PhD position: The impact of medical technology on health spending and health

Job description

We are recruiting a PhD candidate for a project on the impact of medical technologies on health and health spending.

Health care expenditures have been growing at a faster rate than the overall economy in most developed countries. An important driver of growing health care expenditures is the introduction of new medical technology (e.g. Chandra & Skinner 2012). However, besides increasing health spending, the introduction of some medical technologies also has brought improvements in health (Cutler 2007). As health spending is often to a large extent publicly funded, deciding about what medical technologies to collectively fund should be based on sound estimates of its costs and benefits taking into account its distributional consequences (Meltzer & Smith 2011).

In this project, the focus is on evaluating a particular sort of medical technologies: medical devices. Here, we can think of MRI scanners, surgical robots but also stenting in patients with heart disease. Ideally, medical technologies are evaluated in randomised clinical trials (RCTs) which is the standard when assessing pharmaceuticals. However, RCTs might not be the ideal way to evaluate medical devices for several reasons (Drummond et al. 2009). First of all, a drawback of RCTs is that the persons participating in the RCT are usually highly selective and not representative of the population that will use the technology in real life. An issue specifically related to medical devices is that there is an interaction between the device and the user (e.g. surgeon) and, consequently, that its impact may vary over time due to learning curves. Furthermore, for a lot of medical devices (e.g. MRI scanners) the link between investments and consequences is less clear. The key mechanism by which such devices generate benefits is by producing information that reduces uncertainty regarding diagnosis in many different diseases. Such information may impact on and inform multiple programs within the healthcare system to function better (Morton et al. 2016).

The proposed research aims to empirically investigate the impact of medical devices on the growth of health spending and the impact on population health and its distribution thereof (e.g. gender, age, socio-economic status). Furthermore, the proposed will contribute to a methodological framework for evaluating medical devices. This will involve combining modern statistical, econometric and simulation modelling methods that can identify the impact of medical devices on health spending and health.

This project consists of two objectives: (1) estimating the impact of medical devices on health spending growth and health in the Dutch population (2) develop a simulation model that predicts how new medical devices can influence future spending growth and population health in the Netherlands. To accomplish the first objective we will use large linked datasets provided by Statistics Netherlands and identification strategies will build on previous studies that have estimated the impact of medical technology on mortality (e.g. Almond et al. 2010, Doyle Jr et al. 2015). Insights derived from answering the first objective will feed into the simulation model that will be developed for the second objective. This is an ambitious agenda and they are listed to set out the broad scope of the research. The doctoral student will have some freedom to explore ideas and identify those that are most appealing and feasible.

Requirements

The candidate is expected to have (i) a (research) master degree in Economics, Econometrics, or a quantitative field such as biostatistics or applied mathematics, (ii) experience with statistical software (R, Stata, or similar programs), and (iii) excellent communication and writing skills in English. Preferably, the candidate has experience in applied micro-econometrics/statistical analysis and has a demonstrable interest in health economics and economic evaluation. The candidate is expected to contribute to all parts of the project, but qualifications and interests may guide their focus.

Conditions of employment

Fixed-term contract: An appointment for 4 years.

We offer an appointment as PhD student for a period of 1.5 year, which will be extended with a second term of 2.5 years if the candidate performs well. Remuneration will be according to the PhD scales set by the Collective Labor Agreement for Dutch Universities (CAO NU), and will range from € 2.325 per month in the first year to € 2.972 per month in the fourth year (gross amounts, in case of fulltime employment). The EUR has attractive employment conditions, which include a holiday allowance of 8.0%, an end-of-year bonus of 8.3% and up to 41 days paid time off. Substantial tax benefits apply to non-Dutch citizens, conditional on permission granted by the Dutch Tax Office. Applicants should have the right to work in the Netherlands for the duration of the contract.
Fulltime is considered to be 38 hours per week.
The starting date will be determined together with the candidate.

Employer

Erasmus University Rotterdam

The Erasmus University Rotterdam (EUR), named after Rotterdam-born humanist and theologian Erasmus, is a research university with a strong international orientation and a pronounced social focus, both in its education and research activities. On the lively, modern campus, more than 28.000 students and scholars of more than 100 nationalities are constantly encouraged to develop their talents and meet their ambition. Our more than 2700 scientists and employees work together with all our students to solve challenges faced by global society, drawing their inspiration from the consistently dynamic and cosmopolitan city of Rotterdam. The academic education offered at our faculties is intensive, engaging and strongly focused on practical application. We increasingly perform our research in multidisciplinary teams, which are closely interwoven with international networks. In terms of research impact and the quality of its degree programmes, EUR can compete with the foremost universities in Europe, which is reflected in its consistent top-100 position in most major universities rankings. Erasmus University Rotterdam’s key values are daring, curiosity, social involvement, breaking new ground and striving for success. More information can be found on www.eur.nl.

Department

Erasmus School of Health Policy & Management

Erasmus School of Health Policy & Management (ESHPM) is part of Erasmus University Rotterdam and is responsible for a bachelor and four master programs on policy and management in healthcare, which serve 1000 students. In addition, research is being done on three major research themes: ‘competition and regulation in healthcare’, ‘quality and efficiency in healthcare’ and ‘healthcare management’. ESHPM has about 175 employees. The position offered is within the Health Technology Assessment group.

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