Changing the world for 50 years
Economic expertise at the heart of the health service
Posted on Monday 1 July 2013
A healthy dose of economic insight backed by world class research has been administered by the University of York’s world-renowned Centre for Health Economics (CHE) for the last 30 years to help guide major spending and investment decisions across the National Health Service.
As one of the first university departments of its type, the pioneering CHE is a leading influence on UK health policy, winning awards and plaudits and helping shape the way society thinks about health and health care.
And as the NHS grapples with financial pressures combined with one of the most controversial and far reaching reorganisations in its history, research carried out by economists at York looks set to remain central to decisions about where and how increasingly limited budgets are spent.
It’s not our job to make the decisions, but to ensure they are informed by sound science
Professor Maria Goddard
Over the last three decades, the centre has examined the economic case for drugs and treatments available for some of our most enduring health conditions including cancer, asthma and heart disease. It studied the effectiveness of public health campaigns targeting smoking and alcohol, examined waiting times, hospital efficiency and compared the costs and benefits of hundreds of surgical techniques and interventions.
Costs and benefits
“It’s not our job to make the decisions, but to ensure they are informed by sound science. Economics is not just about looking at the costs and benefits of a new drug, treatment or service but also, in a world of limited budgets, the consequences of making that decision in terms of what cannot then be provided for other patients,” says CHE Director, Professor Maria Goddard.
“These sorts of decisions have been made throughout the history of the health service, but it is better they are made on the basis of objective evidence and research and that’s what we provide.
”Work carried out at York includes development of the formula used for more than 20 years to allocate health resources equitably across England, a model which influenced the approach taken in countries such as Brazil and Finland.
Researchers from York also helped establish the National Institute for Health and Care Excellence (NICE), the body charged with making, often controversial decisions, about the availability of treatments and drugs in the NHS.
The Centre for Health Economics was established by Professor Alan Maynard, an internationally-acknowledged health economics expert.
It was awarded a Queen’s Anniversary Prize in 2007.
In the 2008 Research Assessment Exercise the CHE, together with the Department of Health Sciences and the Centre for Reviews and Dissemination, were ranked equal first in the UK for health services research.
CHE also developed the Quality Adjusted Life Year (QALY) measurement, the gold standard measure of the quantity and quality of life, a concept which underpins NICE assessments. The World Health Organisation (WHO) uses variations of the QALY measurement for planning health services around the globe.
Professor Goddard says: “When NICE are evaluating drugs or treatments they have input from a wide range of individuals and organisations, not just health economists. The sorts of issues an economist might consider would include the likelihood of a drug extending life, or improving quality of life. We would also want to compare it with cheaper alternative drugs and treatments.
“Spending decisions made in the health service can never be reduced solely to pure science, but providing such evidence to decision-makers grappling with difficult problems is our contribution to the process of making equitable and efficient use of NHS resources.”
The team of around 38 CHE researchers are in constant demand at conferences around the world and they regularly advise governments and policy makers both in the UK and abroad. A programme of expert workshops attracts over 300 people a year from all over the world to be trained in the methods developed by CHE researchers.
The most recent health service reorganisation, officially ushered in this year by the Health and Social Care Act, is set to provide an abundant source of research for years to come.
“One argument related to the current reforms is that increased competition will improve quality and make services more responsive to patients,” says Professor Goddard. “That’s quite hard to evidence because there are so many other factors, many outside the control of a health service or hospital that can influence services. It will require careful analysis and robust methodology to provide good answers.”
The health service has finite resources and the reality is that it is just not possible to provide every possible treatment and care for every citizen
Professor Maria Goddard
Issues around funding the health service in times of austerity will always raise temperatures, but the role of health economists at the heart of these arguments seems assured.
“The health service has finite resources and the reality is that it is just not possible to provide every possible treatment and care for every citizen. As a consequence, society faces acutely difficult decisions about how best to use the resources at its disposal in an equitable and efficient way. That’s the challenge of health economics,” says Professor Goddard.
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