Essays on health capital and the efficiency of health care
Technological change in health care has transformed the practice of medicine and has had associated improvements in life expectancy and health related quality of life during the last hundred years. However, the increase in health care spending has also been important.
Everything seems to indicate that the future of health care systems would be even more influenced by the increase in medical and pharmaceutical advances. Processes of diffusion and adoption of technologies entail, by technological imperative or professional incentives, the use of technologies once they are available. Empirical data indicate that medical innovations let to an increase in mean health care utilization, heterogeneous reductions of morbidity and mortality, and increase in health care spending. The political answer has tried to make compatible the access to innovations by population with cost contention of health care systems. But, given that innovations may be valuable, it seems more pertinent to ask ¿what is the economic and social value of additional improvements in health status as a consequence of technological change?
Economic evaluation is the most direct approximation of a health economist to the measure of costs and health consequences of health care services. Paper 3 [García-Altés A, Rota R, Barenys M, Abad A, Moreno V, Pons JMV, Piqué JM. Cost-effectiveness of a score and scope strategy for the management of dyspepsia. European Journal of Gastroenterology and Hepatology 2005;17(7):709-19] presents a direct application of cost-effectiveness analysis to measure the efficiency of the treatment of a clinical condition. Annex 3 [García-Altés A. Twenty years of health care economic analysis in Spain: are we doing well? Health Economics 2001;10(8):715-29] presents a review of economic evaluation studies done in Spain from 1980 to 1999, focusing on the methods used, future research areas, and health policy implications.
The studies that have applied new economic perspectives to this problem, such as generalized cost-benefit analysis, make it possible to assess in economic terms the global impact of innovations on the treatment of a certain disease in real conditions and through time. The paper on Annex 1 [García-Altés A, Puig Junoy J. [A reconsideration of the value of health care spending. New economic approaches and implications for the establishment of public policies in Spain]. In: Puig Junoy J, López-Casasnovas G, Ortún V, eds. [More resources for health?]. Madrid: Masson, 2004] carries out a thorough revision of those concepts, and describes some methodologies and results obtained in some recent research applications.
The revision of the economic value of health care expenditure has entailed the description and analysis of new indicators of welfare level attributable to health care, using measures uncommon on traditional national accounting. Those new measures, like health capital, are a reference to assess the increase of health care expenditure. Paper 1 [García-Altés A, Pinilla J, Peiró S. [An approach to "quality-adjusted life years" quality of life weights from self-assessed health status] Gac Sanit 2006;20(6):457-64] applies a recently developed methodology to construct quality of life weights for Spain using the National Health Survey. Annex 2 [García-Altés A, Pinilla J, Ortún V. The evolution of health capital in Barcelona, 1994-2006: the paradox of health revisited] goes further in this methodology, and measures the evolution of health capital in Barcelona from 1994 to 2006, taking into account changes in self-assessed quality of life, prevalence of diseases, and limitations in usual activities due to chronic conditions.
Finally, the increasing interest in gaining a more in-depth knowledge of the productivity and value of health care systems has been a stimulus for a diversity of initiatives. Paper 2 [García-Altés A, Borrell C, Coté L, Plaza A, Benet J, Guarga A. Measuring the performance of urban healthcare services: results of an international experience. J Epidemiol Community Health 2007;61(9):791-6] presents the results of such an experience, comparing the performance of Barcelona and Montreal health care services.
The main health policy recommendation is the need to compare health care spending with the obtained benefits. But, and given the knowledge in variations of medical practice and gaps between efficacy and effectiveness, positive net benefit of health care spending does not necessarily imply that more resources should be invested in health care. The results of economic evaluation of each particular innovation should be taken into account in decision making processes, making the relevant comparisons in each case with the previously existing technologies or with alternative interventions. In any case, it is necessary a more transparent decision making process regarding the allocation of health care resources.
Advisor:Ortún Rubio, Vicente; Porta, Miquel
School:Universitat Autónoma de Barcelona
Source Type:Master's Thesis
Keywords:418 departament de pediatria obstetricia i ginecologia
Date of Publication:11/24/2008