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Emotions, values


We have a particular strength in researching the values which drive the decisions of healthcare payers. Emotions and values are the foundation of health economics. So the next time you are talking to some cool-headed procurement professionals who just want the figures, remember this: before they can analyse the numbers, they had to decide which numbers to analyse.

At its most basic, when they set a cost-related criterion (eg threshold incremental cost-effectiveness ratio) they placed a value on the specified healthcare outcomes (eg years of life).

So it all starts with the value judgements. Values are the critical determinants of any decision regarding healthcare resource allocation. The health economics are merely a tool for working out what those values imply for a given case.

And that's only the start.

For example, if a disadvantaged social group suffers poor health, healthcare decision makers may divert resources towards them for the sake of social justice - even though this may produce less health benefit than if the same cash was spent elsewhere. So payers may value justice over healthcare "productivity" as measured by health economists.

Moreover, payers must balance prevention and cure. If that was guided entirely by ICERs, payers would spend more on prevention than they do now. One estimate was that for a given healthcare budget, you could get 10 QALYs from dialysis of kidney patients, 266 QALYs from hip-replacement operations or 1197 QALYs from stop-smoking campaigns. This suggests a need to massively divert resources towards stop-smoking campaigns. Nevertheless, payers make a value-judgement favouring hip replacements and dialysis, again overriding health economics considerations. 

And let's not forget the politicians. They often reverse the decisions of health payer organisations with respect to particular treatments. This is often portrayed as a victory for irrational populism over systematic evaluation. But perhaps, just sometimes, it may be a victory for commonsense moral judgements over technical evaluations lacking sufficient humanity.

So if you want to understand why an organisation decided for or against your health technology, it's not enough to look at the numbers. You need to understand the values that shaped those numbers. That's what we can help you do.
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