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Health and efficiency: clinical effectiveness dissected.

M Keaney1, A R Lorimer

  • 1Scottish Clinical Audit Resource Centre, Department of Postgraduate Medical Education, University of Glasgow, UK.

Health Care Analysis : HCA : Journal of Health Philosophy and Policy
|August 5, 1998
PubMed
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Health policy must address the values influencing cost-effectiveness analysis to prevent impoverished healthcare systems. Explicitly defining values in policy-making is crucial for maintaining patient-centered care.

Area of Science:

  • Health Policy Analysis
  • Health Economics
  • Bioethics

Background:

  • The integration of economic principles into healthcare policy, particularly cost-effectiveness analysis, is increasingly shaping clinical effectiveness. This trend raises concerns about the potential for values inimical to basic humanity to influence healthcare systems.
  • The current healthcare landscape, often characterized by 'managed-care,' already reflects some of these restrictive tendencies, necessitating a critical examination of underlying values.

Purpose of the Study:

  • To highlight the critical role of values in health policy-making, particularly within the domain of cost-effectiveness analysis.
  • To analyze the implications of health economists' criteria for defining cost-effectiveness on the concept of clinical effectiveness.
  • To underscore the significance of the debate surrounding clinical effectiveness in the context of health economics' growing influence, specifically within the National Health Service (NHS).

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Main Methods:

  • Conceptual analysis of the interplay between values, economics, and health policy.
  • Examination of the definition and application of cost-effectiveness criteria in healthcare.
  • Critical review of the influence of health economics on clinical effectiveness policy.

Main Results:

  • The uncritical adoption of 'value-neutral' economic principles in health policy can lead to a restricted, impersonal, and impoverished healthcare system.
  • The definition of cost-effectiveness, typically determined by health economists, significantly dictates the nature of clinical effectiveness policies.
  • The increasing reliance on health economists' criteria represents a significant shift in control over healthcare policy, particularly concerning clinical effectiveness within the NHS.

Conclusions:

  • Health policy analysts must explicitly address and scrutinize the values embedded in economic analyses to ensure policies align with fundamental humanistic principles.
  • A critical understanding of cost-effectiveness is essential to safeguard the integrity of clinical effectiveness and prevent the erosion of patient-centered care.
  • The influence of health economics on healthcare policy requires careful consideration to maintain a healthcare system that is equitable, effective, and humane.