The development of health economics teaching in the UK from a course director’s perspective: A qualitative study

1. The development of health economics teaching in the UK from a course director’s perspective: Aqualitative study Dr Emma Frew, Dr Paula Lorgelly and Dr Tracey Sach Funded by the Economics Network Health Economics Teaching in the UK

2. Background, context, rationale • Health economics is a relatively new sub-discipline of economics, first becoming distinct as a discipline in the 1960’s. • Growing level of health economics research • Little published research on health economics teaching • Recent paper on reading lists • Little is known about how health economics teaching has developed, how it tries to meet the needs of practicing future health economists or decision makers, or about changing trends in health economics teaching. Health Economics Teaching in the UK

3. Aims and objectives • Aim: • to elicit the experiences of course directors of health economics courses or modules • Objectives: • to raise awareness about the history of health economics teaching development in the UK, • Understand how course directors believe this has influenced practice, • to identify the processes used to develop health economics courses, including some assessment of how course directors perceive practice to influence their teaching. Health Economics Teaching in the UK

4. Universities offering health economics qualifications Aberdeen Birmingham City UEA Glamorgan Keele Nottingham Sheffield York Universities offering undergraduate modules Aberdeen Birmingham City UEA Keele Liverpool Newcastle Nottingham QMU Sheffield Strathclyde Ulster York Previously identified universities Health Economics Teaching in the UK

5. Methods • Updated list of universities/course directors, that is identify sample • Pre-interview data gathering • Semi-structured face-to-face interviews with course/module co-ordinators • Interviews recorded and transcribed • The “constant comparison” technique will be used to analyse the data [Cohen, Manion, Morrison 2007] Health Economics Teaching in the UK

6. Qualitative Analysis: Constant Comparison • Application of open, axial and selective coding. • Researcher compares new data with existing data and existing themes, so that the themes achieve a perfect fit with the data. • If there is a poor fit between the data and themes, then the themes have to be modified until all the data are accounted for. • New and emergent themes are developed in order to be able to incorporate and accommodate all the data in a good fit – achieve ‘saturation’ point. Health Economics Teaching in the UK

7. Identified universities • LSE* • City • LSHTM • UEA • Oxford* • Nottingham** • Birmingham • Sheffield*,** • York • Aberdeen* Health Economics Teaching in the UK

8. Pre-interview data • Course documentation • Prospectuses, cost and funding, student numbers and demographics • Course/module content, methods of teaching, assessment Health Economics Teaching in the UK

9. Semi-structured interviews • Experience of teaching and coordinating • History of teaching health economics at their institution • Development as a sub-discipline • History of teaching health economics in the UK • The practice of health economics/being a health economist • Future developments and challenges Health Economics Teaching in the UK

10. Results • Respondents • Universities • Qualification • Student population • Qualitative Health Economics Teaching in the UK

11. Interviewed Universities • Birmingham • Oxford • York (x2) • Sheffield (x2) • UEA • Nottingham • LSTHM Health Economics Teaching in the UK

12. Course names • MSc in Health Economics • MSc in Economics & Health Economics • MSc in Health Economics & Health Policy • Master in Health Economics & Decision Modelling • MSc in Health Economics & Management • MSc in Economics • MSc in Global Health • MSc in Public Health • PG Certificate/Diploma in Health Economics • Also undergraduate teaching of medics/economists Health Economics Teaching in the UK

13. Who studies postgraduate health economics? • Part-time and full-time students • At least three universities only offer full time qualification • Large number of international students • Range from ½ to 99%, ‘significant’, ‘a lot’, ‘most’ • Mixture of new undergraduates and ‘mature’ students • At least two traditionally take students straight from UG degree • Others a mixture of health professionals, pharma, public health • Many new to economics • Funding • Mostly self funded students, some NIHR/MRC/ESRC MSc studentships, some pharma fellowships Health Economics Teaching in the UK

14. Identified Themes Health Economics Teaching in the UK

15. Quotes • Personal/individual experiences; teacher training: • Very little: “…maybe a week to 10 days of training (in design of distance learning)…” • None: “…I started teaching before the requirement for new lecturers kicked in…” • Course; motivation: • To build capacity: “…it's important for both our health services research capacity here that we have people who are competent in Health Economics out in the clinical networks. And also that we have researchers in Health Economics developing to a more advanced level, sort of capacity development…” • Part of core funding: “…had only just got the funding for setting up the Health Economics facility as it was then and part of the deal there was to have a masters programme for capacity development …” • On top of subject area: “…good for our profile, it was good for us, it kept you on your toes, you kept making sure that you were on top of your game... keeps you on the cutting edge, keeps you in communication, keeps using examples, you know, you don't fall behind the way, because you have to read text books and papers and things just for your students apart from anything else. Health Economics Teaching in the UK

16. Quotes • Type of students • Various academic backgrounds: “…you get a complete spectrum. It’s one of the difficulties or challenges about teaching here, you get everyone from the person that's just done a degree in history to somebody whose been looking after people with Malaria for 20 years, medically qualified” – “you get everybody…” “…we have a mixture of economics students and non economics students and everybody else…” • Split between international and home: “… until the early 90s, it was quite small, maybe 12 students each year, mostly UK students.  It grew a lot in the early 90s because they put a lot more money into studentships from the DoH for UK students with the internal market reforms and so on, so it was at its biggest in the early 90s but it was still predominantly UK students and then when I took over, basically it’s become more international. So now the UK students, there’s always 8 or 10 of them but they are in a minority. “ Health Economics Teaching in the UK

17. Quotes • Funding • External: …‘well, this is the only degree in PGT Economics that has external funding’. So, now that we’ve got it, we’ve got no incentive, whatsoever, to scrap it. • Delivery; reading lists • Against: “…I don’t believe in reading lists… what we do is at the start of the academic year we have a workshop…they learn about how to download, how to search, data bases, how to get hold of electronic articles…the library has a distance learning service which will photocopy articles and chapters of books and send it out to them and basically we say ‘look, these resources are essential to you as a researcher in Health Economics, you have to be able to do this, we are not wiping your bottom or whatever - now off you go and do it yourselves..” • For: “…we always make sure that we update our reading lists on an annual basis”… Health Economics Teaching in the UK

18. Quotes • Delivery; assessment methods: • Closed-exams:…we have closed exams, which I think is a strength - those exams are 3 hours - that’s very important for the quality of the course - that they’re not just writing an essay with all the risk that carries, they’re doing proper closed examinations…” • Course assessment…”our students are judged on 2 x 3,000 word essays for each module…” • Discipline; who is a health economist: • Self-identity:… we shouldn’t forget that we have got the word economics in our job titles…I have heard it said that Health Economists are somewhat removed from the main subject discipline of economics … I think quite a lot of Health Economists are comfortable within their own zone in a way - journals, conferences and seminars. So there is maybe a risk that it is somewhat a little bit isolated and the perception of Health Economics that is held by other Economists, is not always great. Health Economics Teaching in the UK

19. Quotes • Academic promotion • ”…to get a position in the department people have got to have a PhD, yeah…” • Use of HE in decision making • “…well NICE has made a big difference andQALYs… before, people didn't really dabble much in QALYs because it was so difficult to get … so everything was in natural units…” Health Economics Teaching in the UK

20. Issues raised • Recruitment of PhD students and researchers with health economics qualifications • International students return home or are not eligible for research council funding • International students are needed to ‘break even’ • Assessment methods/teaching content and practice vary. • The development of decision-making bodies such as NICE has influenced content of teaching. Health Economics Teaching in the UK

21. Completeness of the sample • Many new courses included • Two ‘defunct’ courses included • One ‘floundering’ course included Health Economics Teaching in the UK

22. Discussion • Question: Is health economics postgraduate teaching any different to other economics postgraduate teaching or even generic postgraduate teaching? • Ultimately seeking to develop future research ideas focussed on health economics teaching • Health Economics education • Health economics and its relationship with Departments/Schools of Economics Health Economics Teaching in the UK