Using Cost-Effectiveness Analysis to Improve Health Care: Opportunities and Barriers

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By considering the economic, social, legal, and ethical factors that contribute to the situation, and how they can be negotiated in the future, this book offers a unique perspective. It traces the roots of EA in health and medicine, describes its promise for rational resource allocation, and discusses the nature of the opposition to it, using Medicare and the Oregon health plans as examples. In exploring the disconnection between the promise of CEA and the persistent failure of rational intentions, the book seeks to find common ground and practical solutions.

It analyzes the prospects for change and presents a roadmap for getting there. It offers pragmatic advice for cost-effectiveness analysts, discussing ways in which they can better translate their research findings into the basis for action. The book also offers advice for policy makers and politicians, including lessons from Europe, Canada, and Australia, and underlines the need for leadership to establish the conditions for change. Product details Format Hardback pages Dimensions Table of contents 1.

Introduction ; 2. The promise and promotion of CEA ; 3. Understanding the resistance ; 5. Legal, political and ethical concerns ; 6. Lessons from Oregon ; 7. Does anyone in America really use CEA?

Using Cost-Effectiveness Analysis to Improve Health Care

Examples from the field ; 8. Cost-effective analysis abroad ; 9. Imagining a future for CEA ; Advice for CEA practitioners ; Advice for policy makers and politicians show more. Review Text Just when you thoght it was safe dismiss cost effectiveness analysis as another dry and broing topic, of interest only to geeky economists or hard hearted bureaucrats, a book has emerged that makes the subject unexpectedly compelling.

The Harvard academic Peter Neumann passionately and eloquently articulates why we should all take more of an interest in how our health system gets value for money from medical treatments and technologies. More importantly, it shows why the country with the world's biggest and most dysfunctional health economy, the United States, has been so slow to embrace this tool for rationally making decisions about money and medicine.

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This book focuses on the challenges and potential associated with the use of cost-effectiveness analysis CEA in health care.


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The first chapter gives an introduction. It discusses the roots of CEA in health and medicine, its promise for Using cost-effectiveness analysis to improve health care: opportunities and barriers. It discusses the roots of CEA in health and medicine, its promise for rational resource allocation, and its promotion to the medical community.

Is there evidence to support investment in public health?

Chapter 3 explores the nature of the opposition to CEA, describing the antagonism CEA has encountered at public and private health programs health programs Subject Category: Miscellaneous see more details health programs Subject Category: Miscellaneous see more details across the nation. Chapter 4 considers explanations for the resistance, including a lack of understanding about the conceptual approach, mistrust of the methodology, and mistrust of the motives of researchers and their sponsors. Chapter 5 analyses legal, regulatory, and political barriers to CEA, and includes a discussion of the ethical debate surrounding its applications.

Chapter 6 takes on the Oregon experience and the dos and don'ts it provides for American policy makers. It argues that CEA has actually enjoyed influence in the USA, not as an explicit instrument for prioritizing health services, but as a subtle lever on policy discourses. The chapter first reconciles hostility towards CEA with the rapid growth of analyses in mainstream American medical journals. It then reviews ways in which various policy makers in the public and private sectors have managed to incorporate CEA, sometimes under the radar screen, into their internal processes. Chapter 8 turns to decision makers overseas who have incorporated CEA into their coverage and reimbursement deliberations.

It reviews the experience of the UK's National Institute of Clinical Excellence, the recently created health authority with a broad mandate to issue guidance on the effectiveness and cost-effectiveness of health technologies and the clinical management of specific conditions. The chapter also discusses the experiences of public authorities in other nations, particularly Australia australia Subject Category: Geographic Entities see more details and Canada canada Subject Category: Geographic Entities see more details , which have formalized the use of CEA in resource allocation considerations.

Opportunities and Barriers

In chapter 9 the book looks ahead. First, it anticipates the way forward by providing a perspective on what we have learned in 25 years of cost-effectiveness research.

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Second, it imagines a future for CEA that includes the prospects for change and a roadmap for getting there. Chapter 10 offers pragmatic advice for practitioners. It discusses ways in which analysts can better translate their research by altering the manner in which they frame and present studies, by considering their audience more carefully, and by changing the language they use to describe their results. The chapter also discusses the importance of considering "affordability" alongside cost-effectiveness ratios.

Chapter 11 presents advice for the policy maker and politician. It also considers the need for leadership at local, state, and national levels.

Using cost-effectiveness analysis to improve health care: opportunities and barriers.

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