Centre for Health Economics Seminar
The use of public values in health care decision-making is now well established in organisations such as the National Institute of Health and Care Excellence (NICE) in England, and ZorgInstituut Nederland in the Netherlands. These values tend to focus on measured changes in health status. Where the interventions being evaluated draw on both health and social care, however, existing measures that capture only health changes may result in poor decisions. Newer ‘capability’ measures have concentrated on wellbeing, described in terms of what a person is able to do and be in life. These measures have been generated by talking to people at different stages of life about what is important to them in their lives, and have the advantage that they capture a broader assessment of wellbeing, that could be influenced by both health care interventions and social care interventions.
The start and end of life, however, cause particular difficulties for evaluation. These extremes of the life-course are characterised not just by potentially different values in terms of ‘what a person is able to do and be in life’, but also by a greater need for, and reliance upon, support from others. Both of these factors influence what needs to be measured in evaluation. This lecture focuses on the challenges of measuring and valuing capability at either end of the life-course and incorporating these values into a decision-making framework that can be used by an organisation such as NICE. The lecture begins by presenting and discussing a programme of work on capability measurement at end of life. This research programme has generated and valued new measures, assessed whether these measures can be used in practice, and developed a framework for end of life decision making. The lecture then shifts towards considering the challenges inherent in measuring capability at the start of life, in preparation for a new programme of research to develop capability measures for children.