The second edition of this guide to economic evaluation is significantly extended. This mirrors the development of economic evaluation since the first edition was published in 1996. The methodology has developed and new techniques, both regarding costing and outcome measurement, have been introduced. Some concepts have, with the same arguments, been deleted or reduced in importance. The application of economic evaluation in decision making has also taken a step forward. This is manifested in the inclusion of a section on NICE.
A number of potentially important structural developments are taking place in the pharmaceutical industry. On the one hand, we are witnessing a large number of mergers and acquisitions between companies across countries, suggesting a move towards a small number of large global players. On the other hand, a large number of new companies have entered in the industry over the past 15 years. Many are biotechnology companies that specialise in research and/or developing technologies for the discovery and pre-clinical stages of the research and development (R&D) process.
This book provides a reassessment of the role of charitable and voluntary fundraising for health care, with a particular focus on the hospital. It does so firstly by summarising the principal findings of a major research project on the pre-National Health Service (NHS) voluntary hospitals. Independent of the state and funded initially by charitable gifts, these hospitals cared for the acute sick before 1948 and were the centres of research and teaching. We discuss their performance, and that of the voluntary system, in its last decades.
I am really grateful to have the chance to spend an hour with you to talk about a subject of enormous importance. I am particularly gratified to be in London because so much of the global leadership on tackling the links between public health and economic development in the developing world originates in the UK - with its grand and esteemed tradition of leadership in science and in public health. I hope that after this evening I can bring back home to the USA some of that global leadership and transmit it to Washington!
It has long been known that a medicine may turn out to have an unexpected beneficial effect on an illness other than the one it was originally intended to treat. This is true for long established medicines, for example the cardiovascular benefits of aspirin, and for more recent products, of which Sildenafil (Viagra) is a dramatic example. Such instances are not rare and serendipidity has been a highly significant aspect of progress as illustrated by Julius Comroe’s (1977) fascinating dissection of the antecedents of some of the seminal advances in medicine.
The Private Finance Initiative (PFI) is officially described as a means for providing skilled and efficient services to public sector organisations and hence to the communities they serve. But the PFI has also become the main source of capital funds for major investment projects in the NHS and the rest of the UK public sector. Since 1997, 85% of the funds for major NHS capital projects has come from PFI sources. Private provision of services to public bodies such as local authorities and National Health Service (NHS) hospitals long predated the advent of the PFI.
Public policy in the UK is placing increasing emphasis on health inequalities. The first signal of this renewed commitment came soon after the Labour government was elected. In 1997 it commissioned an independent review of health inequalities with a view to identifying priority areas for future policy development. The review was published as the Acheson Report (Department of Health, 1998a). In addition, the government released a consultation paper, Our Healthier Nation, which expressed the following key objectives (Department of Health, 1998b):
The purpose of this paper is to set out the background to the development of regulations governing cross-border health care in the EU; to explore the possible implications of the Kohll and Decker rulings (and of subsequent ECJ cases) with particular reference to the experience of cross-border health care in the EU; and to set out some more speculative thoughts on how an internal EU market in health care delivery is likely to develop in the future.
The Secretary of State for Health has recently described health care as a form of ‘social investment’ which is ‘of instrumental importance in improving national economic performance’. This concern with economic productivity is shared by decision makers in other countries, where the impact of health care on workplace productivity has been specified as part of the economic analyses to be submitted in support of claims for the public reimbursement of pharmaceuticals.