HEU, Centre for Health Economics

Making a Difference


Publications authored/co-authored by HEU staff members/associates

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Featured Publications


Estimating the Financial Incentive for Caribbean Teachers to Migrate: An Analysis of Salary Differentials using Purchasing Power Parity (PPP). 2021. Gavin George, Bruce Rhodes, Christine Laptiste.  Journal of Education and Development in the Caribbean.   JEDIC Vol. 19 No. 2

[ABSTRACT] The teaching stock within the Caribbean region has been eroded by migration to developed countries. Higher potential earnings are one of the motivating factors to move abroad, but little is known about the extent of the income disparity between countries in the Caribbean and popular destination countries. Teacher salary comparisons are undertaken between selected countries in the Caribbean; Suriname, Trinidad and Tobago, St. Lucia, and Jamaica and popular destination countries, namely; United Kingdom, United States, and Canada using a purchasing power parity (PPP) exchange rate. Results show that newly qualified teachers can earn substantially more abroad, with Canada paying over twice the PPP adjusted salary compared to that offered in Jamaica (133.1%) and Suriname (110.6%). The United States offers the highest earning increases for mid- and late career teachers at over three times that offered in Jamaica (214.5%) and Suriname (223.4%)...see more 


Forecasting Tourism Demand in Selected Caribbean Countries Using Optimised Grey Forecasting Models.  Social and Economic Studies 70(1&2):35-53

[ABSTRACT] For many Caribbean countries, tourism represents a major source of foreign exchange and is the main contributor to gross domestic product. Therefore, the timely production of reliable estimates for tourism demand is paramount, especially in light of its seasonal nature. This article utilises a quasi-optimisation algorithm to produce optimised values for the generation coefficient (weights) of the grey GM(1,1) forecasting model, together with two modified grey GM(1,1) models. With data for 2008–2015, the parameter-optimised models were then used to produce insample and out-of-sample forecasts of tourism demand (stay-over tourist arrivals) for selected Caribbean countries...see more


A Survey of Selected Grey Forecasting Models with Application to Medical Tourism Forecasting.  Theoretical Economics Letters, 9, 1079-1092

[ABSTRACT] This paper examines the predictive capacity of two Grey Systems Forecasting models. The original Grey GM(1,1) Forecasting model, introduced by Deng [1] [2] together with an improved Grey GM(1,1) model proposed by Ji et al. [3] are used to forecast medical tourism demand for Bermuda. The paper also introduces a quasi-optimization method for the optimization of the alpha (weight) parameter. Five steps ahead out-of-sample forecasts are produced after estimating the models using four data points.  The results indicate that the optimization of the alpha parameter substantially improves the predictive accuracy of the models; reducing the five steps ahead out-of-sample Mean Absolute Percentage Error from roughly 7% to roughly 3.80% across the two models...see more


[ABSTRACT]. Objective: To evaluate how sociodemographic factors and food intake affect survey respondents’ perceptions of the quality of their diet. Methods: This cross-sectional analysis is based on a nonprobability sample of 374 participants in Jamaica aged ≥18 years. The three-stage process used a simple random sample to select three parishes; the main commercial areas of each parish were chosen for sampling. To ensure the inclusion of a cross-section that was as representative as possible, the sample included both public and private sector businesses, such as those in retail, hospitality and tourism as well as nongovernmental organizations. Employees and patrons completed a questionnaire regarding their food consumption and their perception of their own diet. Multiple correspondence analysis was used to evaluate the nonlinear relationships among the variables...see more


[ABSTRACT]. Purpose: To identify and assess the determinants of unhealthy dietary habits among a sample of survey participants in Jamaica. Methods: Because of resource constraints, this cross-sectional assessment is based on a three-stage non-probability sample of 374 survey respondents in Jamaica aged ≥18 years. Firstly, three administrative areas (parishes) were randomly selected. Secondly, the main commercial areas within the selected parishes were identified, from which a non-probability sample of establishments was drawn. A broad selection of establishments covering public, private, and nongovernmental organizations was chosen...see more


The next and last pandemics – The consequences of COVID-19 and its impact on the HIV/AIDS response.  African Journal of AIDS Research 2021, 20(4): x–x

Background: A webinar that examined HIV in the COVID-19 pandemic — The next and last pandemics — was hosted by the International AIDS Economics Network (IAEN), the Health Economics Unit, Centre for Health Economics at the University of the West Indies (UWI-HEU), and Pan Caribbean Partnership on HIV (PANCAP) on 21 July 2021. The meeting aimed to create a forum for: (a) A discussion on the economic impact of COVID-19 on health in general and the HIV response specifically; and (b) The identification of work that has been done addressing the financing and overall sustainability of the HIV response considering the negative impact of COVID-19 on global and local funding sources. The event featured a group of highly respected speakers with a wealth of experience from their respective agencies...see more


EQ-5D self-reported health in Barbados and Jamaica with EQ-5D-5L population norms for the English-speaking CaribbeanHealth Qual Life Outcomes 19, 97 

[ABSTRACT] Background: The EQ-5D instrument is increasingly used in clinical and resource allocation decision making in developed and developing countries. EQ-5D valuation and population norms studies have been undertaken for Trinidad and Tobago, however no population norms or value sets have been generated for the other Caribbean countries. The aims of this study were to provide population norms for Barbados and Jamaica, and to develop a set of population norms that could be used by the other English-speaking Caribbean countries.  Methods: The EQ-5D-5L self-reported health questionnaire was included in surveys of representative samples of adults in Barbados and adults in Jamaica in 2013. EQ-5D health states, mean EQ VAS scores and mean EQ-5D-5L index values (using the Trinidad and Tobago value set) were calculated for demographic groups in both countries based on 2347 respondents from Barbados and 1423 from Jamaica. A set of ‘Caribbean’ norms were developed by combining the Barbados and Jamaica data with norms recently published for Trinidad and Tobago.  Results: Data were obtained for 2347 and 1423 respondents in Barbados and Jamaica respectively. The mean index and EQ VAS values were 0.943 and 81.9 for Barbados, and 0.948 and 87.8 for Jamaica. The health states most commonly observed in the two countries were similar. Generally the demographic patterns of self-reported health were consistent with those found in other studies. Some differences between the countries were observed in the patterns of rates of reporting problems on the EQ-5D dimensions among age-gender groups specifically for anxiety/depression and pain/discomfort.  Conclusion: This study has produced a set of EQ-5D population norms that can be used as base-line values in clinical and clinico-economic analyses for Barbados and Jamaica and for the English-Speaking Caribbean region...see more


The socio-economic determinants of multimorbidity among the elderly population in Trinidad and Tobago. PLoS ONE 15(9): e0237307.

[ABSTRACT] Objective: To estimate the prevalence of multimorbidity and investigate the socioeconomic factors that are associated with multimorbidity among persons 70 years and older in Trinidad and Tobago. Design and methods: The data were obtained from a nationally representative comprehensive cross-sectional survey conducted in 2014 among elderly persons in the targeted age group. The prevalence of multimorbidity among the elderly population was estimated. A logit model was utilized to determine the socioeconomic characteristics that are associated with multimorbidity in the elderly. ...see more.

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EQ-5D-5L Population Norms and Health Inequalities for Trinidad and Tobago.  PLoS ONE 14(4): e0214283.

[ABSTRACT] The EQ-5D instrument is now used in many health systems as a health outcomes measure. Recently an EQ-5D valuation study was conducted for Trinidad and Tobago, but thus far there have been no population norms published for Trinidad and Tobago or for any Caribbean country. The objective of this study is to provide a set of population norms, and to investigate inequalities in health in Trinidad and Tobago. The EQ-5D-5L questionnaire was included in the 2012/2013 Adult Population Survey of the Global Entrepreneurship Monitor for Trinidad and Tobago. This survey covered a representative sample of 2,036 adults aged 18 and over. Demographic data and self-reported health using EQ-5D-5L were collected. The Trinidad and Tobago value set was used to obtain EQ-5D index values...see more.


PRM 30 Results From A New Visual Analogue Scale Protocol For EQ-5D Valuations. Value in Health, Vol. 14(3): 151

[ABSTRACT] OBJECTIVES: The MVH protocol uses a valuation subset of 43 EQ-5D states. Smaller valuation subsets would allow smaller samples if all respondents can value one set of states. This study tests the performance of valuation subsets based on orthogonal experiment designs. VAS values obtained for EQ-5D states are affected by the identity of adjacent states in the elicitation. This study also tests a VAS protocol developed to minimize such effects. METHODS: 230 respondents were each randomly assigned to one of two orthogonal EQ-5D valuation subsets. EQ-5D states were printed on 9cm x 4cm cards with rhomboid edges. Respondents first ranked a shuffled deck of 23 cards. A1meter VAS was then placed next to the ranked cards. Respondents transferred the cards on to the VAS with the rhomboid edges pointing to the respective values. They could see all of the cards in place at the same time. Ties were permitted and respondents were free to change the order of states in moving the cards from the ranked order to the VAS…see more.


Results from an Exploratory Study to Test the Performance of EQ-5D-3L Valuation Subsets Based on Orthogonal Designs and An Investigation Into Some Modelling and Transformation Alternatives for the Utility Function.  Health Economics Review. Vol. 4 (29).

[ABSTRACT] Background:EQ-5D-3L valuation studies continue to employ the MVH protocol or variants of MVH. One issue that has received attention is the selection of the states for direct valuation by respondents. Changes in the valuation subset have been found to change the coefficients of the utility function. The purpose of this study was to test the performance of valuation subsets based on orthogonal experiment designs. The design of the study also allowed a comparison of models based on raw or untransformed VAS values with values transformed at the level of the respondent and at the aggregate level. Methods: Two different valuation subsets were developed based on orthogonal arrays. A VAS elicitation was undertaken with two groups of similar respondents and the resulting utility functions based on the valuations of the two different valuation subsets were compared using mean absolute errors between model and observed values, and by correlation with values in and out of sample. The impact of using untransformed versus VAS values transformed at the level of the individual and at aggregate level and the inclusion of a constant term in the utility functions were also investigated...see more


What is the Financial Incentive to Immigrate? An Analysis of Salary Disparities Between Health Workers Working in the Caribbean and Popular Destination Countries.  BMC Health Services Research 19:109.

[ABSTRACT] Background: The continuous migration of Human Resources for Health (HRH) compromises the quality of health services in the developing supplying countries. The ability to increase earnings potentially serves as a strong motivator for HRH to migrate abroad. This study adds to limited available literature on HRH salaries within the Caribbean region and establishes the wage gap between selected Caribbean and popular destination countries. Methods: Salaries are reported for registered nurses, medical doctors and specialists. Within these cadres, experience is incorporated at three different levels. Earnings are compared using purchasing power parity (PPP) exchange rates allowing for cost of living adjusted salary differentials, awarded to different levels of work experience for the chosen health cadres in the selected Caribbean countries (Jamaica, Dominica, St Lucia and Grenada) and the three destination countries (United States, United Kingdom and Canada)...see more


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Experiences of gender-based violence among FSWs, MSM, and transgender women in Latin America and the Caribbean: a mixed methods analysis to inform HIV programming.  BMC International Health and Human Rights 19:9. 

[ABSTRACT] Background: Female sex workers, MSM, and transgender women—collectively referred to as key populations (KPs)—are disproportionately affected by gender-based violence (GBV) and HIV, yet little is known about the violence they face, its gender-based origins, and responses to GBV. The purpose of this study was to understand the nature and consequences of GBV experienced, to inform HIV policies and programming and to help protect KPs’ human rights. Methods: Using a participatory approach, FSWs, MSM, and transgender women in Barbados, El Salvador, Trinidad and Tobago, and Haiti conducted 278 structured interviews with peers to understand their experiences of and responses to GBV. Responses to open-ended questions were coded in NVivo and analyzed using an applied thematic analysis... see more


Stigma in health facilities: why it matters and how we can change it. BMC Medicine 17:25.

[ABSTRACT] Stigma in health facilities undermines diagnosis, treatment, and successful health outcomes. Addressing stigma is fundamental to delivering quality healthcare and achieving optimal health. This correspondence article seeks to assess how developments over the past 5 years have contributed to the state of programmatic knowledge—both approaches and methods—regarding interventions to reduce stigma in health facilities, and explores the potential to concurrently address multiple health condition stigmas. It is supported by findings from a systematic review of published articles indexed in PubMed, Psychinfo and Web of Science, and in the United States Agency for International Development’s Development Experience Clearinghouse, which was conducted in February 2018 and restricted to the past 5 years...see more


The Impact of HIV-AIDS on Children at Risk – The Case of Trinidad and TobagoIn, HIV-AIDS & Social Work Practice in the Caribbean - Theory, Issues and Innovation.  Ian Randle Publishers.  ISBN 978-967-637-356-6.


Mobile Populations, Vulnerability, and HIV/AIDS in a Globalized World: The Case of the English Speaking Caribbean. In, HIV/AIDS: Global Frontiers in Prevention/Intervention.  Eds. Cyntia Pope, Renee T. White and Robert Marlow. Routledge Publishers.  ISBN 10: 0-415-95382-0

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