Leela Barham, Programme Lead for Learna’s Online Health Economics Masters and PgDip in Applied Health Economics, discusses the need for clinicians with a good understanding of health economics in a post-COVID world.
Change is arguably the only constant in life. That applies to health care systems as much as anything else. There’s always a temptation to reform health care systems and COVID-19 has spurred a need to take stock to learn lessons for the next pandemic as well as how best to cope with the fall-out from COVID-19. And money will be at the heart of many of these discussions. But who could be best placed to help? Clinicians with health economics know-how, argues Leela Barham.
Health economics can help inform decisions
Health economics at its basic level is about how to make the most of the limited resources available to health care systems. Easier said than done, as it can soon become a challenge to identify just what to spend on – and what to stop spending on – when not everything can be paid for.
That’s where health economic tools like economic evaluation play a role: when done well they can be a real aid to decision-making by providing an understanding of the trade-offs between spending options.
There are plenty of other tools in the health economic tool-box too; budget impact assessments can help identify savings as well as higher costs when different interventions are adopted, as just one example.
Health economics informing COVID-19 responses
Perhaps understandably, given the need to move fast and faced with great uncertainty, health economics seems to have played a back-seat role in shaping policy responses to COVID-19. Health economists Cam Donaldson and Craig Mitton even suggest that not a health economist was in sight in the immediate response to COVID-19.
In calmer times now that the immediate pressure of COVID-19 has abated, at least in the UK, health economic questions are being asked about some of the choices made about using NHS resources during the pandemic. For example, the Kings Fund has asked whether temporary hospitals set up to help cope with surges in demand for care – known as Nightingale hospitals – were worth it?
Tighter health care funding is coming
As time has passed the health economic consequences of COVID-19 are beginning to become clearer. For example, researchers from the World Health Organization (WHO) estimated in 2020 that the health-care resource needs for an effective response to COVID-19 in 73 low-income and middle-income countries was US$52.45 billion over 4 weeks. This is a modelling-based estimate and the true cost will depend on a host of factors but it’s a good effort to help understand the scale of the cost of the immediate needs for COVID-19.
In developed countries the cost has been significant too. In July 2020, the Kings Fund pointed out that HM Treasury had already approved £31.9 billion of support for the NHS to help with the costs of personal protective equipment, the ‘Test, Trace, Contain and Enable’ programme as well as ventilators.
Many countries have been responding to the demands from COVID-19 in the short-term with more health care funding by running budget deficits. This is a short-term fix and won’t be something that is likely to be continued indefinitely.
The medium to long-term response of governments to coping with the health needs from COVID-19 are not yet fully known. The World Bank is predicting that government health spending per capita is going to fall in 2021 and 2022. Governments could respond by raising more revenues or shift government spending from other sectors into health. But both of these are hard options to pursue politically especially at a time when economies are still fragile even with some tentative re-opening. The reality is likely to be a tightening of health budgets.
The budgets that are available for health care systems will also need to be stretched further. COVID-19 has led to a pivot in the provision of care to those with the most pressing health needs leaving unmet needs amongst non-COVID-19 patients that may only become more severe. That non-COVID-19 patients may struggle to access care is already being recognised. That could be a tip of the iceberg as the fall-out from COVID-19 in terms of the economic consequences, such as job losses and uncertainty, will have knock impacts on future physical and mental health.
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Harder choices are coming
Harder choices are going to need to be made in post-COVID-19 health care systems. These choices will need to be made at various levels; from the balance of prevention to cure (how much should we pay for future COVID-19 vaccinations? How much should we pay clinicians to vaccinate?) through to how to make savings at the hospital or clinic level (if cuts need to be made, what can be cut that will have the least worst impact on health? If there is only a small increase in health funding, what will have the biggest impact on health?). Clinicians may well be asked to contribute their views to these decisions, and in some cases, those decisions may also include health economists.
Health economics is likely – if the calls made by the profession are heeded – to play a bigger role in responding to future pandemics too. Analysis is already being published to help inform future decisions to respond to pandemics.
Skilling up clinicians in health economics
It’s been argued that medical practitioners should have an understanding of some basic economic principles reflecting the need to make difficult choices in health care. In the UK the General Medical Council stipulates that medical students should be able to discuss the principles underlying the development of health and health service policy, including issues relating to health economics. It’s also been argued that better understanding between economists and health professionals may reduce incomprehension and antagonism.
In the era of COVID-19 these arguments for clinicians to learn about health economics become even stronger. Tough choices are coming. Clinicians can be well placed to make their voices heard in decisions about using scarce resources in health care if they can bring in both clinical and health economic perspectives.