April 4, 2014

A primer on health economics and policy

Social values in health and social care

In just 38 pages Tony Culyer explains  the basics of health policy. It is not a review, these are a collection of key insights that basically come from his book. This is the outline:
  • Introduction
  • Liberalism versus libertarianism
  • The market versus the state
  • Public versus private insurance
  • Equity versus equality
  • Inequalities of health versus inequalities of health care
  • Equity versus efficiency
  • Needs versus wants
  • Prices versus rationing
  • Financial protection versus quality of life
  • Public versus private
  • Agents versus principals
  • Universality versus selectivity
  • Comprehensiveness versus limited benefit bundles
  • Centralisation versus decentralisation
  • Competition versus collaboration
  • Experts versus citizens
  • Mixing values and other things
  • Key messages 
Take this sentence, as an exemple:
Cost is also a value and no mere matter of accountancy. If we introduce a new
health care procedure, the cost will have to come out of expenditure elsewhere
in the NHS –unless there is a concurrent increase in the NHS budget. But less
expenditure elsewhere will normally imply reduction of service elsewhere and
a consequential health loss. The true cost of getting more care (and hence
health) in one area of activity is therefore the minimum necessary loss of care
(and loss of health) elsewhere. This is the important notion of opportunity cost.
Many politicians don't want to hear such messages. I stronlgy suggest you to read this booklet from Kings' Fund.