Professional Documents
Culture Documents
the age of chivalry is gone. That of sophisters, economists, and calculators has succeeded; and the glory of Europe is extinguished forever
Victor R. Fuchs. WHAT SHOULD PHYSICIANS KNOW ABOUT HEALTH ECONOMICS, 2002
Economists are usually concerned with large aggregations: organizations, industries, governments, society as a whole
Victor R. Fuchs. WHAT SHOULD PHYSICIANS KNOW ABOUT HEALTH ECONOMICS, 2002
Health economics?
Health economics lies at the interface of economics and medicine and applies the discipline of economics to the topic of health
But,
Economics is not primarily about saving money It is about using scarce resources as efficiently as possible
Victor R. Fuchs. WHAT SHOULD PHYSICIANS KNOW ABOUT HEALTH ECONOMICS, 2002
Measurement
Are there unmeasurable things? How do we measure health? How do we measure wealth? (Are the two linked?) Can we measure pain?
Derivation
Can each measurement be given an economic value? Can everything be given a value? Can we estimate a value of a human life?
Example
Croatian Institute for Health Insurance Board for Medicines Decides upon which medications are to be funded by the CIHI Which drugs get a priority? Which are rejected?
Indicators
We can define an indicator for everything we measure E.g. 5-year survival after surgical treatment, PTCA and drug treatment, or number of days spent in hospital We can compare costs of all three treatments, and then perform all analyses to define the best option for every patient
Indicators
Indicators have to be relative or adjusted Comparison of costs of the primary care in the rural and urban region? In the region of the town with higher socioeconomic status and slums? Comparison across countries? Central idea in quality assessment and improvement
Economic evaluation
Reality of opportunity cost Useful alternatives compete for resources Making choices is sometime unpleasant Options for colorectal cancer screening
Fecal blood test Barium enema Sigmoidoscopy Colonoscopy
Evaluation
Economic Evaluation
Economic evaluation considers assessment of intervention effects in economic terms, which is often of greatest interest to fund allocators Intervention evaluation involves two measures;
the health effects or effectiveness of the intervention
the value or efficiency of the effects
Economic evaluation expertise can lie outside the competencies of an individual public health nutritionist however simple economic assessment tools can be applied
Economic Evaluation
Economic Evaluation
Economic evaluation involves identifying, measuring and valuing both the inputs (costs) and outcomes (benefits) of the intervention/s
there are two broad areas of economic measurement;
Provider or narrow perspective - consider inputs (costs) and outcomes (benefits), and compares both aspects across alternative interventions Societal perspective - include only some elements of inputs and outcomes
The provider approach has limitations because ranking interventions in terms of value for money may be very different if the analysis includes all costs and benefits
Economic Evaluation
Tracing all inputs and finding valuations for all resources used can be difficult but should not deter intelligent estimates being made Evaluations that consider both outcomes and resources use are full economic evaluations there are four distinct types:
1. Cost-minimisation analysis Involves comparison between two or more alternative interventions whose outcomes are assumed to be exactly the same Assumes all consequences of the alternative interventions are the same Generally not recommended
Economic Evaluation
Criticised for failing to recognise the broader benefits of PHN interventions however quantification of measures is required for analysis
Cannot be used to compare interventions - most suitable when interventions with the same health aims are being compared
Economic Evaluation
Benefits or outcome are expressed as a measure that reflects how individuals value or gain utility from the quality and length of life:
QALYs (quality adjusted life years) DALYS (disability adjusted life years)
Can identify only relatively large changes in individual health status and can put PHN interventions at a disadvantage
Economic Evaluation
Economic Evaluation
Conducting a thorough economic evaluation required specialised health economics expertise and can be a rather resource intensive process. Ideally economic evaluation should only be undertaken if the benefits of improving efficiency of health resources outweigh the costs of evaluation. There is no consensus of opinion of which method is best and the decision is likely to be limited to the type and quantity of information available, and time and resource restraints. Choose a method that is most appropriate to the data available. Although funding agencies financing PHN interventions will be interested in the economic benefit from an organisational perspective most agencies would prefer to promote the societal benefits the intervention they funded had, hence taking a societal perspective to economic evaluation is preferred.
Economic Evaluation
Economic Evaluation