Profile: Rodrigo Moreno-Serra
Rodrigo Moreno-Serra is an MRC fellow studying the use of ‘out-of-pocket’ payments for healthcare at Imperial College London’s Centre for Health Policy. He told Katherine Nightingale about why he wants to use economics to improve healthcare, and why that means putting up with more rain than he’s used to.
No one could accuse Rodrigo Moreno-Serra of hiding himself away in an ivory tower. The health economics researcher is clear about his aim to make sure that the fruits of his research make it to decision-makers — and eventually to the public that needs it.
Having grown up in the emerging economy of Brazil, Rodrigo has seen the impact of an underdeveloped health system, and is keen to make sure that his economics expertise is used to improve the way that health systems are run.
“If you are a researcher it is very exciting to see that the results of your research are being taken into account. I don’t want to only be publishing in nice journals that stay on a shelf, I want to influence policy,” he says.
Rodrigo completed his undergraduate degree in economics at the University of Sao Paulo, followed by a Master’s degree. It was during his Master’s that he realised he wanted to apply his economics knowledge to health systems, in particular to evaluating the performance of the Brazilian health system.
In 2005, he was offered the opportunity to study for a PhD at the University of York, and swapped the bustling metropolis of Sao Paulo for the more sedate environs of York. “It was a stark contrast,” he recalls, “Especially coming not only to British weather, but North Yorkshire weather!”
The cost of healthcare
One aspect of Rodrigo’s fellowship research focuses on so-called ‘out-of-pocket’ payments.
In some countries that don’t have the kind of universal coverage offered by the NHS, people must pay for standard treatments themselves. This means people often don’t visit a doctor or hospital until they are extremely sick and require expensive treatment. If a patient doesn’t have the money, they may be turned down for treatment. And even if they do have the money, they may have to spend their family’s life savings to get treatment.
To work out the level of financial hardship that medical care causes people, researchers compare how much a person has a spent with how much they earn — if the percentage spent on care is above a certain threshold, then that person is defined as having ‘catastrophic health expenditure’. But this doesn’t capture the fact that some people may have spent nothing because they simply couldn’t afford to.
“It sounds like an obvious problem, and it has been acknowledged, but no one has decided to tackle it. We need a way of distinguishing between the people who didn’t spend money because they didn’t need to, and those who needed care but couldn’t afford it,” says Rodrigo.
He is trying to find ways of using existing data to make these distinctions, as well as producing recommendations for how surveys can be designed in the future. Having this kind of information is important for governments to see whether the way they structure their health system is guaranteeing access to care while avoiding financial hardship for patients.
Out-of-pocket payments are also an issue in the UK for expensive treatments. The NHS pays only for treatments approved by the National Institute of Clinical Excellence (NICE), and NICE approves only treatments that it deems cost effective — costing less than £30,000 for each ‘quality adjusted life year’ that the treatment adds to a person’s life.
Rodrigo is trying to develop methods for agencies like NICE to include the benefit of protecting people from financial catastrophe in its calculations. For example, new cancer treatments tend to be expensive and patients appreciate not having to pay for them out of pocket.
“If you account for the value of protecting people from the financial consequences of their illness, you’re going to change the cost effectiveness ratio,” he says.
Friends in important places
One way that Rodrigo is hoping to ensure that his research makes an impact is through collaboration. His fellowship means that he has the financial flexibility to approach useful organisations and go to work with them for months at a time.
“The only way you can influence policy is to work with the organisations that help make policy. My fellowship means I can spend time with organisations such as the World Health Organization, the World Bank.”
Rodrigo still lives in York, but he commutes to London a few days a week to work with his colleagues. The rest of the time he can be found number-crunching in his home office; he obviously wasn’t put off by the Yorkshire weather.