At the Center for Health System Sustainability (CHeSS), we help countries learn from one another to optimize patient care and build resilient and sustainable health systems. We do so by leveraging patient-level data and global partnerships to produce comparative data insights and actionable policy recommendations.
Center for Health System Sustainability
Center for Health System Sustainability
Real-world data for global health policy.
Center for Health System Sustainability
Real-world data for global health policy.
Powering health systems research with patient-level data through global partnership.
We learn what makes health systems high-performing, resilient, and sustainable.
International Collaborative for Costs, Outcomes, and Needs in Care (ICCONIC)
https://www.youtube.com/embed/7wBK4II5N_A
CHeSS asks
What is the biggest issue with the RI healthcare system?
CHeSS: A new center at Brown to study health care systems across countries
A discussion comparing health policy challenges facing the U.S. to those faced by other high-income countries illustrated how the Center for Health System Sustainability aims to improve health care systems through research.
The Latest at CHeSS
All Events
JAMA Health Forum
Tertiary Patents on Drugs Approved by the FDA
Question: How have medical device patents contributed to periods of market exclusivity on drug-device combinations?
Findings: In this cohort study of 331 drug-device combinations approved by the Food and Drug Administration (FDA) from 1986 to 2023, 1751 of 3241 individual patent listings were on the delivery devices of these products. Medical device patents extended periods of protection for 180 products (54.4%) by a median (IQR) of 7.5 (2.8-13.9) years, with most device patents failing to mention the active pharmaceutical ingredients in their claims.
Meaning: Patenting strategies on drug-device combinations may impede generic entry and keep prices high for patients and payers.
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Findings: In this cohort study of 331 drug-device combinations approved by the Food and Drug Administration (FDA) from 1986 to 2023, 1751 of 3241 individual patent listings were on the delivery devices of these products. Medical device patents extended periods of protection for 180 products (54.4%) by a median (IQR) of 7.5 (2.8-13.9) years, with most device patents failing to mention the active pharmaceutical ingredients in their claims.
Meaning: Patenting strategies on drug-device combinations may impede generic entry and keep prices high for patients and payers.
Springer Nature Link
Evaluating the value for money of global fund’s expenditures (2017–2019)
Background: The Global Fund to Fight AIDS, Tuberculosis, and Malaria is one of the world’s largest global health donor agencies, playing a key role by filling recipient countries’ domestic health financing gaps; however, little is known about how well it achieves value for money. Given the current uncertainty regarding global health development assistance, it is critical to understand how to prioritize external donor funding allocations in an effort to maximize health impact.
Methods: In this study, we evaluated 66 recipient countries’ efficiency relative to peers in achieving improvement in health outcomes for TB, malaria, and HIV given their 2017–2019 Global Fund expenditures for (1) health products, (2) program activities, and (3) program management. Using a combination of frontier analysis, linear regression, and cluster analysis, we examined how macroeconomic conditions, epidemiological context, health system factors, and Global Fund spending decisions explain variation in country program performance.
Results: For malaria and HIV, we found a negative relationship between Global Fund spending on program activity and health product costs respectively and countries’ efficiency at translating funds to health impact. For malaria and HIV, there was also significant variation in efficiency across countries according to their economic capacity, disease burden, and most prominent spending area.
Conclusions: Our results suggest possible structural inefficiencies in country program management, dampening the health impact of frontline programs. The lack of broad patterns to predict performance signals the importance of tailoring spending strategies to country-specific contexts.
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Methods: In this study, we evaluated 66 recipient countries’ efficiency relative to peers in achieving improvement in health outcomes for TB, malaria, and HIV given their 2017–2019 Global Fund expenditures for (1) health products, (2) program activities, and (3) program management. Using a combination of frontier analysis, linear regression, and cluster analysis, we examined how macroeconomic conditions, epidemiological context, health system factors, and Global Fund spending decisions explain variation in country program performance.
Results: For malaria and HIV, we found a negative relationship between Global Fund spending on program activity and health product costs respectively and countries’ efficiency at translating funds to health impact. For malaria and HIV, there was also significant variation in efficiency across countries according to their economic capacity, disease burden, and most prominent spending area.
Conclusions: Our results suggest possible structural inefficiencies in country program management, dampening the health impact of frontline programs. The lack of broad patterns to predict performance signals the importance of tailoring spending strategies to country-specific contexts.
Question: How did obstetric-related Emergency Medical Treatment and Labor Act (EMTALA) violations change in association with state-level abortion policy?
Findings: In this difference-in-differences analysis of EMTALA violations from 2018 to the first quarter of 2023, states with no health exceptions saw a substantial rise in obstetric-related violations that were associated with policies adopted by Texas. There was a concurrent rise in emergency department utilization, and screening failures suggest that violations may have increasingly occurred on arrival before treatment.
Meaning: The study results suggest that state abortion laws may undermine federally protected care in obstetric emergencies.
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Findings: In this difference-in-differences analysis of EMTALA violations from 2018 to the first quarter of 2023, states with no health exceptions saw a substantial rise in obstetric-related violations that were associated with policies adopted by Texas. There was a concurrent rise in emergency department utilization, and screening failures suggest that violations may have increasingly occurred on arrival before treatment.
Meaning: The study results suggest that state abortion laws may undermine federally protected care in obstetric emergencies.
Upcoming CHeSS events
Harmonizing International Health Data for Better Outcomes
Professor Irene Papanicolas joins Megan Hall on the Humans in Public Health podcast to discussed her work: she aims to standardize data from across global health systems and compare them in order to inform policy choices and improve health care value and patient care.