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Evaluation-Economic Viability How much will it cost? What value will we be getting for the money? How does that value compare with other alternatives under consideration? If it is something we want to do, how will we pay for it?
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Health Policy Analysis: Chapters 10, 11 and 14
Nutchanart BunthumpornBeth Faiman
Policy Analysis Process and Health Professional Leadership Evaluation-Economic viability Analysis of values-Last but not
least Health professional leadership
Evaluation-Economic Viability How much will it cost? What value will we be getting for the
money? How does that value compare with
other alternatives under consideration?
If it is something we want to do, how will we pay for it?
Evaluation-Economic Viability Define the health care issue
Population, diagnosis, incidence, impact
Study the relevant intervention technologies
Agreeing on the intervention and its effectiveness
Agreeing in detail on the delivery system
Evaluation-Economic Viability Selecting the analytical approach
Cost-effectiveness analysis (CEA) Money is used to measure benefits Fixed budget and little variation in the
preferences for outcomes Cost-benefit analysis (CBA)
Variable budget and varying utilities of outcomes
Hierarchy of Analytical Approach for Comparison and Decision Making
Establish the cost of the illness Conduct a cost-minimization study Conduct a cost-effective study Do a cost-benefit study Consider a cost utility study
Selecting the analytical approach
Two other approaches The human capital approach, which
emphasizes the economic cost to society
The friction cost approach, which measures the loss in productivity
Selecting the analytical approach
Supply and demand analysis Refer to changes in perceived prices Investigate:
The rate of change in demand with a given change in price
The rate of change in supply with a given change in price
Benefit and cost analysis
Evaluation-Economic Viability
Agreeing on the resources required Determining relevant costs
Changes in costs of medicines, consumable supplies, and tests
Changed labor costs Changes in length of stay or location of
treatment Changes in costs incurred by patients and their
family Changes in overhead costs
Evaluation-Economic Viability
Agreeing on the outcomes produced Show the outcome at the both extreme of
the range and report those multiple values
Valuing the outcomes produced Determining the present value of costs
and outcomes Inflation adjusting Discounting
Evaluation-Economic Viability
Dealing with important uncertainties Adding a risk premium to the discount rates Developing a subjective probability
distribution Investing in further research to reduce the
uncertainty Identifying financing methods Considering distributional effects
Comparing with competing alternatives
Financial feasibility Capital allocation processes
Evaluation-Economic Viability
The Policy Process: Analysis of Values Chapter 11
Concerned with the values of healthcare and healthcare professionals
May or may not be considered in the political process
The Policy Process: Analysis of Values Fair access
Priester (1992) suggested the US should give greatest emphasis to equity; defined as “adequate care” but “does not require access to all beneficial care”
He felt that economic considerations have outweighed ethical ones
The Policy Process: Analysis of Values
Efficiency If lack of resources leads to “overlooked”
individuals- this is key “Waste not, Want not” …. not always
One person’s waste is another’s enhanced income
Porter and Teisberg argued against “Zero- sum”
All will get more collectively if waste is minimized
The Policy Process: Analysis of Values
Patient Privacy and Confidentiality Technology and patient record safety
Informed Consent Do the CFR place a constraint on provider
autonomy? Personal Responsibility
Patient lifestyle leads to higher costs Patients should take responsibility for their
behavior
The Policy Process: Analysis of Values
Malpractice Reform Should state and federal states “cap”
the size of awards when they are excessive?
Professional Ethics Consumer Sovereignty
Cannon and Tanner (2005)- HC to all Richmond and Fein (2005)- equity
The Policy Process: Analysis of Values
Social Welfare Do interest groups represent the public? Values over economics; difficult in policy making
Rationing Limiting care that is likely beneficial due to
scarce resources Fair distributing of available resources Society determines decision-making, not
corporations
The Policy Process: Analysis of Values Process equity
Outcome and process should be fair Influence on Society
What are the long term effects of this emphasis of health?
Direct-to-consumer advertising: $3-5B/ann Holy Fire (1996)
Ethical Review conclusion
Health Professional Leadership Health professionals must take an
active role in leadership Perception of disinterestedness? Information Credibility Start locally Take Risks Governance
Health Professional Leadership
Planning alternatives HC is a field that will have high variability and
should not be treated as science Communities: Manage not just individuals Enhance the professional’s role
Train others, networking, practice leadership Conclusion
Thank you!