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Health Studies
Iva Zovkic

HLTB15 WINTER 2013 Week 3 Readings: “Investing in Prevention – The Economic Perspective” by PHAC 1. OVERVIEW  Understanding the economic benefits and costs of preventive health measures enables policymakers and program managers to make better-informed decisions about where and how best to invest to order to improve the health of the population  Economic perspective should be just one of the inputs but it allows us to make a more rigours, systematic and transparent decision-making process in a world of limited resources 2. THE ECONOMIC RATIONALE FOR INVESTING IN PREVENTION 2.1 The economic burden of illness in Canada  Ill health poses a significant economic burden on Canadian health care system and society broadly o Direct costs: value of goods and services for which payment was made and resources used in treatment, care, and rehabilitation related to illness or injury o Indirect costs: value of economic output lost because of illness, injury-related work disability, or premature death  Examples: underperformance at work due to sickness (presenteeism), value of lost non market production due to illness or disability, and the value of time lost from work and leisure activities by family members or friends providing care to ill persons o Value of morbidity and mortality/ intangible costs: intrinsic worth attributed to better health and includes the personal and or subjective consequences associated with illness such as physical pain, mental anguish, anxiety, fear, loss of good health, stress in personal relations, and family life  yyExamples: Quality-adjusted life year (QALY), disability adjusted life year (DALY) or in monetary terms  Total economic burden in Canada due to disease or injury is 188 billion dollars in direct and indirect costs alone (2000)  Indirect costs accrued by society are as great as or greater than the direct costs associated with the provision of health services 2.2 Understanding the economic potential of prevention  Prevention is thought to be cost effective and even cost saving in some instances  Investing in prevention now may reduce more costly treatment later on  Good health in itself may generate economic growth in that people have more opportunities in life to maximize their educational, labour and human potentials  Economic evaluation offers a systematic framework for measuring and comparing the economics of policy alternatives in terms of their costs and consequences  Saha and colleagues note six contributions that economic analyses can make towards informing decision making around preventive services HLTB15 WINTER 2013 o Quantifying the differences between 2 or more effective services for the same condition o Illustrating the impact of delivering a given intervention at different time intervals at different ages or different risk groups o Evaluating the potential role of new technologies for prevention o Identifying key real life conditions that must be met to achieve the intended benefit of an intervention o Incorporating the target population’s preferences for intervention outcomes o Developing a ranking of services in order of their costs and expected benefits  Economic evaluations should be only one of many factors used to determine allocation of scarce health system resources – 1 stpriority of public health as with clinical medicine and allied health professions is to PROTECT and IMPROVE HEALTH  Stein: “efficiency is about how we should allocate our resources to achieve our goals, not WHAT our goals should be. What our goals are and how much we value them is properly outside the language of efficiency.”  Public policy making is both an EVIDENCE DRIVEN and a VALUE BASED enterprise  Neither based on common based assumptions or advocacy pressures or solely on mechanical accountancy of costs and benefits  Economic evaluations however provide much needed accountability, fiscal responsibility and value for money in times of budgetary constraints.  Equal balance of other factors such as public perceptions of safety and acceptability, societal values of equal access, fairness, solidarity, and distributive justice, and avoidance of discomfort, pain and suffering in oneself and others 3. A BRIEF SUMMARY OF THE METHODOLOGY  Surveyed academic and grey literature using key word searches in databases as well as review of relevant literature in reference citation lists  Examples of key words: clinical prevention, primary prevention, health promotion, health protection, population health, cost saving, cost benefit, cost effectiveness, cost utility or economic evaluation  Four faces of the prevention spectrum employed by Goldsmith et al. o Clinical prevention: one on one activities involving a health care provider a
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