, “people”, “public health”, “choice”, “therapy and “risk”. In the 2010s focus is on “behavioural economics”, “population”, “obesity”, “uncertainty”, “ technology”, “health policy”, “health system”. How future research in health economics looks? It cannot be estimated with certainty, but some directions are drawn as follows: “inequality”, “care expenditure”, “health technologies”, “analysis plan”, “adaptative design”, “transparency”, “biodiversity”. These topics may shape the future literature in health economics.

Timeline view of keywords clusters in health economics between 1990 and 2022. Source: Authors

Time zone view of keywords clusters in health economics between 1990 and 2022. Source: Authors

The performed literature analysis enables us to respond to the research queries that were addressed in the paper's introduction, as follows:

How scientific production has evolved in health economics?

It can be observed a general upward trend of health economics publications, but with numerous upward and downward fluctuations, generating sinusoidal cycles with an average duration of 3–4 years. The period 1975 – 1986 is characterized by a very low number of publications. The next two decades (1987 – 2006) are characterized by a slightly increasing trend in the number of publications, with an annual average of approximately 23 publications on health economics. The following period, 2007 – 2022 is characterized by an upward evolution of the number of health economics publications, 1068 publications with an annual average of 67 articles. The evolution of the citations’ number indicates the growing interest of specialists in researching the field, especially after 2000 when a constant and galloping annual increase in citations begins. The last 5 years show a very high interest of researchers and academics in health economics research, which is justified by the existence of worldwide Covid pandemic period.

Who are the most important authors and publications in health economics?

In our study, 4096 different authors were identified, and they individually published between one and 16 papers. Among the most important authors in health economics are Drummond M.F., Jonsson B., Coast J., Donaldson C. and Edwards R.T. Regarding the publication’s titles, 847 distinct journals published all 1620 documents related to health economics. Value Health, Health Economics, British Medical Journal, Pharmacoeconomics and Health Policy are among journals with high interest in health economics publications.

What are the geographical and institutional hubs of knowledge production in health economics?

The analysed publications involved the work of authors from 82 countries. The states with significant contributions in the field of health economics are the USA, England, Canada, Australia, and Netherlands. From the point of view of affiliation, the authors belong to 1723 institutions. The institutions with a high number of publications about health economics are University of London, University of California System, University of York, Harvard University and University of Birmingham.

What kind of collaboration between authors, organizations, and nations are there in the field of health economics research?

There are not strong collaboration relationships between authors. They are divided in small research groups and cooperation for research in health economics is insignificant. The most collaborative authors are Drummond M., Mooney G., Trosch R., Marchese D., and Fuchs V. There are two research teams created around Drummond M. and Mooney G., on the one hand, and around Trosch R. and Marchese D., on the other hand. Cooperation among institutions is depending on cooperation among authors. It is understood that poor collaboration at the individual level is followed by an identical one at the organizational level. The most collaborative institutions in health economics area are University of York, University of Oxford, University of Pennsylvania, University of Washington, and University of Birmingham. Regarding collaboration between countries, the USA and England played a key role in worldwide academic exchanges in health economics area, followed by Canada, Australia, and Netherlands.

Which are the most cited authors and the most cited papers, and which are the most attractive journals for publishing research results in health economics?

The most influential paper is published by Arrow K.J. in 1963, entitled “Uncertainty and the Welfare Economics of Medical Care”. The second most influential paper belongs to an anonymous author who wrote in 1996 a paper about cost effectiveness. We assume that is a book written by Gold M.R., Siegel J.E., Russell L.B. and Weinstein M.C., entitled “Cost-Effectiveness in Health and Medicine”. The third and the fourth most cited publications are signed by Drummond M.F. and his co-authors. In fact, it is about a book entitled “Methods for the Economic Evaluation of Health Care Programmes”, first published in 1987 at and then renewed in several editions. Another influential book was written by Kahneman D., entitled “Thinking, Fast and Slow” and published in 2011. The most cited author is Margolis H., who published in 1982 a book about “Selfishness, Altruism, and Rationality”. Drummond M.F. is on the second position with the publications about “Essentials in Health Economics”. Williams A. is the third cited author, followed by Culyer A.J and Arrow K.J. It should be noted that World Health Organization’s (WHO) publications are ones of the most cited document in health economics research. The most cited journals in health economics are The BMJ – British Medical Journal, The New England Journal of Medicine, The Lancet, Journal of American Medicinal Association and Health Economics. Beside them, other very influential journals are Plos One, Value Health, BMJ Open, Applied Health Economics and Health Policy and BMC Health Services Research.

What are the most debated conceptual approaches in health economics?

“Health economics”, “cost effectiveness” and “care” are the most debated concepts in health economics. But the current research hotspots in health economics are “behavioural economics” and “economic evaluation”.

Discussions and conclusions

The current bibliographic analysis was done for a specialized literature: health economics. This analysis contributes to the evaluation of the progress of the global knowledge in health economics and to the evaluation of the interest in health economics research. Moreover, the research allows the identification of the authors who contributed to the theoretical conceptualization of health economics, but also the identification of the most cited works in the field. A bibliometric analysis of the health economics research topic was produced, based on 1620 papers that were published between 1975 and 2021 and indexed in WoS. According to the tables and figures above, we have identified the important authors, publications, nations, organizations, keywords, and references.

By giving information on the current state of the art and identifying trends and research possibilities through the selection and analysis of the most pertinent publications published in the subject of health economics, the current study completes the body of existing research.

Through an extensive field mapping, the study increases the added value for the study of health economics theory. The development patterns of health economics are described by identifying trends in research production in that field and the most productive nations. The identification of top contributors’ points to possible collaborators (universities and researchers) for additional research projects. Finding the most appealing source names reveals publishing prospects for health economics-related articles. Leading thematic areas and developing research areas can be found to help academics identify research gaps in health economics.

Limitations and future research directions

Even though the bibliometric analysis and mapping visualization on articles relevant to health economics in the current research have produced numerous fascinating results, this methodology has several drawbacks. These limitations are due to the bibliometric analysis and quality of database. A quantitative analysis reduces the influence of subjective judgments. In several parts of the analysis, we were forces to use manual search because of inadequate or incomplete data. Maybe, manual analysis is required to learn additional specifics about different aspects of health economics theory by using a systematic review analysis.

The following limitations of the current study should be considered. First, the search strategy leads to a lost in publications which do not contain the query word in the publication title. Therefore, the main findings should be interpreted in accordance with the selection strategy used in this paper. The dataset is downloaded only from WoS, maybe multi-source searching is more convincing. Publications in other languages were not analysed. For some publications the name of author was missing. Some journals change their title in time, and they appear twice as being different journals. In this analysis it was used an inhomogeneous sample due to the type of publications.

Therefore, these restrictions remain issues that need to be resolved in additional research. To sum up, our analysis cannot cover every crucial publication concerning health economics, but we believe that the results allow us to have reliable insight into the knowledge domain. This study could be carried out in the future utilizing new search criteria, time periods, or bibliometric analytic parameters.

Availability of data and materials

The data can be extracted from Web of Science. All data are available upon application.

Abbreviations

European Union

Gross Domestic Product

Journal Impact Factor

Organisation for Economic Co-operation and Development

Science Citation Index Expanded

Social Science Citation Index

The United Kingdom

The United States of America

World Health Organization

Web of Science

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Acknowledgements

Project financed by Lucian Blaga University of Sibiu through the research grant LBUS-IRG-2022-08.

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Barbu, L. Global trends in the scientific research of the health economics: a bibliometric analysis from 1975 to 2022. Health Econ Rev 13 , 31 (2023). https://doi.org/10.1186/s13561-023-00446-7

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About the Concentration in Health Economics and Policy

The concentration in Health Economics and Policy prepares doctoral students to address the most pressing challenges in health and health care through innovative, rigorous and interdisciplinary research in the field of health economics. This program integrates traditional training in economics with practical training in health policy and health services research to train the next generation of health economists.

The curriculum offers a broad exposure to the health economics literature and public health disciplines, and stresses the policy implications of these fields of research. The curriculum stresses a foundation in applied modern microeconomic theory, economic evaluation, quantitative methods and econometrics, including PhD-level courses from the Department of Economics in the Krieger School of Arts and Sciences.

Doctoral students are paired with a faculty adviser from the Health Economics concentration with similar research interests. Faculty in the Health Economics concentration are working in a variety of research areas including understanding health insurance design, the economic implications of health and health care disparities, market forces and health care prices, pharmaceutical economics, and payment design and access. Doctoral students will also have the opportunity to work with other faculty within the Department, as well as faculty from other Departments including International Health, Population, Family, and Reproductive Health, Biostatistics, the School of Medicine, School of Nursing, the Carey Business School, and the Department of Economics. Students also often work with various centers and initiatives across the University, including the Hopkins Business of Health Initiative.

What Can You Do With a Graduate Degree In Health Economics And Policy?

The program prepares students for successful research careers as health economists. Former students have gone onto careers in academia, government, research-oriented non-profits, and the private sector.

View a list of selected recent graduates and dissertation titles for the PhD Concentration in Health Economics and Policy.

Curriculum for the Concentration in Health Economics and Policy

Browse an overview of the requirements for this PhD program in the JHU  Academic Catalogue  and explore all course offerings in the Bloomberg School  Course Directory .

Admissions Requirements

For general admissions requirements, please visit the How to Apply page.

Standardized Test Scores

Standardized test scores are  not required and not reviewed  for this program. If you have taken a standardized test such as the GRE, GMAT, or MCAT and want to submit your scores, please note that they will not be used as a metric during the application review.  Applications will be reviewed holistically based on all required application components.

Matthew Eisenberg, PhD, MPhil,

uses applied health economics methods to study how consumers make decisions about their healthcare.

All accepted PhD students receive a standard funding package.  As of September 1, 2023 this package includes full tuition support, a $30,000 per year stipend, individual health, dental, and vision insurance and the University Health Services clinic fee for four years.

For funding sources, please see PhD funding page .

Need-Based Relocation Grants Students who  are admitted to PhD programs at JHU starting in Fall 2023 or beyond can apply to receive a $1500 need-based grant to offset the costs of relocating to be able to attend JHU.   These grants provide funding to a portion of incoming students who, without this money, may otherwise not be able to afford to relocate to JHU for their PhD program. This is not a merit-based grant. Applications will be evaluated solely based on financial need.  View more information about the need-based relocation grants for PhD students .

Questions about the program? We're happy to help. [email protected] 410-955-2488

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A Framework for Cancer Health Economics Research

Michael t. halpern.

Healthcare Delivery Research Program, National Cancer Institute

Ya-Chen Tina Shih

Department of Health Services Research, University of Texas MD Anderson Cancer Center

K. Robin Yabroff

Surveillance and Health Services Research, American Cancer Society

Donatus U. Ekwueme

Division of Cancer Prevention and Control, Centers for Disease Prevention and Health Promotion

Cathy J. Bradley

University of Colorado Cancer Center, University of Colorado

Amy J. Davidoff

Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University

Lindsay M. Sabik

Department of Health Policy and Management, University of Pittsburgh

Joseph Lipscomb

Department of Health Policy and Management, Rollins School of Public Health, and the Winship Cancer Institute, Emory University

Lay summary:

Cancer has substantial economic impacts for patients, their families/caregivers, employers, and the healthcare system. However, there is only limited understanding of how economic issues can affect access to cancer care services and receipt of high-quality of cancer care. Health economics research in cancer is particularly important due to the large and increasing number of cancer patients and survivors, but many factors may create barriers to performing cancer health economics research. This Commentary helps to identify important topics and questions in cancer health economics research and assist in the development of this critical field.

Although economic constructs have substantial impact on the delivery of cancer-related services, and cancer and its treatment have substantial economic consequences, there is only limited understanding of how economics affect healthcare delivery, health equity, quality of cancer care, and patient outcomes. This Commentary presents a framework to help identify important topics and research questions in cancer health economics research and assist in the development of this critical field.

Cancer, in addition to impacts on morbidity, mortality, and quality of life, has substantial economic consequences for patients, their families/caregivers, employers, and the healthcare system. Medical care costs for cancer in the U.S. were estimated as $183 billion in 2015 and projected to increase to more than $240 billion in 2030. 1 Almost two-thirds of Medicare beneficiaries with cancer were hospitalized at least once within 12 months following diagnosis; their annual Medicare hospital payments totaled more than $5.7 billion. 2 Cancer survivors experience substantially greater out-of-pocket expenses than do those without a cancer history, 3 Although multiple published studies project costs of cancer treatment, 1 , 4 , 5 there is only limited understanding of other types of cancer-related costs, policy impacts and societal factors on these costs, and economics affecting healthcare delivery, health equity, and quality of cancer care.

Health economics research has been defined as “the application of economic theory, models and empirical techniques to the analysis of decision making by individuals, health care providers and governments with respect to health and health care”. 6 Health economics research is particularly relevant for cancer due to the large and increasing number of cancer survivors; 7 , 8 the widely varying use of and access to multimodal treatments and supportive therapies; the high levels of spending on cancer-related care by patients, employers, public programs, and other stakeholders; and the substantial cancer cost burdens among underserved populations. Despite progress made by cancer health economics researchers, additional information is needed. A critical need exists for research focused on factors influencing patient, provider, health care system, and societal costs related to cancer. More work is needed on the impacts of these costs on quality of care, treatment decisions, outcomes, and health equity. There are opportunities to improve medical care and patient wellbeing by examining economic research topics ranging from cancer prevention and early detection to diagnosis, treatment, survivorship, and end-of-life care.

Health economics research relevant to cancer is currently funded in the U.S. by multiple sources including federal agencies (e.g., the National Cancer Institute [NCI], Centers for Disease Control and Prevention [CDC], Agency for Healthcare Research & Quality [AHRQ]) and private organizations such as the American Cancer Society (ACS). NIH has designated health economics research designed to understand how innovations can most effectively improve health and well-being as a priority area. 9 While cancer health economics research already substantially contributes to our understanding of healthcare delivery and policy, this research area is still underdeveloped. A portfolio review of grants funded by NCI over the past five years found that fewer than 1% of grants included economic analysis (including studies of financial hardship, economic policy analysis, budget impact analysis, and willing-to-pay as well as studies of costs and cost-effectiveness). 10 Multiple factors may create barriers to cancer health economics research including limited data resources/linkages, training, methods, opportunities for research publication/dissemination, and funding opportunities. Addressing these barriers can advance and strengthen this field.

The Division of Cancer Control and Population Sciences (DCCPS) of the NCI is interested in learning more about unmet needs for conducting health economics research focused on cancer and potential activities to support and enhance this field. As part of the Interagency Consortium to Promote Health Economics Research on Cancer (HEROiC), 11 DCCPS will host a virtual conference on the Future of Cancer Health Economics Research on Dec. 2 and 3, 2020 ( https://cancercontrol.cancer.gov/events/future-of-heroic ). This virtual conference will be free, open to the public, and will be livestreamed as well as recorded. In collaboration with researchers from CDC, ACS, and academia, this conference will include presentations and panels on challenges in conducting economics research across the cancer care continuum and broad discussions of key issues to further advance this growing field.

An important consideration for this conference is the scope of cancer health economics research to be discussed. That is, while we do not intend to impose a set definition of cancer health economics research, it is important to identify the topics and research questions on which the conference will focus. To address this, a group of content experts from multiple organizations (the authors of this Commentary) developed an initial cancer health economics research framework. For purposes of this conference, we are particularly interested in two areas of cancer health economics:

• Costs/expenditures and costs/expenditures relative to benefits/outcomes (e.g., cost-effectiveness);
• Financial hardship/toxicity and similar patient-focused economic impacts; and
• Value of care, including elements of value and value frameworks.
• Amounts paid for cancer-related services, including variations in payments by insurers and patients, out-of-pocket costs, payment incentives/penalties, and discount payments for certain care providers (e.g., 340B);
• Effects of cancer-related payments and policies (e.g., insurance plan/benefit design, health care reforms) on the supply, demand, and delivery of cancer-related services, including differential impacts by types/characteristics of health care providers and health care delivery settings as well as impacts on diffusion/availability of new services;
• Impacts of cancer-related payments and policies on disparities/inequity in the supply, demand, and delivery of cancer-related services, including access to care and quality of care; and
• Influence and adequacy of the cancer care workforce and related organizational structures, including issues of training, composition, competition, distribution, and integration, on the supply, demand, and delivery of cancer-related services.

One goal of this framework is to emphasize that cancer health economics research extends beyond the examination of costs/expenditures. That is, this field incorporates the impacts of policies, programs, and environmental, societal, and organizational factors on the supply, demand, and delivery of cancer-related services. The intent of this framework is to encompass research from diverse perspectives that can deepen our understanding of the relationship of economic factors with the delivery of cancer-related services as well as economic studies of implementation/dissemination of cancer care programs. We view this framework as the first iteration of a living document, which will be updated and modified during and following the Future of Cancer Health Economics Research conference.

NCI's mission in conjunction with partners is to lead, conduct, and support cancer research across the nation to advance scientific knowledge and help all people live longer, healthier lives. Cancer health economics research is an important component of this mission and is critical to ensuring access to timely and high-quality cancer care across the care continuum. We look forward to engaging with the cancer community and health economics research stakeholders to advance this important topic.

Acknowledgement:

The views expressed here are those of the authors and do not represent any official position of the National Cancer Institute, National Institutes of Health, or Centers for Disease Control and Prevention.

Contributor Information

Michael T. Halpern, Healthcare Delivery Research Program, National Cancer Institute.

Ya-Chen Tina Shih, Department of Health Services Research, University of Texas MD Anderson Cancer Center.

K. Robin Yabroff, Surveillance and Health Services Research, American Cancer Society.

Donatus U. Ekwueme, Division of Cancer Prevention and Control, Centers for Disease Prevention and Health Promotion.

Cathy J. Bradley, University of Colorado Cancer Center, University of Colorado.

Amy J. Davidoff, Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University.

Lindsay M. Sabik, Department of Health Policy and Management, University of Pittsburgh.

Joseph Lipscomb, Department of Health Policy and Management, Rollins School of Public Health, and the Winship Cancer Institute, Emory University.

Promoting Public Health with Blunt Instruments: Evidence from Vaccine Mandates

We study the effect of mandates requiring COVID-19 vaccination among healthcare industry workers adopted in 2021 in the United States. There are long-standing worker shortages in the U.S. healthcare industry, pre-dating the COVID-19 pandemic. The impact of COVID-19 vaccine mandates on shortages is ex ante ambiguous. If mandates increase perceived safety of the healthcare industry, marginal workers may be drawn to healthcare, relaxing shortages. On the other hand, if marginal workers are vaccine hesitant or averse, then mandates may push workers away from the industry and exacerbate shortages. We combine monthly data from the Current Population Survey 2021 to 2022 with difference-in-differences methods to study the effects of state vaccine mandates on the probability of working in healthcare, and of employment transitions into and out of the industry. Our findings suggest that vaccine mandates may have worsened healthcare workforce shortages: following adoption of a state-level mandate, the probability of working in the healthcare industry declines by 6%. Effects are larger among workers in healthcare-specific occupations, who leave the industry at higher rates in response to mandates and are slower to be replaced than workers in non-healthcare occupations. Findings suggest trade-offs faced by health policymakers seeking to achieve multiple health objectives.

Research reported in this publication was supported by the National Institute on Mental Health of the National Institutes of Health under Award Number 1R01MH132552 (PI: Johanna Catherine Maclean). John Earle also acknowledges support from the Russell Sage Foundation. The views expressed herein are those of the authors and do not necessarily reflect the views of the National Institutes of Health or the National Bureau of Economic Research.

MARC RIS BibTeΧ

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Atmospheric and economic drivers of global air pollution

Carbon monoxide emissions from industrial production have serious consequences for human health and are a strong indicator of overall air pollution levels. Many countries aim to reduce their emissions, but they cannot control air flows originating in other regions. A new study from the University of Illinois Urbana-Champaign looks at global flows of air pollution and how they relate to economic activity in the global supply chain.

"Our study is unique in combining atmospheric transport of air pollution with supply chain analysis as it tells us where the pollution is coming from and who is ultimately responsible for it," said lead author Sandy Dall'erba, professor in the Department of Agricultural and Consumer Economics (ACE) and director of the Center for Climate, Regional, Environmental and Trade Economics (CREATE), both part of the College of Agricultural, Consumer and Environmental Sciences (ACES) at Illinois.

"There is a direct link between a country's level of production and how much air pollution is emitted. But production may be driven by demand from consumers in other countries. We use supply chain analysis to quantify the links between production and consumption. This helps us to understand how production in one country is linked to domestic and foreign demand," he added.

The researchers traced the movement of pollutants through the atmosphere to understand the flow of emissions, using simulations developed by Nicole RIemer, professor in the Department of Climate, Meteorology & Atmospheric Sciences, College of Liberal Arts & Sciences at Illinois. For analytical purposes, they divided the world into five sections: the United States, Europe, China, South Korea, and the rest of the world. South Korea is located downwind of China, and it serves as an example of how a small country can be affected by pollution from a much larger upwind neighbor.

"Over recent years, South Korea has taken several measures to reduce its own pollution, yet it has experienced worsening air quality. Why? The answer is to be found in its upwind neighbor, China. Yet, a large amount of the goods manufactured in China are destined for foreign consumers in the U.S. and in Europe, among other places. As such, who is to be blamed for the increase in air pollution in South Korea? That is the challenge we embarked on with this study," Dall'erba stated.

The researchers found the amount of carbon monoxide emissions coming from China to South Korea increased from 30 teragrams (Tg) in 1990 to 42 Tg in 2014.

"To put these numbers in perspective, 5 Tg of carbon monoxide corresponds to the emissions from all of the cars in the U.S. -- roughly 274 million -- each driving 13,500 miles per year. So it's definitely not a small increase. We conclude that South Korea has, in effect, lost control of their own air quality," Dall'erba explained.

Dall'erba and his colleagues conducted a structural decomposition analysis to identify the economic drivers of carbon monoxide emissions in the five study regions. They found that while China's technological processes to reduce pollution have improved, overall carbon monoxide emissions have gone up because the country's production has increased.

Next, the researchers sought to identify where the demand that drives the increased production comes from. In China's case, some of the increase can be attributed to U.S. and European demand, but it is primarily driven by households in China. The Chinese population grew considerably between 1990 and 2014, and the country became wealthier, leading to higher consumption, Dall'erba noted.

"Our findings show that pollution is a global concern that can't be solved by individual countries. The world is connected, and we're all in this together," said co-author Yilan Xu, associate professor in ACE. "Pollution in one country can result from economic activities in neighboring countries, which in turn is influenced by who's demanding the goods produced in that country. Pollution emitted anywhere in the world is going to have consequences all over the world to varying degrees."

Dall'erba, Riemer, and Xu emphasize that everybody can play a part in reducing emissions. Producers can implement technological change; policymakers can issue regulations or provide incentives; and consumers can make choices that favor sustainable products.

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Story Source:

Materials provided by University of Illinois College of Agricultural, Consumer and Environmental Sciences . Original written by Marianne Stein. Note: Content may be edited for style and length.

Journal Reference :

• Sandy Dall’erba, Nicole Riemer, Yilan Xu, Ran Xu, Yu Yao. Identifying the key atmospheric and economic drivers of global carbon monoxide emission transfers . Economic Systems Research , 2024; 1 DOI: 10.1080/09535314.2023.2300787

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Economic Report of the President draws on work of SIEPR scholars

The annual release of the Economic Report of the President presents an overview of the nation’s economic progress and key policy concerns of the White House.

This year, the 487-page report from President Biden delves into issues related to the aging population, jobs, affordable housing, international trade, artificial intelligence, and the transition to clean energy.

The 2024 report, prepared by the Council of Economic Advisers and released in March, taps the work of several SIEPR scholars and demonstrates how policy-relevant research informs government discussions and decisions. Their studies on topics ranging from labor market changes to the long-term effects of foreclosures underpin a variety of assessments in the report. And notably, in the chapter on “An Economic Framework for Understanding Artificial Intelligence,” the contributions of SIEPR scholars play a significant informative role.

The economic impact of artificial intelligence

Examples of SIEPR fellows and their work credited in the report for illuminating AI implications include:

•    Susan Athey on trade-offs between human- and AI-based decisions and the importance of guardrails in AI system designs, and on competition dynamics of the market structure of digital platforms.
•    Robert Bartlett on how algorithmic decision-making has been found to reduce discrimination in fintech lending .
•    B. Douglas Bernheim on how AI tools could make it easier for firms to collude in complex multimarket interactions.
•    Nicholas Bloom on the complicated relationship between innovation and market competition , and how policy reforms could incentivize innovation .
•    Tim Bresnahan on how general purpose technologies can lead to complementary inventions.
•    Erik Brynjolfsson on the current landscape and trends of AI ;  the patterns of early AI adoption ; the importance of collecting data about AI usage ; how in some work environments, the use of generative AI increases productivity; how machine translation boosted international trade on an online platform; how productivity growth plays out with new general purpose technologies like AI; and how machine learning advances impacted occupations and the economy .
•    Steven Davis on the magnitude of earnings losses from job displacements — something the report says is a pertinent consideration of AI’s potential harms.
•    David Grusky on trends in income mobility , which the report references in relation to the economic effects of labor unions amid AI advances.
•    Daniel Ho , on the opportunities and risks of foundation models from a comprehensive report authored jointly with Brynjolfsson , Julian Nyarko and other researchers at the Center for Research on Foundation Models at the Stanford Institute for Human-Centered Artificial Intelligence; and his advisory work as a member of the National Artificial Intelligence Advisory Committee .
•    Charles “Chad” Jones on how the speed of economic progress is tied more to the rate of innovation than computational capacity; and, jointly with Bloom , on the phenomenon of diminishing returns from research and development .
•    Mark Lemley on the subtleties and complexities of copyright issues for AI-generated art .
•    Sean Reardon , on how economic residential segregation has increased over time — one reason why the reports says “targeted place-based policies” addressing AI impacts could be useful.

On remote work, housing and more

Following are more examples of cited studies on other key economic issues from SIEPR scholars:

•    Bloom on the impact of trade with China on U.S. employment and on innovation and productivity ; a framework to examine public versus private investments in basic R&D ; and how R&D affects product markets and tech innovation , as the report says the dynamics could apply to structural changes in clean energy.
•    Bloom and Davis , on their joint extensive research on the evolution of working from home ; its implications around the world ; its dampening effect on wage-growth pressures ; and its impact on job vacancies across industries and occupations .
•    Marshall Burke on climate change effects on the economic productivity of rich and poor countries; the changing risks and societal burden of U.S. wildfires ; the mental health effects  of rising temperatures; the influence of climate change on human conflict ; and income inequities  in wildfire smoke protection.
•    Davis on a way to examine the flow of job vacancies and recruiting intensity .
•    Rebecca Diamond on the effects of the Low Income Housing Tax Credit on neighborhoods; how foreclosures cause sustained housing instability and financial distress; and, with Franklin Qian — a former graduate fellowship recipient and winner of the Student Discussion Paper Prize at SIEPR — on the effects of rent control .
•    Gopi Shah Goda on how long-term care insurance affects labor outcomes, increasing, the report notes as an example, the likelihood of adult children staying longer with full-time work.
•    Jones on the economic consequences of a declining population ; how the nonrivalry of ideas is responsible for the rise in living standards; and fleshing out variables of economic growth .
•    Jonathan Levin on the employment-related trade-offs of multilateral contracting ; on semiconductor R&D policy recommendations through his role on the President’s Council of Advisors on Science and Technology; and the use of advance market commitments with vaccine production — an approach the report says could be a strategy to mobilize clean energy developments.
•    Grant Miller on the role of public health improvements in curbing infectious disease.
•    Petra Persson and Maya Rossin-Slater , along with Kate Kennedy-Moulton , a former SIEPR predoctoral fellow, on maternal and infant health disparities ; and Rossin-Slater , on the cost-effectiveness of the food stamp program , which, the report says, is an example of federal assistance that can also serve to alleviate the financial burden of housing.

Citations in the report also include former student affiliates or postdoctoral fellows of SIEPR — a testament to the institute’s mission in fostering the next generation of policy thought leaders. One example is Luca Braghieri , a former SIEPR graduate fellowship recipient who co-authored with SIEPR senior fellows Matthew Gentzkow and Hunt Allcott a 2019 paper on the welfare effects of social media. Braghieri’s recent study on social media and mental health is cited in the 2024 Economic Report of the President. 

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4 ways businesses, cities and communities around the world are reshaping the care economy

Governments, businesses, local authorities, communities and individuals must work together to promote the importance of care to the economy. Image:  Unsplash/CDC

.chakra .wef-1c7l3mo{-webkit-transition:all 0.15s ease-out;transition:all 0.15s ease-out;cursor:pointer;-webkit-text-decoration:none;text-decoration:none;outline:none;color:inherit;}.chakra .wef-1c7l3mo:hover,.chakra .wef-1c7l3mo[data-hover]{-webkit-text-decoration:underline;text-decoration:underline;}.chakra .wef-1c7l3mo:focus,.chakra .wef-1c7l3mo[data-focus]{box-shadow:0 0 0 3px rgba(168,203,251,0.5);} Andrea Willige

.chakra .wef-9dduvl{margin-top:16px;margin-bottom:16px;line-height:1.388;font-size:1.25rem;}@media screen and (min-width:56.5rem){.chakra .wef-9dduvl{font-size:1.125rem;}} Explore and monitor how .chakra .wef-15eoq1r{margin-top:16px;margin-bottom:16px;line-height:1.388;font-size:1.25rem;color:#F7DB5E;}@media screen and (min-width:56.5rem){.chakra .wef-15eoq1r{font-size:1.125rem;}} Health and Healthcare is affecting economies, industries and global issues

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Stay up to date:, health and healthcare.

• The need for care is growing, but most is performed unpaid by women.
• The care economy requires more investment and new models to make it sustainable, while enabling unpaid carers to participate in the wider economy.
• A new white paper from the World Economic Forum highlights models around the world being used to reshape the care economy.

All of us will either receive or provide care at different stages of our lives. This includes healthcare, childcare, elderly care or any other form of looking after others or being looked after.

Care underpins the entire global economy, according to a white paper released by the Global Futures Council of the World Economic Forum. And with our care needs growing, the care economy – with all of its paid and unpaid activities, labour and the relationships that support it – needs more investment to ensure future sustainability and resilience.

The Future of the Care Economy 2024 finds that, more often than not, the care economy relies on unpaid work and unfair care arrangements. Two billion people, the majority of whom are women , work as unpaid full-time carers, preventing them from seeking paid employment and directly affecting the economy. And even those who are paid for providing care often earn much lower wages than most other workers.

The challenge lies in transforming this precarious situation into a catalyst for economic growth. Here are four examples of businesses, cities and communities working to reshape the dynamics of the care economy, enabling it to become a growth engine.

Bogotá’s Care Blocks

In Colombia’s capital, Bogotá, the Secretary of Women’s Affairs launched a public sector initiative to address the city’s care deficiencies disproportionately affecting women – around a third of women in the city were providing full-time unpaid care.

For them and many other part-time carers, the city provides services at centralized Care Blocks , where those in need of care can be looked after by professionals and join in with recreational activities. This helps to relieve the load on their main carers who can, in turn, access skills training, wellness offers and income-generating activities. To reach rural parts of Bogota, Care Buses have been created, providing a mobile version of the Care Blocks.

The initiative works with a growing ecosystem of private-sector partners to help lower care workloads and create opportunities for caregivers to pick up work, study or socialize.

The Netherlands' Buurtzog care model

In the Netherlands, Buurtzog (“neighbourhood care”) nurses deliver a range of home care services across the country. In this model , care provision can be self-managed and customized to meet specific needs. It is particularly suited to older adults or people with disabilities or chronic conditions and those with long-term care requirements, the organization says.

Nurses participating in the model work in self-managed teams within their neighbourhoods and are responsible for developing their caseloads within the community. This involves working together with other healthcare and personal care providers as well as strengthening community and family support networks around the client.

SEWA’s childcare cooperative in India

On-site childcare for workers has many advantages, from lower absenteeism to greater employee engagement, the Forum reports. It is also a highly accessible model, available to businesses of any size, as well as unions or groups of employees.

One example is the Self-Employed Women’s Association (SEWA) in India, which represents more than two million informal workers across 18 of India’s states.

The organization’s cooperative childcare service, Sangini, is owned and managed by SEWA shareholders. The goal is to enable its members to work and ensure girls can regularly attend basic education.

Parents are required to pay 10-15% of the service’s operating costs, with the bulk of the remaining funding coming from private sources such as charities and the government. Additional funding also comes from the Reserve Bank of India, whose employees pay higher fees for childcare services provided by SEWA to fund Sangini.

Digital care management in Paraguay

Along with initiatives led by individuals, local government and communities, businesses have an important role to play in the future of the care economy, the Forum says.

Online care systems are increasingly being used to provide care where people lack access to services. It is a growing area and one in which businesses can make a valuable contribution – by providing technology solutions.

Digital care management platforms extend the reach of care services to remote locations where regulatory frameworks may be lacking or where labour shortages affect care provision.

In healthcare, for example, using telehealth platforms can help with triaging patients and reducing the workload on medical facilities. Similarly, digital platforms can help with remote monitoring of care receivers when carers or family members are not on-site.

Another example is the digital Helpers platform that supports Paraguay’s domestic workers, who make up more than 15% of the population in urban areas . Helpers facilitate contracting, training and payment of social security charges.

The importance of a care mindset is key

A collaborative ecosystem will be essential to turning the care economy around and making it the economic force it has the potential to be, the Forum concludes. Governments, businesses, local authorities, communities and individuals must work together to promote the importance of care to the economy.

Value-based healthcare is about focusing on delivering health outcomes that truly matter to the individual and the society at large in cost-effective ways. The focus is on putting the individual at the centre of health and care.

There is growing concern over the sustainability and cost of healthcare – rising globally at an unprecedented rate. By eliminating inefficiencies in healthcare delivery, about one-fifth of health spending in the OECD and some $1 trillion in the United States alone can be saved every year.

The World Economic Forum’s Global Coalition for Value in Healthcare has welcomed its first cohort of four value-based healthcare innovation hubs in the Netherlands, Portugal, Wales and Denmark.

These hubs form a community of practice, whose learnings, methodologies and tools will help multiple organizations scale up their health system transformation and accelerate the pace of value-based healthcare.

Read more , and find out how to join the community of hubs.

Have you read?

Building a care economy: 4 leaders on why investing today will create a virtuous cycle of prosperity, affordable childcare is possible — and access to it would benefit us all, men want to increase care work at home. here's how business can help, don't miss any update on this topic.

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World Economic Forum articles may be republished in accordance with the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Public License, and in accordance with our Terms of Use.

The views expressed in this article are those of the author alone and not the World Economic Forum.

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The Research Brief: the private rental sector is extortionate

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Welcome to the Research Brief, where Spotlight , the New Statesman ’s policy section, brings you the pick of recent publications from the government, think tank, charity and NGO world. See more editions of the Research Brief here.

What are we talking about this week? Rent and why it’s going up. The Resolution Foundation just published a report called: Through the roof: Recent trends in rental-price growth . They found that, on average, rents have risen by 20 per cent since the start of 2022.

Don’t tell me about it, get my landlord to do something. Well, actually the report found that neither rising landlord costs nor landlord greed alone could explain the rise in rents. More than a third (38 per cent) of landlords don’t have a mortgage, but it does acknowledge that landlords have more power than tenants when it comes to setting the rent. Some have suggested that landlords are selling up and reducing the overall supply of rented housing, particularly in response to new regulations on no-fault evictions coming in, but there is little evidence of this affecting a large enough number of homes.

Is the population increasing too rapidly for us to build adequate housing? Not really. Housing supply has fluctuated for a while. But right now, the ratio of houses available to number of families is roughly the same as it was in the 1990s (780 homes to 1,000 families), so it’s not about population growth or immigration.

Screw this, I’m leaving London. Too late – rents are rising across the UK but are rising faster in some areas. Rents in Bristol, South Gloucestershire, Leicester and parts of Greater Manchester have risen by 50 per cent since 2016. By contrast, rents in West Lancashire, Richmond upon Thames, Redcar and Cleveland and Blackpool have risen by less than 15 per cent in that time.

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How broke am I?   The average private renter spends a third of their income on rent. Private renting is the most expensive form of living, and its provides relatively small and poor quality housing. The threat of a no-fault eviction is also always around the corner. One in five families now lives in private rented housing (up from 11 per cent at the end of the 1990s), and 30 per cent of low-income families headed by someone aged 30-49 now privately rent.

So, who should I picket? Capitalism. Rises in earnings are a big part of the overall rise in rents. If your wages go up, your rent does too. This was a relationship that was disrupted during the pandemic but has since returned in order to “correct” the market. Higher inflation and interest rates since 2022 have also fed into this problem. 

And I just put down a deposit on a takeaway coffee . Don’t expect to be splashing out on luxuries like coffee or showers. The Resolution Foundation predicts that rents will continue to rise by a further 13 per cent over the next three years. 

How do we avoid this bleak future? The Resolution Foundation suggests a rent stabilisation model, where a landlord can’t increase rents beyond inflation for the first three years of a tenancy. Increasing the Local Housing Allowance (LHA) would also mean poorer people are less likely to be “priced out” of rented housing, but the government has said it will freeze the LHA from 2025. Long-term, the only way is to build more homes.

In a sentence? The private rental sector is broken – we need curbs on price hikes, and for someone to build some damn housing.

Read the full report from the Resolution Foundation here .

If you have a report, briefing paper or a piece of research that you’d like featured in the Research Brief, get in touch at  [email protected] .

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World Health Day 2024: Frontiers in Public Health presents: "My Health, My Right"

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About this Research Topic

World Health Day 2024 presents an opportunity to delve into the theme "My Health, My Right," as designated by the World Health Organization (WHO). This Research Topic aims to explore and analyze various aspects of health equity, individual rights, and their intersection within the broader context of global health. Key areas of interest include but are not limited to: Health Equity: Investigating disparities in access to healthcare services, resources, and outcomes among different populations and regions. Human Rights and Health: Exploring the relationship between human rights frameworks and the realization of health rights, including issues such as healthcare access, informed consent, privacy, and discrimination. Social Determinants of Health: Examining how social, economic, and environmental factors influence health outcomes and contribute to health inequalities. Health Policy and Governance: Assessing the effectiveness of policies, strategies, and governance structures in promoting health equity and upholding the rights of individuals to health. Community Empowerment and Participation: Exploring initiatives that empower communities to advocate for their health rights, participate in decision-making processes, and contribute to improving health outcomes. Health Education and Literacy: Evaluating the role of health education, literacy, and empowerment in promoting individual agency, informed decision-making, and the realization of health rights. Innovative Approaches and Interventions: Highlighting innovative approaches, interventions, and best practices aimed at addressing health disparities, promoting health equity, and safeguarding health rights. Ethical Considerations: Addressing ethical dilemmas and considerations related to health equity, individual rights, and the provision of healthcare services, particularly in diverse cultural and socio-economic contexts. This Research Topic welcomes original research articles, reviews, perspectives, and commentaries that contribute to advancing understanding, knowledge, and solutions related to promoting health equity and individual rights on World Health Day 2024. Contributions from diverse disciplines, including public health, medicine, social sciences, ethics, law, and policy, are encouraged to provide comprehensive insights into this important global health issue.

Keywords : Health Equity, Human Rights and Health, Social Determinants of Health, Community Empowerment and Participation, Ethical Considerations

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