Health economics education in undergraduate medical training : introducing the health economics education (HEe) website

In the UK, the General Medical Council clearly stipulates that upon completion of training, medical students should be able to discuss the principles underlying the development of health and health service policy, including issues relating to health economics. In response, researchers from the UK and other countries have called for a need to incorporate health economics training into the undergraduate medical curricula. The Health Economics education website was developed to encourage and support teaching and learning in health economics for medical students. It was designed to function both as a forum for teachers of health economics to communicate and to share resources and also to provide instantaneous access to supporting literature and teaching materials on health economics. The website provides a range of free online material that can be used by both health economists and non-health economists to teach the basic principles of the discipline. The Health Economics education website is the only online education resource that exists for teaching health economics to medical undergraduate students and it provides teachers of health economics with a range of comprehensive basic and advanced teaching materials that are freely available. This article presents the website as a tool to encourage the incorporation of health economics training into the undergraduate medical curricula

HEALTH AND HEALTH ECONOMICS: A CONCEPTUAL FRAMEWORK

Over the last three decades, treating health economics as an independent scientific discipline and providing specific treatment to the topics related to the economics of the health care sector have become more and more common. Currently, the field is so well established that it has appeared in the ordinary curriculum of most universities, and even if health economists are mainly to be found in the medical departments, the connections to economics proper are being strengthened, and the methodologies applied are getting refined. In this connection the paper highlights about the concept of health, why does health matter, relationship between health and Health Economics, and the justification of health economics

Behavioral Economics and Health Economics

The health sector is filled with institutions and decision-making circumstances that create friction in markets and cognitive errors by decision makers. This paper examines the potential contributions to health economics of the ideas of behavioral economics. The discussion presented here focuses on the economics of doctor-patient interactions and some aspects of quality of care. It also touches on issues related to insurance and the demand for health care. The paper argues that long standing research impasses may be aided by applying concepts from behavioral economics.

The Future of Health Economics

This paper discusses health economics as a behavioral science and as input into health policy and health services research. I illustrate the dual role with data on publications and citations of two leading health economics journals and three leading American health economists. Five important, relatively new topics in economics are commended to health economists who focus on economics as a behavioral science. This is followed by suggestions for health economists in their role of providing input to health policy and health services research. I discuss the strengths and weaknesses of economics, the role of values, and the potential for interdisciplinary and multidisciplinary research. The fourth section presents reasons why I believe the strong demand for health economics will continue, and the paper concludes with a sermon addressed primarily to recent entrants to the field.

How can health economics be used in the design and analysis of adaptive clinical trials? A qualitative analysis

Introduction Adaptive designs offer a flexible approach, allowing changes to a trial based on examinations of the data as it progresses. Adaptive clinical trials are becoming a popular choice, as the prudent use of finite research budgets and accurate decision-making are priorities for healthcare providers around the world. The methods of health economics, which aim to maximise the health gained for money spent, could be incorporated into the design and analysis of adaptive clinical trials to make them more efficient. We aimed to understand the perspectives of stakeholders in health technology assessments to inform recommendations for the use of health economics in adaptive clinical trials. Methods A qualitative study explored the attitudes of key stakeholders—including researchers, decision-makers and members of the public—towards the use of health economics in the design and analysis of adaptive clinical trials. Data were collected using interviews and focus groups (29 participants). A framework analysis was used to identify themes in the transcripts. Results It was considered that answering the clinical research question should be the priority in a clinical trial, notwithstanding the importance of cost-effectiveness for decision-making. Concerns raised by participants included handling the volatile nature of cost data at interim analyses; implementing this approach in global trials; resourcing adaptive trials which are designed and adapted based on health economic outcomes; and training stakeholders in these methods so that they can be implemented and appropriately interpreted. Conclusion The use of health economics in the design and analysis of adaptive clinical trials has the potential to increase the efficiency of health technology assessments worldwide. Recommendations are made concerning the development of methods allowing the use of health economics in adaptive clinical trials, and suggestions are given to facilitate their implementation in practice

Four decades of health economics through a bibliometric lens

This paper takes a bibliometric tour of the past 40 years of health economics using bibliographic"metadata"from EconLit supplemented by citation data from Google Scholar and the authors'topical classifications. The authors report the growth of health economics (33,000 publications since 1969 -- 12,000 more than in the economics of education) and list the 300 most-cited publications broken down by topic. They report the changing topical and geographic focus of health economics (the topics'Determinants of health and ill-health'and'Health statistics and econometrics'both show an upward trend, and the field has expanded appreciably into the developing world). They also compare authors, countries, institutions, and journals in terms of the volume of publications and their influence as measured through various citation-based indices (Grossman, the US, Harvard and the JHE emerge close to or at the top on a variety of measures).Health Monitoring&Evaluation,Health Systems Development&Reform,Health Economics&Finance,Rural Development Knowledge&Information Systems,Health Law

Situating care in mainstream health economics: an ethical dilemma?

Standard health economics concentrates on the provision of care by medical professionals. Yet ‘care’ receives scant analysis; it is portrayed as a spillover effect or externality in the form of interdependent utility functions. In this context care can only be conceived as either acts of altruism or as social capital. Both conceptions are subject to considerable problems stemming from mainstream health economics’ reliance on a reductionist social model built around instrumental rationality and consequentialism. Subsequently, this implies a disregard for moral rules and duties and the compassionate aspects of behaviour. Care as an externality is a second-order concern relative to self-interested utility maximization, and is therefore crowded out by the parameters of the standard model. We outline an alternative relational approach to conceptualising care based on the social embeddedness of the individual that emphasises the ethical properties of care. The deontological dimension of care suggests that standard health economics is likely to undervalue the importance of care and caring in medicine

Panel Data Sample Selection Model: an Application to Employee Choice of Health Plan Type and Medical Cost Estimation

This paper utilizes a nonparametric panel data sample selection model to correct selection bias in the analysis of longitudinal medical claims data. Selection bias in the health economics data is a common problem and many health economists have used Heckman type selection models in cross-sectional analyses. Since longitudinal data structure is common in health economics data, especially medical claims data, the correction of selection bias in the longitudinal sense is especially valuable for health economics related researches. The complicated modeling and extensive computer programming needs, however, resulted to only a few health economics researches in this direction. This paper suggests a relatively simple estimation framework to correct sample selection bias in longitudinal data. An example of health care utilization of PPO type plan holders in an employee pool is also provided as follows: in the first step, a random effect panel data probit model was used to estimate each employee’s choice between HMO type plans and PPO type plans; in the second step, a nonparametric fixed effect panel data selection model, using the estimates from the first step, was used to estimate the medical expenditures of PPO plan holders (similar to Kyriazidou, Econometrica 1997). Since the second step estimation can be expressed as a weighted least squares regression, this framework is simple to use, but among others, this nonparametric framework is robust from any parametric misspecification and free from a controversial health econometric problem called retransformation in two part model (Manning, Journal of Health Economics 1998; Mullahy, Journal of Health Economics 1998; Ai and Norton, Journal of Health Economics 2000). There are some interesting results from this example, but among others, the selection bias influenced significantly on the Age effect of medical expenditures. Since there were more young employees in the HMO plan holders, the Age effect of PPO plan holders was almost doubled after considering for selection biasSample Selection Model; Panel Data

Use of Discrete Choice Experiments in health economics: An update of the literature

The vast majority of stated preference research in health economics has been conducted in the random utility model paradigm using discrete choice experiments (DCEs). Ryan and Gerard (2003) have reviewed the applications of DCEs in the field of health economics. We have updated this initial work to include studies published between 2001 and 2007. Following the methods of Ryan and Gerard, we assess the later body of work, with respect to the key characteristics of DCEs such as selection of attributes and levels, experimental design, preference measurement, estimation procedure and validity. Comparisons between the periods are undertaken in order to identify any emerging trends.discrete choice experiments, health economics

HEALTH AND HEALTH ECONOMICS: A CONCEPTUAL FRAMEWORK

Over the last three decades, treating health economics as an independent scientific discipline and providing specific treatment to the topics related to the economics of the health care sector have become more and more common. Currently, the field is so well established that it has appeared in the ordinary curriculum of most universities, and even if health economists are mainly to be found in the medical departments, the connections to economics proper are being strengthened, and the methodologies applied are getting refined. In this connection the paper highlights about the concept of health, why does health matter, relationship between health and Health Economics, and the justification of health economics.Health and Health Economics