Publications

• Scott, A.M., Amies-Cull, B., Oguzman, E., Webster, J., Thomas, R.L., Mason, A., Bojke, L., Quinn, M., Clarkson, P., Spearing, J., Shepperd, S. (2026). Social and Health Conditions That Drive the Need and Demand for, Use of and Expenditure on Social Care in the UK: A Systematic Review. Cochrane Evidence Synthesis and Methods. doi:10.1002/cesm.70093
  Abstract

  Background: The need for social care, in the form of practical assistance and personal care, is increasing alongside a growing older population with long-term conditions and places those with limited or no access to publicly funded care at risk of increasing levels of unmet need.

  Aim: This systematic review sought to understand the role of social and health conditions in the need, demand, utilization, and expenditure on social care in the United Kingdom.

  Methods: We searched Medline, CINAHL, EconLit, ASSIA, and the Campbell Collaboration from January 1, 2009 to April 14, 2025, and gray literature on August 21, 2024, for randomized trials, cohort studies, case control studies, and interrupted time series, cross-sectional, and modeling studies of populations aged ≥ 60 years old, in a UK setting, that examined the association of social and health conditions with the need and demand for, use of and expenditure on social care. We conducted risk of bias assessments using ROBINS-E for longitudinal studies, and intended to use Risk of Bias 2 for randomized trials. We applied GRADE to assess the certainty of evidence. Results were synthesized narratively, and presented in an Evidence Gap Map.

  Results: We included 10 longitudinal cohort and eight cross sectional studies, study sample size ranged from 526 to > 400,000 participants. Five of the cohort studies were assessed as high risk of bias, and the cross sectional studies as moderate concern or high risk of bias. Older age was associated with increased unmet need for care in most studies, and living alone with increased unmet need for care and use of residential care. Results for ethnicity, deprivation and sex varied across studies, with studies using different measures of deprivation that limited comparability of findings. A range of long-term health conditions were assessed, some studies indicated an association with an increased need and use of care; there were mixed findings for cost. For populations with cognitive impairment or dementia, the association with age and the use and cost of care varied, there was no clear association for sex, ethnicity and living alone; a previous hospital admission or ongoing health problems that included severity of dementia were associated with increased use of care.

  Conclusion: Our review of UK evidence indicates that there is insufficient evidence to accurately identify populations age > 60 years that are at increasing risk for needing care due to their social and health conditions.

• Thomas, R.L., Roope, L., Duch, R., Robinson, T., Zakharov, A.V., Clarke, P. (2025). Lottery or Triage? Multi-country survey-based experiment evidence from the COVID-19 pandemic on public preferences for allocation of scarce medical resources. Medical Decision Making. doi:10.1177/0272989X251367777
  Abstract

  Context: Bioethicists have advocated lotteries to distribute scarce healthcare resources, highlighting benefits which make them attractive amid growing healthcare challenges. During the COVID-19 pandemic, lotteries were used to distribute vaccines within priority groups in some settings, notably in the United States. Nonetheless, limited evidence exists on public attitudes towards lotteries.

  Methods: To assess public support for vaccine allocation by lottery versus expert committee, we conducted a survey-based experiment during the pandemic. Between November 2020 and May 2021, data were collected from 15,380 respondents across 14 diverse countries. Respondents were randomly allocated (1:1) to one of two hypothetical scenarios involving COVID-19 vaccine allocation among nurses: (i) by lottery; (ii) prioritization by a committee of expert physicians. The outcome was agreement on the appropriateness of the allocation mechanism on a scale from 0 (“strongly disagree”) to 100 (“strongly agree”), with differences stratified by a range of covariates. Two-sided t-tests were used to test for overall differences in mean agreement between lottery and expert committee.

  Findings: Mean agreement with lottery allocation was 37.25 (95%CI 34.86 – 39.65), ranging from 21.1 (95%CI 15.07 - 27.13) in Chile to 62.33 (95%CI 54.45 - 70.21) in India. In every country, expert committee allocation received higher support, with mean agreement of 61.19 (95% CI: 60.04–62.35), varying from 51.25 in Chile to 69.77 in India. Greater agreement with lotteries was observed among males, higher-income individuals, those with lower education, and those identifying as politically right-leaning.

  Conclusions: Despite arguments for lottery-based allocation of medical resources, we found low overall public support, albeit with substantial variation across countries. Successful implementation of lottery allocation will require targeted public engagement and clear communication of potential benefits.

• Thomas, R.L., Millett, C., Sousa Soares, R., Hone, T. (2024). More Doctors, better health? A generalised synthetic control approach to estimating impacts of increasing doctors under Brazil’s Mais Medicos Programme. Social Science and Medicine. doi:10.1016/j.socscimed.2024.117222
  Abstract

  Worldwide, there are an insufficient number of primary care physicians to provide accessible, high-quality primary care services. Better knowledge on the health impacts of policies aimed at improving access to primary care physicians is important for informing future policies. Using a generalised synthetic control estimator (GSC), we estimate the effect of the increase in primary care physicians from the Programa Mais Médicos in Brazil. The GSC allows us to estimates a continuous treatment effects which are heterogenous by region. We exploit the variation in physicians allocated to each Brazilian microregion to identify the impact of an increasing Mais Médicos primary care physicians. We explore hospitalisations and mortality rates (both total and from ambulatory care sensitive conditions) as outcomes. Our analysis differs from previous work by estimating the impact of the increase in physician numbers, as opposed to the overall impact of programme participation. We examine the impact on hospitalisations and mortality rates and employ a panel dataset with monthly observations of all Brazilian microregion over the period 2008–2017.

  We find limited effects of an increase in primary care physicians impacting health outcomes - with no significant impact of the Programa Mais Médicos on hospitalisations or mortality rates. Potential explanations include substitution of other health professionals, impacts materialising over the longer-term, and poor within-region allocation of Mais Médicos physicians.

• Thomas, R.L., Mentzakis, E. (2024). The direct and spillover effects of diabetes diagnosis on lifestyle behaviours. Health Economics. doi:10.1002/hec.4803
  Abstract

  Using blood sample data we exploit an arbitrary cut-off of diabetes risk and through a fuzzy regression kink design we estimate the effect of a diabetes diagnosis on own and partner health-related behaviours. Diabetes diagnosis increases the probability of exercising, both for those diagnosed with diabetes and their partner. We also conduct mediation analysis which suggests that joint household participation is the channel behind this effect. Our results have significant implications for the understanding of the channels that induce behavioural change, and household decision making, as well as, for the evaluation of diabetes related policies.