PhD students

Meet our PhD students

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Michael Anderson

Essays on the evaluation of national initiatives to improve healthcare quality in the UK

Michael's PhD focuses on evaluating national initiatives to improve healthcare quality by drawing upon large healthcare datasets from both the NHS and the private sector. The first national initiative he aims to evaluate is the NHS England Evidence Based Interventions Programme which seeks to protect patients and improve quality of care by disinvesting in low value care with limited or no evidence of clinical effectiveness. The second national initiative he aims to evaluate is the impact of national guidance on quality of care and outcomes for patients who experience acute myocardial infarction. Michael hopes to produce insights which will inform national level policy and benefit patients.

Supervisor(s): Professor Elias Mossialos and Professor Alistair McGuire




Camille Bou

“I know I can’t”: how household context shapes the time-use, subjective wellbeing and attainment expectations of Young Informal Carers in the United Kingdom

Young informal carers (YIC; colloquially called young carers and young adult carers) are people aged 24 and below providing unpaid care to family members with chronic illnesses, disabilities, mental health conditions, and/or substance abuse problems. They make up an important part of the growing informal carer population, and their roles can impact their lives in positive and negative ways. Particularly problematic is the evidence that they have worse mental and physical health and achieve lower outcomes in education, employment and training (EET) relative to their non-carer peers; however, much remains unknown as to how their caring situations influence these relationships. While it is clear that being a YIC impacts important life outcomes, young people who are informal carers can attain also their aspirations and lead fulfilling lives, thereby contradicting the simplistic picture often painted in health and social care policy that caring is necessarily harmful.

The context in which YIC are born, grow, work, live and age merits further investigation. Using quantitative secondary survey data and qualitative primary interview data, this mixed-methods project explores the importance of household context in shaping YIC outcomes, focusing specifically on their time-use (i.e., time spent towards their different responsibilities), subjective wellbeing, and expectation of attainment in EET. Rooted in the field of Social Determinants of Health, the findings of this thesis will enable the reflection of policy implications programmes targeted towards YIC. 

Supervisors: Professor Martin Knapp and Dr. Juliette Malley




Adelina Comas-Herrera

The use of economic concepts and evidence in dementia policy

Almost all presentations at global dementia policy events start with slides highlighting the enormous costs of dementia to society, used as an argument for the need for policy action in dementia. While this suggests that policymakers and advocates are paying at some attention to health economics (or at least cost of illness studies), the extent to which economic concepts and evidence have played a role in the development of dementia policies (other than as a justification for the need for action) is unclear.

Adelina Comas-Herrera's PhD will analyse the relationship between health economics evidence on dementia and policymaking. She will map the extent to which the existing economic evidence covers the key policy decision areas in dementia. She will then analyse dementia policy documents to identify and contextualise uses of economic concepts and evidence and, in three countries, she will study in depth the way in which economic arguments and evidence were used by different actors involved in the policy process.

Supervisors: Professor Martin Knapp, Dr Justin Parkhurst



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Josie Dixon

Supporting people with dementia and their carers to prepare and plan for advanced illness and end of life

Using data gathered from 900 people with dementia and their carers, Josie’s PhD project will explore the factors that influence whether and how people with dementia and their carers think about and prepare for later stages of their illness and for end of life. It will explore people’s experiences of planning ahead, including of any support that they have received.

Furthermore, it will examine the difference that preparing for future care makes to end of life outcomes and experiences. Research methods include secondary analysis of survey data, follow-up qualitative research and a postal survey of carers. A workshop with study advisors, people affected by dementia and other invited stakeholders will be used to consider policy implications.

Supervisors: Professor Martin Knapp, Dr. Kitty Stewart




Olina Efthymiadou

The role of "Risk Sharing Agreements" in managing the entry of new, high cost medicines; exploring the HTA determinants and impact of agreements in Australia and Europe

Literature has recognised the potential of Risk Sharing Agreements (RSAs), as a policy tool for the reimbursement of pharmaceuticals, to deliver benefits such as faster access to new medicines, increased coverage, optimised utilisation and management of Health Technology Assessment (HTA) related uncertainties. However, it has been observed that only in limited cases countries implemented an RSA for the reimbursement of the same drug-indication pair and even in these cases, there was still variation in the type of RSA implemented. Health system specific context as well as cross-country differences in HTA assessment requirements have been suggested as determinants of such variation in RSA practices across countries.

Overall, despite their theoretically recognised potential, these agreements have not yet gained widespread acceptance and are looked upon with caution, primarily because there is still a lack of transparency around the factors that drive their implementation and more importantly, because their effectiveness in meeting their objectives has yet to be evaluated. Therefore, the aim of this research is twofold; first, to draw a clear picture on the definition and the HTA related drivers of RSAs across settings and second to monitor the impact of the agreements implemented so far on key health policy goals. 

Supervisors: Dr. Panos Kanavos, Professor Alistair McGuire



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Anna-Maria Fontrier

Orphan designation: is a lifesaving treatment worth millions of dollars?

Health technology assessment (HTA) is being widely used as a reimbursement and negotiation tool, contributing to the sustainability of national healthcare systems. However, HTA systems across countries vary substantially in the way they are set up and their role in coverage decisions. In my research I am looking into different HTA systems across Europe, Canada and Australia using a conceptual framework to capture important endpoints both at system- and HTA- level to understand whether HTA has an impact on coverage decisions.  

In addition, I am exploring ways to assess the value of pharmaceuticals used for rare and very rare conditions when considering their reimbursement at national level.  Scotland and Canada have substantial differences in the way they evaluate medicines for rare conditions. In Scotland, there are well-established processes, including involvement of various stakeholders such as patients and clinicians in the assessment of these medicines. Whereas in Canada, value assessment does not account for the rarity of the condition, which means these medicines are assessed in the same way as all medicines. In my thesis, I am exploring whether payers should account for rarity and be more flexible in terms of limited clinical evidence due to very small population samples and very high prices due to the monopolistic power of manufacturers, to ultimately promote equality.

Supervisors: Panos Kanavos and Irene Papanicolas




Philipp Frieman

Design and evaluation of a chat-based online peer support intervention for unpaid carers 

There is a lack of accessible, scalable and evidence-based support for unpaid carers. Working with the innovative support provider Mobilise (funded by Zinc), I will design and evaluate a chat-based peer support platform. First, we will take a human-centred design approach and develop the intervention through literature review and prototyping sessions with carers. Next, we will test a Minimum Viable Product (MVP) of the platform in a short pilot study. We will collect survey-based quantitative wellbeing measures and conduct a qualitative process evaluation to understand participant experiences in more detail. If the platform shows promise, we will use the findings from the evaluation to develop it further and assess its clinical effectiveness in a large randomised controlled trial. 




Arianna Gentillini

Orphan drugs: availability, coverage, and pricing dynamics in selected high-income countries

The number of drugs targeting rare diseases has increased exponentially over the past 20 years and, thanks to advances in precision medicine, this trend is expected to continue. This, combined with the high prices of orphan medicinal products (OMPs), raises budgetary concerns on the sustainability of the orphan drugs ecosystem among healthcare payers.

The overarching goal of my research is to understand drivers of availability, coverage, and pricing dynamics of orphan drugs via four interlinked paper. As part of this PhD, a database of OMPs will be designed and populated to quantitatively investigate factors associated with coverage and launch decisions of OMPs, such as disease prevalence and burden of illness. Finally, the empirical link between orphan drugs prices and (a) the clinical outcome they provide to patients as well as (b) R&D costs needed to bring them on the market will be explored.

Supervisors: Dr Panos Kanavos, Professor Alistair McGuire




Genevieve Jeffrey

Genevieve's main research interests lie in health economics, particularly in understanding infant and child health outcomes and their wider implications. Her current projects focus on exploring the factors contributing to nutritional inequalities across income groups and their implications on the incidence of Non-Communicable Diseases such as cardiovascular diseases, diabetes, cancers and respiratory diseases and how they disproportionately affect those in poverty. In addition, she is also researching on the role of one’s surroundings in influencing these health outcomes.

Supervisors: Professor Alistair McGuire, Dr Elisabetta De Cao



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Maria Karagiannidou

Towards an equal and sustainable long-term care system in Greece with focus on three main ingredients of such a system: eligibility criteria, resources to pay for care, and receipt of unpaid care

As Greece, with its rapidly ageing population, is preparing to reform the country’s ageing policy, the design and development of a new long-term care system receives gradually more attention in national health care policy. Thus, the aim of this PhD is: (i). to examine the rates of disability in terms of ADLs, IADLs, mobility limitations by age, gender, socioeconomic characteristics in old age, in order to provide estimate the numbers of older people who might be eligible for care under different needs-based eligibility criteria; (ii). to investigate what proportion of older people would be required to contribute to the costs of their long-term care under different means test rules; and (iii). to ascertain the rate of use of unpaid care and hence how much difference it would make if people receiving unpaid care were offered reduced care packages as in Germany or as in England.




SangJune Kim

SangJune Kim's primary interest centers on universal health coverage through better health financing. At the moment, he is looking at the interplay between social health insurance and private health insurance, the effect of long-term care on the medical utilisation, and hospital behaviour in response to the change in the payment system.

Supervisors: Professor Elias Mossialos, Dr Joan Costa-i-Font




Arush Lal

Aligning Political Priorities in Global Health Policy and Governance: Integrating Global Health Security and Universal Health Coverage to Strengthen Health Systems Resilience

Health systems have struggled to cope with recent health emergencies like Ebola and COVID-19. While robust literature has been written on how countries can better prepare for infectious diseases and ensure accessible health services, little has been discussed on how divergent politics and governance fragment global health policy and undermine health systems. Given increasing calls to align key global health agendas, such as global health security and universal health coverage, further evidence is needed to identify areas of synergy. This research will analyse the extent of alignment between dominant global health domains at the local, national, and global levels, and synthesize resulting policy implications to guide global health agenda-setting to maximise funding, improve governance, and foster resilient health systems.

Supervisors: Dr Justin Parkhurst, Dr Clare Wenham




Shoshana Lauter

A Linchpin in The Social Care Space: Ethnographic Studies on Trauma-Related Psychiatric Diagnosis and Tenability

Shoshana researches the diagnosis of trauma-related disorders amongst low-income social care users in New York City and London. Following deinstitutionalization in the mid-20th century, the community mental healthcare movement alongside and within social services has broadened the purpose of psychiatric diagnosis as well as those who authorize and employ it. Today, as mental illness is correlated with stressors of urban poverty at unprecedented levels, an in-depth examination of trauma-related diagnosis’ contribution is critical; it is a relatively new, controversial, uniquely social diagnostic category underexplored by the social sciences. By recruiting, observing and interviewing diagnosed service users at local social care agencies and charities, we will be able to assess the diagnosis’ effect on the individual's daily psychosocial experience, as well as microlevel issues of economic struggle and social immobility. A critical ethnographic evaluation of trauma-related diagnosis and those who are labelled by it will be vital to our understanding of psychiatry’s presence in the post-pandemic social care space. 

Supervisors: Dr Sarah Evans-Lacko, Dr Emily Freeman, Professor Martin Knapp (2020/21)




Cassandra Lovelock 

Mental Health Carers Experiential Knowledge; Formation, Utilisation, and Application within the Formal Care Team and Beyond

Around 1.5 million family and friends provide substantial amounts of unpaid support to someone experience a mental health problem with that number growing. This project is investigating mental health carers experiential knowledge - how it informs their identity and how they utilise their knowledge within the formal care team and to influence wider mental health services. Drawing on the personal experiences of the researcher and a lived experience advisory group, this work is co-creating meaning to understand mental health carers as more than just their role in the formal care team but as individuals. Moving forward this piece of work aims to inform the development of critical theory specifically for unpaid care.

Supervisors: Dr Sara Evans-Lacko, Professor Martin Knapp




Dr Ritesh Maharaj

Dr Maharaj's PhD thesis is an evaluation of the variation in the delivery of critical care services in the UK at national, regional, hospital, and patient level. He will also examine variations in costs and potential policies to optimally reorganisation the service. 

Primary supervisor: Professor Andrew Street, Professor Alistair McGuire




Mackenzie Mills

Early Access to Medicines Schemes: Regulatory Policies vs HTA Practices and Their Impact on Access to Innovative Treatments

There is a growing disconnect between regulatory agencies that are promoting accelerated access to medicines based on premature clinical data and health technology assessment (HTA) agencies that require robust clinical and economic evidence to recommend reimbursement of medicines. Evidence suggests that significant differences exist across countries on admittance to early access schemes, time to availability of medicines and reimbursement of medicines. While market size and firm characteristics have been linked to these differences, less is known about the impact of early access pathways and health technology assessment agencies.

Supervisors: Dr Panos Kanavos, Dr Joan Costa-i-Font



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Iva Parvanova

Iva's research focuses on the practice of informal patient payments and gift-giving to health providers in post-communist countries. In particular, she uses experimetal methods to look at the negative network externalities created through such practices. Additionally, she will study the effectiveness of various anti-corruption policies in minimizing propensity of petty corruption in transitioning health care systems.  




Nilesh Raut

Nilesh’s research areas are Health Economics, Economics of Ageing, and Applied Econometrics. His PhD research investigates the interaction of health, caregiving, insurance, and economic activity of the elderly living in the USA. He is currently investigating the impact of long-term care insurance (LTCI) on the labor supply of the elderly using the Health and Retirement Study (HRS) of the USA.

Supervisors: Dr Joan Costa-Font, Dr Ranjeeta Thomas




Sam Rickman

How can the analysis of unstructured data from administrative care records support adult social care policy and operations?

The administration of adult social care services produces data. In England, every person requesting publicly funded care must receive an assessment under the Care Act, 2014. In practice these assessments have been widely recorded in electronic databases for around 20 years.

Such systems are replicated internationally, with most OECD countries using some form of electronically recorded needs assessment, often including an algorithmic element, to establish eligibility for receipt of public funding, and to record care planning and delivery. However, although data is collected, administrative care data is “complex, heterogeneous, poorly annotated and generally unstructured”.

There is research and software to extract information from health records. However, there is a research gap around the extraction of information from unstructured data in administrative social care records. I hope to build upon the analysis of structured data in administrative care records by asking:

  1. To what extent is unstructured adult social care data useful in describing needs, services and outcomes of adult social care users?
  2. To what extent can such data add value to existing analysis and models?
  3. Can this value be embedded into existing operational adult social care systems?

Supervisors: Dr Jose-Luis Fernandez, Dr Juliette Malley



Amritpal Rehill

Amritpal Singh Rehill

Locating hidden carers: variations in self-identified unpaid care provision

Unpaid care from family and friends has been recognised as the most important source of care for individuals with long term-care needs in OECD countries. Providing care, even at relatively low intensities, has however been linked to negative (as well as some positive) consequences for the carer, on domains including physical and mental health, quality of life, employment and income. Fortunately support is available to prevent the exacerbation of these impacts and future increase in demand or formal services required for the carers themselves eventually, but this is only accessible to those identifying themselves as a carer and going on to receive a carer assessment. Numerous carer organisations have raised concerns that there are individuals who appear to be doing caring related tasks who do not identify as a carer and subsequently are not receiving the support they need.   

As part of this PhD I aim to understand what determines whether an individual identifies themselves as a carer or not, through qualitative interviews with individuals who are assisting individuals with long-term care needs but who don’t currently identify themselves as carers. I will also use survey data to understand which groups of individuals are more or less likely to identify themselves as carers, how the health and quality of life of those not identifying as a carer changes over time compared to individuals identifying as carers, and will aim to understand what impact if any the Care Act, a major recent piece of legislation, has had on carer identification. 

Supervisors: Dr Raphael Wittenberg and Dr Jose-Luis Fernandez




Maximilian Salcher-Konrad

Evidence standards for drug marketing authorisation: empirical evaluation of expedited approval pathways

Maximilian’s PhD research focuses on evidence requirements for drug marketing authorisation, critically reviewing recent developments in medicines regulation aimed at accelerating market approval for new medicines.

Maximilian empirically evaluates the assumptions underpinning expedited approval programmes such as conditional marketing authorisation in the EU and accelerated approval in the US, and focuses in particular on the use of non-randomised studies to provide evidence on the efficacy of new medicines.

Supervisor(s): Dr Huseyin Naci, Professor Alistair McGuire



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Brooke Scoles

Measuring Attitudes toward Diseases in Text

Can negative attitudes toward specific medical conditions be measured in text data? I will use natural language processing techniques to develop a method of measuring negative stereotyping of diseases in text. One disease where stereotyping may have declined over time is in ME/CFS as the COVID pandemic has increased awareness of post-viral illnesses. Using ME/CFS and LongCOVID as a case study, I will check whether there has been a change in the use of stereotyping language over time and whether there are any other diseases that are covered in the press with similar tone. The last part of this research will look at whether the diseases that are perceived negatively have worse policy outcomes such as lower funding, different responses to complaints, or fewer treatments.




Liana Rosenkrantz Woskie

Liana Rosenkrantz Woskie is a completing PhD candidate in the Health Policy and Health Economics programme. Her research focuses on measuring health system performance with a focus on how systems are (and are not) held accountable to patients. She also sits at the Harvard T. H. Chan School of Public Health as a Research Fellow and is finishing her dissertation on the contemporary prevalence and drivers of coercive female sterilization. 

She has been published in the Lancet, JAMA, HealthAffairs, the Journal of Feminist Economics and the British Medical Journal (BMJ). Her work has been funded by the National Academy of Science and Medicine, the Rockefeller Foundation, Gates Foundation and World Health Organization, among others. Her research, which also spans U.S. health financing and pandemic preparedness, has been featured by the New York Times, NPR Goats and Soda, Times Magazine and the Guardian. 

Supervisor(s): Dr Irene Papanicolas, Dr Clare Wenham, Professor Elias Mossialos




Xiaozhou Zhao

Patients’ Outcomes and Providers’ Behavior Under Prospective Payment System in China

In China, the payment system is gradually transferring from fee for service (FFS) to prospective payment system (PPS), while there are still potential limitations in developing PPS. First, the PPS tariffs may not be accurate due to a lack of systematic approaches to cost accounting. Second, cost sharing may cause a decrease in the quality of health services compared to FFS.  It is therefore important to investigate the change in patients’ health outcomes after implementing PPS in China, rather than solely focusing on expenditure implications. To address concerns about consequences of PPS adoption in China, Xiaozhou's PhD project will analyse the effect of PPS on the cost of treatment and on health outcomes by focusing on the PPS pilot project implemented in Chengdu, Sichuan province in 2011. At the meantime, this project investigates whether patient’s health outcomes worsen after PPS policy adoption.

Moreover, PPS can change the resource allocation within hospitals. Under PPS, the input level of the hospitals has been changed: the average Length of Stay (LOS) for hospitals is decreased ; and due to the decrease in admissions, the number of occupied beds is decreased . According to the definition of technical efficiency, the hospitals should maximize output for given input levels (or treat as many patients as possible by using the given resources) . Then it is important to estimate the output level of the hospitals for the adjusted input level under PPS, and analyse whether PPS improves the efficiency of the hospitals. To explore the relationship between the input and output of the hospitals after PPS adoption in China, Xiaozhou's PhD project investigates the change in hospital productivity before and after the PPS adoption in Chengdu in 2011, and tries to explain the change in hospital productivity through the change in the hospitals' degree of specialization. 

Supervisor(s): Professor Andrew Street, Dr Rocco Friebel