BRITISH ECONOMIC AND HEALTH POLICY British Economic and Health Policy

British Economic and Health Policy

Abstract

In 1977 the World Health Organization's Assembly endorsed a Health for All strategy. The strategy entails a multi-sectoral, multi-faceted approach to health improvement that draws on statutory, voluntary and community collaboration to address both individual lifestyles and social, political, material and ecological determinants of health status. Accordingly member states of the WHO European region, including the UK, adopted 38 health-related targets in 1984 that were revised in 1991. Some Health for All targets focused on traditional medical and public health issues such as poliomyelitis, diseases of the circulatory system and water quality. The targets also, however, advocated a systematic and coherent approach to the spectrum of policies relevant to health. Thus, for example, the targets included an aim that by the end of the century “management structures and processes should exist in all Member states to inspire, guide and co-ordinate health development, in line with health for all principles” (target 34). In specific areas such as the environment “there should be effective management systems and resources in all Member states for putting policies on environment and health into practice.”

Introduction

Economic evaluations of health care programmes and treatments have now been conducted for the last 30 years. The key methodological principles have been specified and a number of textbooks have been published [l-4]. Also, over the past 5 years there has been an exponential rise in the number of published studies, which have assessed treatment alternatives in all branches of medicine. Economic appraisal compares the benefits of health care interventions with their costs. There are a number of specific techniques, which differ primarily in the extent to which the benefits are measured and valued. For example, in one approach, cost-minimization analysis, the costs of two treatments or technologies are compared on the basis that they generate identical benefits (e.g. such as in a comparison of a branded and a generic drug). In another approach, cost -benejt anal_vsis, attempts are made to value all the benefits in monetary terms, so that they can be made commensurate with the costs. Most evaluations value the costs of alternative technologies in money terms and relate these to the achievements of those technologies in terms of improvements in length or quality of life.

Discussion

POLICY ISSUES AMENABLE

TO ECONOMIC ANALYSIS in seeking to increase the relevance of economic appraisal, it is important to consider the link between health technology assessments, in particular economic appraisal, and health care decision making more generally. Health care systems in different countries vary widely and it is not possible to devise general rules for how this should be done. However, (Haan,) outlined a number of mechanisms.

Policy instruments, for encouraging a more rational diffusion and use of health technology. In this section a number of these policy instruments for using economic appraisal results are discussed, with relevant examples from a number of countries. In practice more than one approach is likely to be required, the exact mix depending on the overall organization ...