Health technology advancements were outstripping our ability to pay for them – we need to ration overtly

Dare Oladokun in the BMJ 18th May 2016 enthuses about health economics, and its importance for doctors. 

The most important quote is “My interest was sparked when I was undertaking research and realised how quickly health technology advancements were outstripping our ability to pay for them…..”

The case is made eloquently, and we do need to ration overtly. There are other drivers, such as demographics, and encouragement of autonomy, but the technological argument is irrefutable – except from the grave.

Is there an economist in the house?

Authors: Dare Oladokun

Publication date:  18 May 2016


Dare Oladokun explains why studying health economics is useful for doctors

There is a shortage of health economists both nationally and internationally.[1] Health economists who also have clinical experience are even less common[1] and occupy a niche that benefits both their clinical and academic practice.

What is health economics?

Health economics involves the application of economic principles and methodologies to healthcare production and distribution. It is a bridge between economics and the health sciences that allows the application of methodologies between both disciplines.[2] Typical axioms of economics and market behaviour do not always apply to healthcare so health economists modify and apply economic principles to guide decision making.

Health economics has gained prominence in recent times as healthcare finances become increasingly tight. It has come to the fore as a framework for combining knowledge from economics with health research fields—such as public health, management, and informatics—to guide healthcare spending and resource allocation.

Why doctors should study health economics

Doctors can benefit from understanding health economics because they deal with the challenges that health economists are trying to solve. Clinicians often have to choose between competing interventions for disease management and they sometimes need to make economic cases to push for adoption of new technologies within their practice.

Choosing the most effective interventions—regardless of “value for money”—will ultimately lead to the exhaustion of resources. Conversely, basing these decisions on cost alone is also wrong—doing nothing is often the cheapest option. The ability to perform economic evaluations, or at least critically evaluate health economic evidence, can be invaluable for decision making.

Clinicians with knowledge of health economics can help to provide a balance between the human aspect of healthcare and the empirical nature of economics. They are ideally placed to identify problems that can benefit from an economics approach. Guidelines are often based on health economic evidence. Knowledge of the processes involved can help doctors understand the limitations of such evidence and may encourage their participation in the development of future guidelines.

Doctors interested in non-clinical career paths can also benefit from training in health economics. Health economics is at the forefront of health research and the need for high quality economic evaluations represent research priorities for numerous diseases.[3] [4] The unprecedented availability of digital health data also makes possession of econometrics and economic modelling skills valuable for clinical and health services researchers. There is currently a drive for doctors to take on leadership roles[5] and health economics training, alongside management training, can prove very useful.

My interest was sparked when I was undertaking research and realised how quickly health technology advancements were outstripping our ability to pay for them. Recent politicisation of healthcare delivery in the UK also increased my interest in questions such as how best to pay for healthcare, how much to provide, and for whom such care should be provided. These are questions junior doctors often have little time to think about in their busy daily practice so I decided to take a year out to study for a full time masters degree in health economics at the University of Heidelberg in Germany.

Training in health economics

Prospective health economists usually undergo masters study followed by further academic training or professional experience in the field. Masters courses are widely available and some universities offer combination courses with subjects such as public health, health policy, or management. The National Institute for Health Research funds studentships and fellowships.[6] Doctors wishing to study health economics can apply for out-of-programme experiences or career breaks following foundation or core specialty training. They can also undertake part time study alongside clinical training. Those unable to commit to a masters programme can undergo shorter training such as postgraduate certificates. Free online education platforms such as Coursera ( [Link] ) and Futurelearn ( [Link] ) offer introductory modules in health economics.

While there are many excellent courses in the UK, I chose to study abroad for an international outlook. Observing the NHS from the outside has given me a new perspective on its strengths and weaknesses. I plan to return to clinical training after the programme and, while I remain committed to a clinical career, the junior doctors’ contract dispute has made me realise that it doesn’t hurt to have options.

I have read and understood BMJ’s policy on declaration of interests and declare that I have no competing interests.

References

  1. Kaambwa B, Frew E. Health economics in the UK: capacity, constraints and comparisons to the US health economists. Int Rev Econ Educ  2013;12:1-11 [Link] .
  2. Kernick DP. Introduction to health economics for the medical practitioner. Postgrad Med J  2003;79:147-50. [Link]   [Link] .
  3. Meara JG, Leather AJM, Hagander L, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet  2015;386:569-624. [Link]   [Link] .
  4. ENT UK. National research agenda for ENT, hearing and balance care. 2015. [Link] .
  5. West M, Armit K, Loewenthal L, et al. Leadership and leadership development in healthcare: the evidence base. 2015. [Link] .
  6. National Institute for Health Resrearch. NIHR masters studentships in economics of health. 2014. [Link] .

    Dare Oladokun foundation year three doctor and masters in health economics candidate, Heidelberg University, Germany

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This entry was posted in A Personal View, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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