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Gonna do a thread I'll occasionally update about things that may/should/may not be live issues in health economics post-COVID-19 because I think that, in every discipline, there's a lot to grapple with.
(1) Gonna start with the truly boring stuff: health system productivity. When I worked at York I worked on two NHS England productivity reports that gave topline figures on growth. As I recall we highlighted where these topline figures were composed of input/output growth/falls.
A related book chapter that we did pointed to positive productivity growth arising from input restriction and questioned how long this could continue.
Anyway. What looks like inefficiency in normal times can actually represent a efficient choice depending on the uncertainty under which you operate under. So spare capacity looks like a waste of money until you see how necessary it is in crises, by their nature rare events.
A hopefully useful analogy: if you own a house and you buy house insurance, you shouldn't consider it a waste of money if you get to the end of the year and your house hasn't burned down.
I do not have anything to say beyond this other than raising the point. I'm thankfully not a damn accountant and I never want to think about NHS productivity again because it was the most tedious and miserable piece of work I have ever done in my life.
(2) Measures of health outcome and the social legitimacy of decision-making. Over the pandemic we've seen an increased focus on averting deaths and an aversion to considering life years. Possibly this is just the public paying more attention rather than a change in values.
This is to say nothing of quality of life. We generally focus on a composite measure of quality and quantity of life (QALYs normally) but a bigger than normal focus of social policy has been on just averting deaths irrespective of age & irrespective of other aspects of health.
Even in normal times people kick off about "the NHS" not funding new drugs. We have had plenty of Daily Mail front pages usually featuring comments by one now-prominent academic calling the NHS "Stalinist" after it refused to pay huge amounts of money for ineffective treatment.
I don't really know what we can read into this (I think fairly characterised?) general attitude towards averting deaths, whether people have thought it through and what it all means for the legitimacy of decision-making that health economists inform.
Basically: in immaculate conception we try to inform decisions that maximise population health. These sometimes involve people not getting treated because the use of resources would be inefficient (expensive / ineffective treatments).
Lots of stuff has been said about "health versus the economy" but As A Health Economist I've always seen it as primarily health versus health: decisions that have positive impacts on person A's health have negative impacts on person B's health.
So I don't know where we are now with this. It seems clear that some types of health are apparently higher valued than others, or that there are now expressed public preferences about tradeoffs that I can't fully square the circle on. I don't know what this means for us.
That's it for now anyway.
