Recently published: Are Wider Societal Effects Considered in Healthcare Decision-making?

Health interventions can produce economic gains for patients and national economies. In practice, however, the health-wealth link is rarely considered.

Recently published is a paper on the consideration of wider societal effects of health interventions, including productivity gains and savings in non-health sectors, in resource allocation decisions by health technology assessment (HTA) agencies and government departments. The article is authored by OHE’s Martina Garau, Koonal Shah, and Adrian Towse.

There is evidence suggesting that, in certain diseases areas such as Alzheimer’s disease, depression, and breast cancer, health interventions can produce economic gains, including improvements in the productivity of patients and their carers at work, and cost savings to other sectors such as education and social care.

The study included interviews with decision makers and experts in eight countries (Australia, France, Germany, Italy, Poland, South Korea, Sweden, and the United Kingdom).

We found that in the eight countries examined, with the exception of Sweden, considerations of wider societal effects have little to no impact on decision making, from budget setting across ministries to reimbursement decisions on individual therapies.

Our interviews revealed several barriers to incorporating wider effects into decision making, which we grouped into the following themes:

• System fragmentation, related to a persistent culture of silo budgets whereby interlinks between governmental departments’ expenditures are not considered;
• Methodological and data generation issues, such as difficulties in demonstrating with reliable data the impact of a specific treatment on productivity;
• Practical issues due to added complexity if those effects are included in decision making;
• Equity issues if the inclusion of productivity effects favour interventions for working-age individuals;
• Weakness of evidence on the relationship between health and economic growth, which is limited in relation to high-income countries.

We conclude by suggesting ways to overcome these barriers. In countries with established HTA processes and methods allowing the inclusion of wider effects in exceptional cases or secondary analyses, it might be possible to overcome the methodological and practical barriers and move towards a more systematic consideration of wider societal effects in decision making. This would be consistent with principles of efficient priority setting.

Barriers to the consideration of wider societal effects in government decision making are more fundamental, due to an enduring separation of budgets within the public sector and current financial pressures. However, only consideration of all relevant effects of public investments, captured in the medium- and long-term, can lead to the allocation of resources to where they bring the best returns.

The paper, published in the International Journal of Technology Assessment in Health Care, is based on a research study that was funded by Eli Lilly and Company. 

Download the full paper here.

Full reference: Garau, M., Shah, K.K., Sharma, P. and Towse, A., 2016. Is the Link Between Health and Wealth Considered in Decision Making? Results from a Qualitative Study.  International Journal of Technology Assessment in Health Care, 31(6), pp.1-8.

For further information, please contact Martina Garau at OHE.

Related work:

Johannesson, M., Jonsson, B., Jonsson, L., Kobelt, G. and Zethraeus, N., 2009. Why Should Economic Evaluations of Medical Innovations Have a Societal Perspective? OHE Briefing