Elias Mossialos

Elias Mossialos
The London School of Economics and Political Science | LSE · Health Policy

Professor

About

555
Publications
190,639
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17,343
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Introduction
Elias Mossialos is Professor of Health Policy at the London School of Economics and Political Science. His research focus is comparative health systems and policy, addressing questions related to health reforms, financing health care, pharmaceutical policies and the impact of EU law on health systems. He is currently analysing incentives to address the need for sufficient investment in the development of antibiotics in order to meet changing medical needs.
Additional affiliations
January 1994 - May 2016
The London School of Economics and Political Science
Position
  • Professor of Health Policy

Publications

Publications (555)
Article
In 2004 the government of Mexico initiated an ambitious program, Seguro Popular, to extend health insurance coverage to poor and informal-sector workers. While the program had a protective effect during its early stages, its impact on out-of-pocket health spending over time is unclear. This study used two waves of the Encuesta Nacional de Salud y N...
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Background: The degree to which elevated mortality associated with weekend or night-time hospital admissions reflects poorer quality of care ('off-hours effect') is a contentious issue. We examined if off-hours admissions for primary percutaneous coronary intervention (PPCI) were associated with higher adjusted mortality and estimated the extent t...
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As cancer drug prices rise, it remains unclear whether the cost of new interventions is related to their beneficial impact for patients at a societal-level. Using data for 2003- 2015 from the IQVIA MIDAS® dataset, the relationship between cancer drug costs and drug clinical benefits was studied in four countries with different approaches to drug pr...
Article
The UK's response to the pandemic The UK has recorded one of the highest death rates associated with COVID-19 globally, whether measured as deaths that are directly attributable to COVID-19 or by excess mortality. The reasons for this high rate are complex and not yet fully understood, but elements of the UK Government response have been criticised...
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Background: Universal health coverage (UHC) encompasses 2 main components: access to essential healthcare services and protection from financial hardship when using healthcare. This study examines Myanmar's efforts to achieve UHC on a national and subnational level. It is a primer of studying the concept of UHC on a subnational level, and it also...
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Background Molnupiravir (M) and Nirmatrelvir/Ritonavir (N/R) have been authorized for use in COVID-19 patients at high risk for severe disease. We aimed to evaluate the effectiveness of M and N/R in highly vulnerable SARS-CoV-2 patients using a retrospective cohort study design. Methods The study population consisted of SARS-CoV-2 infected non-hos...
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Importance Both the commercial sector and academia play a vital role in medicine development. Ongoing debates exist on their contribution and the value of medicinal products entering the market. Objective To identify the provenance and clinical benefit of medicines that entered the French market between 2008 and 2018. Design and Setting In this c...
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First‐in‐class (FIC) designation became a hallmark of innovation, however, even at the marketing authorisation stage, little is known about the clinical benefits these products deliver. We identified the provenance of the FIC drugs that entered the French market from 2008 to 2018 and matched these medicines to the clinical benefit grading by Haute...
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Digital health technologies used in primary care, referred to as, virtual primary care, allow patients to interact with primary healthcare professionals remotely though the current iteration of virtual primary care may also come with several unintended consequences, such as accessibility barriers and cream skimming. The World Health Organization (W...
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Large pharmaceutical companies have withdrawn from antibiotic R&D because of the high risk of failure and because antibiotics are less profitable than other areas; small and medium-sized enterprises (SMEs), which now drive antibiotic R&D, face difficulty securing funding for preclinical and early clinical trials, and risk significant economic losse...
Chapter
The World Health Organization (WHO) World Health Report 2000 defines health systems as ‘all the activities whose primary purpose is to promote, restore or maintain health’(World Health Organization, 2000). This definition is deliberately broad, and intended to encompass all organizations, institutions and resources that are devoted to improving hea...
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Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inap-propriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently...
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Background The adoption of digital health care within health systems is determined by various factors, including pricing and reimbursement. The reimbursement landscape for digital health in Europe remains underresearched. Although various emergency reimbursement decisions were made during the COVID-19 pandemic to enable health care delivery through...
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Background and Aims As screening for the liver disease and risk‐stratification pathways are not established in patients with type‐2 diabetes mellitus (T2DM), we evaluated the diagnostic performance and the cost‐utility of different screening strategies for MASLD in the community. Methods Consecutive patients with T2DM from primary care underwent s...
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Background Evidence for the association between social determinants of health (SDoH) and health-related quality of life (HRQoL) is largely based on single SDoH measures, with limited evaluation of cumulative social disadvantage. We examined the association between cumulative social disadvantage and the Health and Activity Limitation Index (HALex)....
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The health care sector experiences 76% of cybersecurity breaches due to basic web application attacks, miscellaneous errors, and system intrusions, resulting in compromised health data or disrupted health services. The European Commission proposed the European Health Data Space (EHDS) in 2022 to enhance care delivery and improve patients' lives by...
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Introduction: Generic pharmaceuticals account for the majority of the $359 billion US pharmaceutical market, including for cardiology drugs. Amidst a lack of price transparency and administrative inefficiencies, generic drug prices are high, causing an undue burden on patients. Methods: We identified the 50 most used generic cardiology drugs by vol...
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Background We aimed to evaluate the effectiveness of molnupiravir and nirmatrelvir/ritonavir in highly vulnerable SARS-CoV-2 patients using a retrospective cohort study design. Methods The impact of each drug was determined via comparisons with age-matched control groups of SARS-CoV-2-positive patients who did not receive oral antiviral therapy....
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Background Although meningitis is largely preventable, it still causes hundreds of thousands of deaths globally each year. WHO set ambitious goals to reduce meningitis cases by 2030, and assessing trends in the global meningitis burden can help track progress and identify gaps in achieving these goals. Using data from the Global Burden of Diseases,...
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Background: Digital therapeutics are patient-facing digital health interventions that can significantly alter the health care landscape. Despite digital therapeutics being used to successfully treat a range of conditions, their uptake in health systems remains limited. Understanding the full spectrum of uptake factors is essential to identify ways...
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Antimicrobial, and particularly antibiotic resistance are one of the world's biggest challenges today, and urgent action is needed to reinvigorate the antibiotic development pipeline. To inform policy discussions during and after the 2023 Swedish Presidency of the Council of the European Union, we critically appraise incentive options recently prop...
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Background: Although meningitis is largely preventable, it still causes hundreds of thousands of deaths globally each year. WHO set ambitious goals to reduce meningitis cases by 2030, and assessing trends in the global meningitis burden can help track progress and identify gaps in achieving these goals. Using data from the Global Burden of Diseases...
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Background: Diabetes is one of the leading causes of death and disability worldwide, and affects people regardless of country, age group, or sex. Using the most recent evidentiary and analytical framework from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), we produced location-specific, age-specific, and sex-specific estimat...
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The crowded global health landscape has been joined by the European Union Health Emergency Preparedness and Response Authority (HERA). HERA will assume four broad areas of responsibility: horizon scanning for major health threats; research and development; support for capacity to manufacture drugs, vaccines, and equipment; and procuring and stockpi...
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Valuable information can be obtained from a systematic evaluation of a successful national transplant program. This paper provides an overview of Italy’s solid organ transplantation program which is coordinated by the National Transplant Network (Rete Nazionale Trapianti) and The National Transplant Center (Centro Nazionale Trapianti). The analysis...
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Conceptual frameworks are valuable resources that can be used to guide the planning, evaluation, and development of healthcare services. However, there are currently no comprehensive frameworks focused on organ donation and transplantation that identify the critical factors underlying a successful national program. To address this knowledge gap, we...
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Greece has fallen far behind many comparable European countries in the field of organ donation and transplantation and has made little progress over the past decade. Despite efforts to improve its organ donation and transplantation program, systemic problems persist. In 2019, the Onassis Foundation commissioned a report to be prepared by the London...
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The Republic of Croatia is a global leader in organ donation and transplantation despite having fewer resources and more modest healthcare expenditures than other countries in the European Union. The results of an extensive literature review were combined with expert input in an iterative multi-step data collection and evaluation process designed t...
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Over the past two decades, Portugal has become one of the world leaders in organ donation and transplantation despite significant financial constraints. This study highlights how Portugal achieved success in organ donation and transplantation and discusses how this information might be used by other countries that are seeking to reform their nation...
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The United Kingdom (UK) supports a highly successful organ donation and transplantation program. While the UK originally had one of the lowest organ donation rates in Europe, sustained reforms have resulted in steady improvement. Of note, the UK nearly doubled its rate of deceased donations between 2008 and 2018. In this report, we present a case s...
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The organ donation and transplantation program in Spain has long been considered the gold standard worldwide. An in-depth understanding of the Spanish program may promote the development and reform of transplant programs in other countries. Here, we present a narrative literature review of the Spanish organ donation and transplantation program supp...
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Background: Most cancer drugs enter the US market first. US Food and Drug Administration (FDA) approvals of new cancer drugs may influence regulatory decisions in other settings. The study examined whether characteristics of available evidence at FDA approval influenced time-to-marketing authorisation (MA) in Brazil, and price differences between...
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Abstract Introduction Educational attainment is an important social determinant of health (SDOH) for cardiovascular disease (CVD). However, the association between educational attainment and all-cause and CVD mortality has not been longitudinally evaluated on a population-level in the US, especially in individuals with atherosclerotic cardiovascula...
Preprint
BACKGROUND The adoption of digital health care within health systems is determined by various factors, including pricing and reimbursement. The reimbursement landscape for digital health in Europe remains underresearched. Although various emergency reimbursement decisions were made during the COVID-19 pandemic to enable health care delivery through...
Preprint
UNSTRUCTURED The health care sector experiences 76% of cybersecurity breaches due to basic web application attacks, miscellaneous errors, and system intrusions, resulting in compromised health data or disrupted health services. The European Commission proposed the European Health Data Space (EHDS) in 2022 to enhance care delivery and improve patien...
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Public interest is an important component influencing the likelihood of successfully implementing digital healthcare. The onset of the COVID-19 pandemic allowed us to assess how public interest in digital health changed in response to disruptions in traditional health services. In this study, we used a difference-in-differences approach to determin...
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Background: Avoidable mortality, including both treatable and preventable deaths, is frequently used as an indicator of health system performance. Whilst the term treatable mortality refers to deaths that might be averted by medical interventions, preventable mortality generally reflects the impact of system-wide health policies. The concept of pr...
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Background: The burden of patient safety incidents (PSIs) is often characterised by their impact on mortality, morbidity and treatment costs. Few studies have attempted to estimate the impact of PSIs on patients' health-related quality of life (HRQoL) and the studies that have made such estimates primarily focus on a narrow set of incidents. The a...
Preprint
BACKGROUND Digital therapeutics are patient-facing digital health interventions that can significantly alter the health care landscape. Despite digital therapeutics being used to successfully treat a range of conditions, their uptake in health systems remains limited. Understanding the full spectrum of uptake factors is essential to identify ways i...
Article
Objective: To examine the independent and interdependent effects of race and social determinants of health (SDoH) and risk of all-cause and cardiovascular disease (CVD) mortality in the US. Data source/study design: Secondary analysis of pooled data for 252,218 participants of the 2006-2018 National Health Interview Survey, linked to the Nationa...
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Introduction Zimbabwe has one of the highest rates of private health insurance (PHI) expenditures as a share of total health expenditures in the world. The perfomamce of PHI, known as Medical Aid Societies in Zimbabwe, requires close monitoring since market failures and weaknesses in public policy and regulation can affect overall health system per...
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Background Unmet need is a metric used to assess the performance of health care systems throughout the world. One of the primary objectives of the Brazilian health care system is to identify ways to improve the health outcomes of all citizens. To accomplish this challenging goal, the health care system in Brazil will need to identify and eliminate...
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Background: The COVID-19 pandemic highlighted the fragmented nature of governmental policy decisions in Europe. However, the extent to which COVID-19 vaccination policies differed between European countries remains unclear. Here, we mapped the COVID-19 vaccination policies that were in effect in January 2022 as well as booster regulations in April...
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Besides the significant benefits of vaccination against COVID-19, the risk of severe disease and death from COVID-19 among highly vulnerable populations remains of concern. Implementation of oral antiviral treatment has shown significant benefits for outpatients with high risk for severe disease, however, their effectiveness remains to be evaluated...
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Background One of the primary objectives of the Brazilian health care system is to improve the health and well-being of all citizens. Since the establishment of the Unified Health System/Sistema Único de Saúde (SUS) in 1988, Brazil has made strides towards reducing inequalities in health care services utilisation. However, there are currently no co...
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Global investments in pandemic preparedness and COVID-19: development assistance and domestic spending on health between 1990 and 2026 Global Burden of Disease 2021 Health Financing Collaborator Network † Show footnotesOpen AccessPublished:January 24, 2023DOI:https://doi.org/10.1016/S2214-109X(23)00007-4 Summary Background The COVID-19 pandemic h...
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BACKGROUND: Due to the emergency responses early in the COVID-19 pandemic, the use of digital health in health care increased abruptly. However, it remains unclear whether this introduction was sustained in the long term, especially with patients being able to decide between digital and traditional health services once the latter regained their fun...
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The circulation of SARS-CoV-2 omicron BA.4 and BA.5 subvariants with enhanced transmissibility and capacity for immune evasion resulted in a recent pandemic wave that began in April–May of 2022. We performed a statistical phylogeographic study that aimed to define the cross-border transmission patterns of BA.4 and BA.5 at the earliest stages of vir...
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Background: Although human immunodeficiency virus (HIV) infection in the Russian Federation was historically concentrated among marginalized populations (people who inject drugs, sex workers, men who have sex with men, and the prison population), recent evidence suggests that it has become a more generalized epidemic. The objective of our research...
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The extent to which cumulative social disadvantage-defined as aggregate social risk resulting from multiple co-occurring adverse social determinants of health (SDOH)-affects the risk of all-cause mortality, independent of demographic and clinical risk factors, is not well understood. The objective of this study was to examine the association betwee...
Article
Introduction: Psychiatric disorders and social determinants of health impact the management of medical conditions. We examined the relationship between anxiety, cumulative social risk, and adherence to antihypertensive medications. Methods: We used data from the 2020 national health interview survey to evaluate antihypertensive medication use. Anxi...
Article
Introduction: The COVID-19 pandemic reportedly disrupted access and delivery of healthcare across diverse populations. We evaluated gender differences in the relationship between health rating and the disruption of medical care in patients with atherosclerotic diseases (ASCVD) due to COVID-19. Methods: This was a cross-sectional study of 2,678 adul...
Article
Objective (1) Identify and review current policies for the cardiovascular screening of athletes to assess their applicability to the paediatric population and (2) evaluate the quality of these policy documents using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool. Design Systematic review and quality appraisal of policy do...
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China initiated its healthcare reform in 2009 to provide accessible and affordable healthcare to all. We summarised China’s drug reforms between 2009 and 2020 using the WHO framework. China has initiated comprehensive drug policies to address different issues, including: (1) issuing or amending major regulations with changes in institutional settin...
Article
Background: Hospice and palliative care were originally implemented for patients dying of cancer, both of which continue to be underused in patients with heart failure (HF). The objective of this study was to understand the unique challenges faced by patients dying of HF compared with cancer. Methods: We assessed differences in demographics, hea...
Article
Objectives Stroke is the most common cause of disability in high-income countries. Several countries offer a limited range of advanced treatments with implications for outcomes, disability and costs. This study estimates the burden of disability that could have been avoided through the transition from traditional (no intravenous thrombolytic therap...
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Background: The aim of this study is to evaluate the extent and associations with patient-reported disruptions to cancer treatment and cancer-related care during the COVID-19 pandemic utilizing nationally representative data. Methods: This analysis uses data from the 2020 National Health Interview Survey (NHIS), an annual, cross-sectional survey...
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Background The independent healthcare sector in the UK collects PROMs for several surgical procedures, but implementation has been challenging. We aimed to understand the enablers and barriers to PROMs implementation in the independent healthcare sector in the UK. Method Between January and May 2021, we remotely conducted semi-structured interview...
Article
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Background: Due to the emergency responses early in the COVID-19 pandemic, the use of digital health in healthcare increased abruptly. However, it remains unclear whether this introduction was sustainable in the long term, especially with patients being able to decide between digital and traditional health services once the latter regained their f...
Preprint
Full-text available
Background: A brief health-related quality of life (HRQoL) tool with construct validity for atherosclerotic cardiovascular disease (ASCVD) may facilitate integration into healthcare delivery. We examined ASCVD-related changes in the Health and Activity Limitation Index (HALex), a generic HRQoL measure comprising perceived health and activity limita...
Preprint
Full-text available
Background: Evidence of the association between social determinants of health (SDoH) and health-related quality of life (HRQoL) is largely based on single SDoH measures, with limited evaluation of cumulative social disadvantage. We examined the association between cumulative social disadvantage and the Health and Activity Limitation Index (HALex)....
Article
Full-text available
Importance Effective COVID-19 vaccines and therapeutics reached the market within the first year of the pandemic. This rate of development and availability was an unprecedented achievement that required attention to numerous research and development, regulatory, and policy challenges. However, only limited evidence is currently available on the sou...
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It is known that social inequities result in health disparities in outcomes, highlighted in the coronavirus disease 2019 (COVID-19) pandemic. This commentary discusses the actionable initiatives that have been implemented to address social inequities in healthcare in the United States. The publicly available social needs screening tools and Interna...
Preprint
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Background Due to the emergency responses early in the pandemic, the use of digital health in healthcare increased abruptly, yet it remains unclear whether this introduction was sustainable on the long term. We explore trends in digital health-seeking behaviour as proxy for readiness to adopt digital health as a mainstream form of healthcare. Meth...
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Current literature assumes that non-pharmaceutical interventions (NPIs) reduce COVID-19 infections uniformly, that is, irrespectively of their strength. The role of economic support measures (ESM) in controlling the virus is also overlooked. Using a panel threshold model of COVID-19 cases in the US states, we identify three distinct regimes of ‘low...
Article
On 3 May 2022, the European Commission launched the European Health Data Space, designed as the foundation for a European Health Union. Its aim is to improve care delivery and patients’ lives by empowering all EU citizens to control and use their personal health data. In doing so, it looks to remove information barriers and create a single market f...
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Background Heart failure (HF) poses a substantial economic burden to the United States (US) healthcare system. In contrast, little is known about the financial challenges faced by patients with HF. In this study, we examined the scope and sociodemographic predictors of subjective financial hardship from medical bills in patients with HF. Methods I...
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To address unresolved questions about drug safety and efficacy at the time of approval, the European Medicines Agency (EMA) may require that manufacturers conduct additional studies during the post‐marketing period. As a growing proportion of new cancer drugs are approved on the basis of limited evidence of clinical benefit, timely completion of po...
Article
10561 Background: Disruptions to cancer care during the COVID-19 pandemic due to disease mitigation efforts, supply-chain issues, and fear of COVID-19 have all been reported, but study of their extent has been limited. The purpose of this study is to evaluate the extent and associations with patient reported disruptions to cancer treatment and othe...
Book
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Four separate health care systems are responsible for delivering health services Since devolution in the late 1990s, the respective governments in England, Scotland, Wales and Northern Ireland have been responsible for organising and delivering health care services. United Kingdom residents enjoy access to a National Health Services (NHS) based o...