The Healthcare Department

Local Level Economic Evaluation
An article in the British Medical Journal caught my eye as it talks informaing local level decision making. It raised the issue of the gaps due to the remit of some agencies like the National Institute for Health and Clinical Excellence (NICE) in the UK. The authors make the point that while NICE decides on what should be funded by the National Health Service it does so in a setting where there are no funds ringfenced for the new interventions approved. As no specific guidance is given on what should be 'un-funded' the process of NICE guidance can contribut to the postcode prescribing it is supposed to decrease. Of course NICE has increased its guidance for implementation and it is possible that this type of guidance may become part of that initiative in the future.

Worth a read:
See BMJ November 25th edition How much will Herceptin really cost?
by Ann Barrett, Tom Roques, Matthew Small, and Richard D Smith
(free for week then subscription needed)
http://www.bmj.com/cgi/content/short/333/7578/1118?etoc

posted by Arthur @ 3:19 AM 0 comments

The Perfect Posting: Economic Impact of Avian Influenza

Where do we start? This is actually an opportunity to contribute to a blog posting on the impact of 'Bird Flu' on the healthcare sector in a developing country. The assumption is that the following topics are essential: Potential socioeconomic impact of pandemics/ avian influenza, What is ‘bird flu’?, Modes of transmission (bird to bird, bird to human or human to
Human), Assessing the economic impact, Modeling the health impact.

A couple of 'reference' articles:

Derek J. Smith, Predictability and Preparedness in Influenza Control, Science, Apr 2006; 312: 392 - 394

The Global Economic and Financial Impact of an Avian Flu Pandemic and the Role of the IMF Prepared by the Avian Flu Working Group (in consultation with Departments and the Joint Bank-Fund Health Services Department) February 28, 2006
http://www.imf.org/external/pubs/ft/afp/2006/eng/022806.htm

Newcomb, James (2005), Economic Risks Associated with an Influenza Pandemic, Bio Economic Research Associates (bio-era), Cambridge, MA., November.

Preparing for the Next Pandemic By M.T. OsterholmNew England Journal of Medicine.
http://content.nejm.org/cgi/content/full/352/18/1839

Stacey L. Knobler, Alison Mack, Adel Mahmoud, Stanley M. Lemon, Editors, The Threat of Pandemic Influenza: Are We Ready?, Workshop Summary http://www.nap.edu/catalog/11150.html

Are We Ready? (A large-scale disaster like a pandemic flu or terrorist attack could overwhelm the nation's healthcare providers), By Katherine Hobson
5/1/06 (from http://www.usnews.com/usnews/health/articles/060501/1disaster_4.htm )

posted by Arthur @ 10:38 AM 0 comments

Just flagging a couple of promising looking links:
WHO European region evidence for policy site
http://www.euro.who.int/evidence/policy/20040623_1
UK Centre for Evidence Based Policy publications
http://evidencenetwork.org/cgi-win/enet.exe/pubs?QMW

Feel free to email me with your links to organisations/sites that look at evidence and policy.

posted by Arthur @ 5:17 PM 0 comments

How to produce research that influences healthcare decision making
Wouldn't we all like to know why some work results in action being taken and other work.. well produces no such response. Patwardhan and collegues (2006) in the winter edition of IJTAHC seek for answers by reviewing the literature and conducting interviews with producers and consumers of technical reports. Worth a read. In a nutshell they appear to be suggesting that:

• It needs to be clear what the (potential/intended) users are looking for (major changes in the scope of work have implications for the time and budget required, fesability and thus success of the project).
• There needs to be open communication between the users and producers
• The team and processes need to be conducive to producing a good quality report

What other guides should one follow in increasing the chances that the output of one's research are taken on board by policy makers?

posted by Arthur @ 6:31 PM 0 comments

Hello World. We're Back! Welcome to The Healthcare Department. So much has happened and is happening. There is much going on in health around the world so we should not lack for material. The plan is to focus on the use of heath economics in policy making but we may stray into general public health and preventive medicine occasionally.

The name The Healthcare Department has been chosen because it can remind us that much of healthcare provision that can claim to be accessible, equitable, of quality is provided by the state. By way of making it clear what we are about, what comes next can serve as the foundation for The apostles’creed of this blog:

I believe that health results from a combination of inputs of which healthcare is just one. [The others include: genetics, environment, behaviour, education, wealth, social capital and health care (both preventative and curative).]

I believe that there are finite amounts of resources available for use in healthcare. [At the same time there appear to be increasing demands on the resources for healthcare provision. As a result choices (sometimes difficult ones) have to be made about what healthcare will or should be provided and that these choices are best made after considering the evidence for effectiveness and cost effectiveness of the interventions being considered.]

I also believe that it is also useful to challenge ourselves and those in decision making situations to find innovative ways to maintain and improve the level of health.

I believe that it is useful to have persons and/or agencies that operating at arms length who are charged with the responsiblity of advising on the use of resources for health.

[Agencies like The National Institute for Clinical Excellence seek to espouse principles of transparencey, consistency, involvement and fairness in health care decision making. The agencies will likely face challenges in terms of the acceptablity of explicit rationing, the timeliness of the guidance provided, and ensuring that the guidance is implementable and implemented. ]

And because economic evaluation seeks to improve decision making about the allocation of resources it potentially has much to offer healthcare decision making. [Of course health economists will tend to believe that economic evaluation is underused in decision making while policy makers may believe the opposite. ]

Here endeth the Healthcare Apostles Creed.

We look forward to hearing what readers think about the topics and the analysis in this blog. I welcome both your commendations and criticisms. If you wish you can start by helping withthe creed. Is it true, useful, complete? Let us know. Happy reading and again welcome to The Healthcare Department blog.

posted by Arthur @ 7:04 AM 1 comments