Brian C.F. Chan, PhD, is an Affiliate Scientist with the Neural Engineering and Therapeutics Team at KITE – Toronto Rehabilitation Institute and an Assistant Professor at the Institute of Health Policy, Management and Evaluation at the University of Toronto. Dr. Chan works closely with the Ontario Neurotrauma Foundation, Praxis Spinal Cord Institute, Ontario Spinal Cord Injury Alliance and Spinal Cord Injury Ontario to ensure that the research conducted by his team is of importance to the spinal cord injury community.
Guide me through your research trajectory and what prompted your focus on health economics in the SCI care agenda?
I was a research assistant for HOPE Research Centre working on various health economic projects when the opportunity for completing a PhD co-supervised by Dr. Nicole Mittmann and Dr. Murray Krahn came up. My doctoral studies were funded by a HE capacity building grant by ONF and Praxis. I was able to evaluate the lifetime cost of SCI and chronic ulcers using health care administration data for my PhD. After doctoral studies I was able to continue my research as a Post-doc co-supervised by Dr. Cathy Craven and Dr. Walter Wodchis. This was also funded through ONF and Praxis through a mentor-mentee training grant. Then as a post-doc I was able to work on a larger assortment of economic studies in SCI and begin to build capacity for future research on economics in this population. This has progressed to an affiliate scientist position at KITE-TRI where I can continue expanding on the opportunities for economic evaluations in SCI and training future researchers in this space. All this could not have happened without my various supervisors, mentors, Praxis and ONF.
What impacts do health economics have on the SCI community?
The health care system has limits. It’s limited because of budgets, limited because of the number of health care providers, limited because of office and clinic space. Because of these limits, choices need to be made on how best to spend the money or how care providers should spend their time or how to use the space. That way the best care can be provided. Health economic studies provide knowledge about the impact of these choices and help inform decision makers about where certain choices may provide better health care to individuals in the SCI community.
How developed is the health economics space as related to SCI in Ontario? Is your work a continuation of work that’s been established?
Health economics has grown substantially in the last few years since there has been more and more pressure by governments, health care facilities and providers to deliver great health care on a limited budget. Decision-makers are becoming more aware of the need for economic evidence in the choices that they make. There are so few researchers who specialize in health economics and focus in the SCI community not only in Ontario but also internationally. Ontario-based researchers like Julio Furlan (also at KITE-TRI) and I are hoping to build capacity; with ONF’s help, we will be able to build a strong foundation for future work.
What specific research question are you responding to in this appointment? Is there a specific research study?
Do you have a particular focus, be it looking at technology to support SCI care, acute care service, or home care service?
There are so many areas that economic studies touch upon. It can be used to evaluate technologies (I use this broadly to include devices as well as chances in health care practice), study current acute care service deliver to identify improvements and examine the costs and cost drivers for individuals with SCI living in the community. This can include costs to the health care system, to the individual or even to their family and friends who provide care. My goal, alongside fellow researchers is to build work in all areas because they are all important. My focus has been evaluating developing technologies for SCI and understanding the cost of care for individuals living in the community.
What are the desired outcomes of the study?
The main outcomes of interest in these studies are the cost-effectiveness of technologies, or cost-savings or even just the cost of care. With that in mind the desired outcomes of this type of work is to help decision-makers make more informed decisions on how best to deliver health care to maximize health.
Looking forward, what impacts do you think health economics will have on SCI care and rehab in Ontario over the next 10 years?
Health economics provides evidence for decision-makers so that they will be more confident in the tough decisions they need to make. Hopefully this will speed up the introduction of changes to practice and new technologies that will have a positive impact on SCI care and rehab. Over the next 10 years, in partnership with ONF and other groups with a shared interest to improve the lives of those with SCI, we will strive to develop economic studies that will advance care and improve the health of those with SCI.