Before coming to IHME, Rouselle Lavado worked on a variety of projects within the Philippines’ health care system, researching diverse topics such as health facilities’ performance benchmarks, costing of government programs, and health care financing.
Rouselle, also known as Rose, says that studying health care presents unique challenges. “The Philippinesis a country of 7,000 islands, which poses a problem in terms of delivery of health services.”
One of Rose’s projects was researching the performance of provinces in delivering health care compared to the budgets they received. “Unlike other goods, measuring the production of health is not as straightforward,” Rose explains. “If our input is budgets for health, what is the output? Ideally, it should be overall outcome measures, such as gains in disability-adjusted life years, but such measures are not currently produced at the subnational level. So for now we settle for individual output measures, such as immunization rates. But how many separate measures should we include to confidently say our metric captures the delivery of health services in the province?”
In 2009, Rose became a part of a group that was tasked to examine the performance of the national health insurance program. “Most of the time, you find conflicting numbers, depending on where you get the information. My task was to reconcile the conflicting coverage rate figures of the country’s nationally representative household survey with an insurance agency’s internally generated statistics.”
The results of the study led to changes in how the poor were covered by health insurance, and the experience showed Rose the importance of producing reliable estimates to inform policy decisions, inspiring her to pursue a fellowship at IHME.
At IHME, Rose is working with other researchers to develop new ideas about how to analyze health data. She is a member of the Health Financing research team, helping determine how much individuals pay for health care in different countries. “People can be pushed into poverty because of health care expenses,” explains Rose.
Quantifying the amount of private expenditure on health is challenging in many countries, and Rose’s research involves figuring out how to make cross-country data on personal health care expenditure consistent and comparable.
As Rose explains, one difficulty is that countries ask different questions in their surveys: “One country’s survey may ask how much was spent on medicines, hospital fees, diagnostics, and one will ask a single question on how much was spent on health. The results will not be comparable.”
Another problem is differences in recall periods across countries. “If you are asked how much you spent on health care, most likely you will remember your expenses over the past week better than over the past year.”
Rose’s work will complete the picture of health financing that IHME publishes in its annual Financing Global Health policy report by including data on out-of-pocket spending on health care.
The intersection of data on health spending and health outcomes is what Rose feels is most valuable about IHME. “It is not one field dominating the research. We are working together to solve problems,” she says. “IHME’s interdisciplinary research allows scientists to learn from each other’s strengths and build on each other’s weaknesses.”
