Category Archives: Health Care Policy

The Federal Health Budget

I don’t want to get into politics too much but the latest media twitterings about the federal health budget and trimming Medicare (and perhaps the Pharmaceutical Benefits Scheme as well) has me a little annoyed. The thing is that the mechanisms for trimming are already in place. What I am referring to is the federal health technology assessment process and the role of the Medicalbag-147782_640 Services Advisory Board (MSAC), the Pharmaceutical Benefits Advisory Board (PBAC) and the Prostheses List Advisory Committee (PLAC) (replacing the Prostheses and Devices Committee (PDC)). At one of the Health Technology Assessment International (HTAi) conferences I attended, I learnt that the original remit of MSAC was to review all technologies funded by Medicare. But MSAC funding was only able to stretch to reviewing new technologies for approval. I think this is still the case. This means that there is probably a large number of legacy (the word I heard used to describe items in Medicare before the advent of MSAC)  technologies still being reimbursed by the federal government that are ineffective and costly. So, why doesn’t the federal government increase funding to MSAC, PBAC and PLAC (and modify the remits) in order to review all technologies reimbursed by government so that ineffective, costly and perhaps unsafe technologies can be removed? It will be a increase in spending in the short term but in the long term, could save money.

I am not an expert in this area (ie – definitely not a health economist!) and am just reporting about what I know and have learnt. If readers have any comments, I would love to read them!

Assessing the Impact of Economic Evidence on Policymakers in Health Care—A Systematic Review

Assessing the Impact of Economic Evidence on Policymakers in Health Care—A Systematic Review

Structured Abstract

Background: Many health care experts are demanding greater use of economic evidence in the assessment of new and existing health technologies.

Objectives: To assess whether and how economic evidence has an impact on health care decisionmaking in the United States and in other countries and to identify antecedents or obstacles for use in health policy.

Data Sources: Searches of MEDLINE, EconLit, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase®, and ISI Web of ScienceSM from 1991 until January 2012.

Review Methods: The review included original studies that applied a quantitative or qualitative method for evaluating use of economic evidence in any country. We excluded articles that were opinion- or experienced-based without newly generated data. Paired reviewers independently determined whether articles met eligibility criteria and then extracted data from eligible studies. Reviewers also assessed the quality of each study and graded the strength of the body of evidence using an adaptation of the grading of recommendations assessment development and evaluation (GRADE) recommendations, indicating study limitations, quality, strength of findings, and the type of data available.

Results: Of 19,127 titles initially screened, 43 studies were included, with all but five published since 2000. The most frequently studied countries were the United Kingdom (15), and Australia, Canada, and the United States (5 each). Most studies (27 studies) considered national-level policy and examined the key health actors involved. Important decisionmaking topics were reimbursement and health package decisions, and priority setting in program development.

Thirty studies found evidence that use of economic evidence had a “substantial” impact on health care policymaking, 27 of which emphasized at least one other criterion, such as equity considerations, usually ill-defined (14 studies), clinical effectiveness, budget impact, ethical reasons, and advocacy arguments. The 30 studies confirmed the acceptance of economic evidence as having an impact on either general policy or specific decisions, such as reimbursement decisions. In 11 of the studies, the use of economic evidence had only a “limited” impact on health policy decisions. In two studies, economic evidence had no impact on health policymaking.

A few factors played a key role in the use of economic evidence: (1) quality and transparency of the studies that provided the economic evidence was a promoting factor (7 studies) in the case of a good study and a strong obstacle in the case of a poorly presented study (18 studies); (2) transparency and quality of the decisionmaking process was important in the acceptance or rejection of the decision (10 studies for acceptance, 13 studies for rejection); and (3) clarity of the economic information and the way it was communicated were promoting factors (7 studies), while lack of clarity was an obstacle in accepting evidence (17 studies).

Of the 37 observational studies of policy impact, 11 (30%) received a favorable rating on more than three of the 8 items on the study quality checklist. Five of the studies had a comparison group and provided intermediate quality evidence that economic evidence is useful in general health policymaking.

Conclusions: The body of evidence on the use of economic evidence in policy is small and patchy. It shows that the utility of economic evidence, alone or in combination with systematic reviews, is influenced by technical issues, such as transparency and clarity, as well as by the transparency of the decisionmaking process.

Climate change and sustainable consumption: What do the public think is fair?

This report explores public attitudes to fairness in the context of sustainable consumption and climate change.

Click to access sustainability-attitudes-fairness-full.pdf

Evidence from many areas of behaviour suggests that views about fairness can be powerful in driving pro-social behaviours. This research, through a series of focus groups, explored strategies that can tap into people’s sense of fairness around sustainable consumption and climate change to see if this could build public support for behaviour change and sustainability policies.

The report: asks if people can look at climate change and sustainable consumption in terms of fairness; explores the basis of views about fairness in this context and investigates the types of information required for people to look at the issue in this way; considers the extent to which looking at climate change in terms of fairness can motivate support for behaviour change; and examines what people think is fair in actions to reduce household CO2 emissions.