Article Analysis

1. Forner Gros, MJ 2015 1
ECONOMÍA DE LA SALUD
HEALTH ECONOMICS

2. Forner Gros, MJ 2015 2
Topics & Disciplines
 Governments should provide health care to all citizensGovernments should provide health care to all citizens
 Evaluation of each medical and individual case seems toEvaluation of each medical and individual case seems to
be the right, moral ,ethical way of treatmentbe the right, moral ,ethical way of treatment
 Health care resources are inevitably limitedHealth care resources are inevitably limited
 Economic viewpoint of health services is
needed

3. Forner Gros, MJ 2015 3
Positive & Normative
 Positive : the study of economics based on objective
analysis, does not content value judgments
“ What is and what has been “
 Normative: subjective and value based, normative
economic statements have to be correct to a previous
opinion
“ What should be “

4. Forner Gros, MJ 2015 4
Positive & Normative
Health
Care
Policy
More
Positive
Economics
Less
Normative
Economics
BETTER
POLICY
MAKING
Understanding of the difference between positive-normative

5. Forner Gros, MJ 2015 5
Doctors
 “It would be immoral for any clinician to take costs into
account when deciding what treatment to recommend to a
patient, so the intrusion of hard-headed economics into
fine humanitarian areas such as medicine, would be
actually refused and unwelcome”
 Ethical doctors´ duty: to do whatever is best for the patient,
no matter what the cost -----normative assertion
 Economic view: Ignoring costs lead to not consider
opportunity costs to the others; any resources devoted to
one patient are denied to other patients, whose health
would suffer as a consequence

6. Forner Gros, MJ 2015 6
Doctors
“Health professionals have an ethical duty to make the BEST
use of the AVAILABLE resources and this means that hard
decisions must be made….It is clear that doctors are not
obliged to comply with patients´ requests for treatment when
they make inequitable demands on scarce resources”
Medical Ethics Committee of the British Medical Association
Distributive justice rather than efficiency

7. Forner Gros, MJ 2015 7
Accountants
 Health accountants may consider health assistance and
other medical procedures as real money costs, so a
measure of value of health outcomes would be possible
The wrong idea: economists are only interested in costs
The right idea: economists are interested in benefits, and
especially how benefits are valued

8. Forner Gros, MJ 2015 8
Epidemiologists & Clinical Researches
•They showed economists understanding value- judgments
• Quality-adjusted life year (QALY): measure of disease
burden, including both the quality and the quantity of life lived.
Use – assessing the value for money of a medical
intervention – traducing interventions into real costs –
allocating healthcare resources – optimal for society, including
most patients (not equity for all)

9. Forner Gros, MJ 2015 9
QALYQALY
Bandolier
Evidence-based thinking about health care

10. Forner Gros, MJ 2015 10
Epidemiologists & Clinical Researches
QALY: arithmetic product
life expectancy
quality of the remaining life years
QALY undervalues treatments which benefit the elderly
or others with a lower life expectancy???
• Health care policy should??– maximise the health of the
population at large /equity objectives or both??

11. Forner Gros, MJ 2015 11
Welfarists
 Primary objectives in health economics policy:
 Maximise population health
 Reduce inequalities
 We may have to settle for a reduced level of population
health in order to reduce health inequalities within that
population

12. Forner Gros, MJ 2015 12
 These days, health resources, mainly economics, are limited
 Everyone has the right to receive the best treatment to improve life
quality
 QALY are far from perfect as a measure of outcome
 Ethical dilemma:
Equity is possible?
What should we do?
Should we decide as a whole?
How can health policy decide what is the best for society or
any individual person, with these scarce resources?
The answer is straightforward Economic discipline

13. Forner Gros, MJ 2015 13
Economic ProjectEconomic Project
Solutions to scarce economic resources? QALF, copayment, cuts?
•QALY: no perfect outcomes
•Health cuts: can produce savings in spending in some respects, but increase
others, and the end result is at best uncertain.
•Copayment: those most affected are the elderly and the chronically ill, who can
see their situation worse and whose health impairment may require additional
resources in the medium term savings than initially expected.
Therefore, to reduce inequality and mitigate the social consequences of the
economic crisis, it is indispensable to improve and strengthen the public
health system.
We should not cut back the budget in health, but to make a better and efficient
distribution of the limited resources.
SUSTAINABILITY OF THE HEALTH SYSTEM