OHE’s contribution to health economics

‘Health economists often credit the UK with being the natural home for the discipline – why?’

We conducted interviews with 18 esteemed health economists to explore this question and to investigate both the interconnection between health economics and the pivotal influence of the Office of Health Economics (OHE) in steering its direction.

Spanning from its origins in the UK during the 1960s to its worldwide influence, this piece explores the fundamental contributions of the OHE to the advancement of health economic theories and studies. Esteemed figures in the field provide perspectives on the OHE’s scholarly contributions, its involvement in policy discussions, and its lasting importance in the continuously changing realm of health economics.

Afterall, health economic thinking and research began in the UK during the 1960s and it was from here that British health economists drove the discipline forward, eventually reaching and influencing international audiences.

They also credit the Office of Health Economics (OHE) as a significant contributor to that success. Its academic output in terms of research and analysis, whether conducted or commissioned by the OHE, was key to the development of the academic discipline, they say.

Professor Paul Nightingale, Associate Dean of Research at the University of Sussex Business School, says it’s an organisation he has “got a lot of respect for”; associating the OHE with quality work that is well presented.

“Within SPRU, we’ve always been interested in, enjoyed and respected the OHE’s work and found that it to be of high quality and robust. It’s much better written than typical academic stuff and each brick builds up a wall of solid evidence. I’ve really appreciated that approach.”

This reputation for producing high quality and useful work is a theme echoed by other UK health economists.

Richard Murray, Chief Executive Officer at The King’s Fund, and formerly Chief Economist at the Department of Health, says the OHE’s outputs have been heavily relied upon by working health economists, including those in government and industry.

Reflecting on his time working as an economist working in the Department of Health in various roles before Chief Economist (2010-13), he says the quality of work from the OHE ensured that “it would have been seen — and was seen”.

“It was one of the centres of expertise, particularly on some of the more technical aspects of the health economics, alongside some of the academic institutions that, if you wanted a view or needed a discussion, you would go to. The OHE was part of that kind of broader community and constellation.”

He has particularly valued the OHE’s work on quality assurance and particular healthcare applications. “Anything to do with pharmaceuticals or that end of medical technology — it was the thought leader and we all recognized that it was.

“Universities could produce some brilliant stuff but also some of very poor quality that should have never been put into the public domain. But I don’t remember anyone ever saying that of OHE. Its strength was in presenting both the theoretical and the practical side – in involving people testing some of the hypotheses presented and involving clinical leadership.”

Nigel Edwards, Chief Executive of the Nuffield Trust, says the OHE has been a useful organisation for “pushing policy debate on”.

“It’s also been a catalyst for moving debate on/making it more thoughtful,” he says. “If we believe that many ideas have emerged by a gradual evolutionary process, I think organisations like OHE are a good catalyst for making that debate move more quickly and in a way that’s more thoughtful.”

This point is echoed by Nightingale: “Within its niche it’s a really, really important player,” he says. “I think OHE has been very good at being at the table and having that gut sense about important policy issues for the future, and then co-producing the research with people who need it to make sure that its findings are published at the right time. If you can do that, you can be much more effective than if you’re a huge organization doing tonnes and tonnes of research that’s published too late and for the wrong people, perhaps they’ve missed the point or it’s on a topic that’s slightly wrong or it isn’t presented in a way that’s usable to the right people at the right time.

“It’s got a reputation for being able to work across organizational boundaries in the way that is increasingly important. In fact, I think it’s better than SPRU and better than York in being able to work with the industry, government, academia or with other groups.

“That nimbleness of the research is something that I think a lot of organisations, SPRU included, could learn from… it’s a very important space to be working in — the ability to combine data intensive work with a really rich understanding of what that data means and a very impressive understanding of the micro and macro politics of the policy making process.”

For John Cairns, Professor of Health Economics at the London School of Hygiene and Tropical Medicine, OHE’s blended role of carrying out research while facilitating the contribution of industry in debates about policy is valuable.

“I think that’s a valuable role. I remember some of my colleagues in the past who have been rather anti pharma and anti, by extension, OHE, and I don’t think that’s appropriate. We don’t all have the same objectives, but we’re all engaged in similar types of activity, and we should recognise each other’s strengths and contributions.”

Martin Buxton, Emeritus Professor of Health Economics at Brunel University London, and founder of Brunel’s Health Economics Research Group, credits OHE’s ability to work with industry as one of its key strengths too.

“The OHE has carried out research projects for some companies on issues which they would have been cautious to take elsewhere.  They wouldn’t have wanted a pure academic unit to do it, and indeed some academic units wouldn’t have wanted to, but equally, they probably didn’t want to go to a commercial consultancy either who would have asked them what they wanted the answer to be before they wrote a report with that answer. So, I think it has a role there with industry and I see that in a positive light.”

Buxton, who has been an appraisal committee member of the National Institute for Health and Clinical Excellence and who has advised most of the major pharmaceutical companies, adds: “OHE was held in quite a high degree of respect by health economists throughout the UK and to no little extent abroad, but I think all the time that respect recognised that theirs wasn’t a totally independent view of the world.

“Over the years, OHE has organised a significant number of workshops, seminars, and expert panels that have addressed quite a lot of important issues, and it’s always seemed to me that those were always done honestly and were essentially unbiased.  Indeed, there have been a few where I thought the conclusions were not perhaps what their funders, either ABPI or in some cases a specific company, would have wished, but I think in that OHE has played an important role.”

Peter Smith, Emeritus Professor of Health Policy at Imperial College London, acknowledges the OHE’s respected ‘middleman’ role between the pharmaceutical industry and the government — “but with scientific integrity”.

“I would say the culmination of that in many ways is its work with pricing information. People can argue about whether that’s an inside job, but it’s something that in my view has brought an outcome that is beneficial for both parties…People could say, ‘you’re just a middleman’ and you’re compromised in your scientific integrity as a result but it’s an incredibly important role because the alternative would be standoffs.

“It may be that as a result there has to be some sacrifice in terms of the perceived independence, but I think that’s been a price, certainly from the point of view of both the industry and the country, that’s been well worth it.”

The OHE also has an important role in helping to educate policy makers and the public about health economics, argues Jon Sussex, Chief Economist at RAND Europe and former Deputy Director of the OHE. “I am not sure that OHE has helped the development of health economics per se, but I think it’s actually helped the use of health economics,” he says. “It has published things which other people are not willing to publish because they don’t fit the usual academic mould.

“I think the direction that OHE is pushing in is similar to that of the Parliamentary Office of Science and Technology: explaining things to people who want to know but who aren’t economists…explaining economic matters that are important in language that non-economists can immediately understand and, as part of that, bringing together information from disparate places which is relevant — I think that is a very valuable function.”

This outreach function in educating people about health economics is something that David Parkin, Senior Visiting Fellow at The Office of Health Economics and Honorary Visiting Professor at City University London, values in the OHE.

Like other health economists, Parkin isn’t sure how to class the OHE as an organisation, but this doesn’t take away from it being an important player.

“It’s an interesting think-tank as well as a consultancy, and research institute. It doesn’t have any political placing or anything like that but that doesn’t mean that it doesn’t have interesting and radical ideas, and it promotes them and seems open to all that sort of stuff,” he says.

Nightingale agrees, summarising the organisation’s appeal in its “accumulated expertise”, analysis and ability to influence policy. “It exists in this strange place – not quite academic, not quite consultancy, not quite policy, not quite think tank. There isn’t even a word to describe these sorts of organizations, but they are hugely important, and that boundary-spanning helps oil the clunky cogs of the wider policy world.”