This Conference on Genomics, Healthcare and Public Policy, organised by the Office of Health Economics in collaboration with the School of Public Policy, University College London, and Pharmaceutical Partners for Better Healthcare, examined the status and likely consequences of healthcare applications of genetics. Advances in genetics will open up opportunities for universities and industry, they will induce changes in the practice of medicine, and lead to alterations in the structure and organization of health services in many countries.
International and UK experience illustrates the difficulty of involving the publica in health caare priority setting in ways that enable politicians, managers and doctors to incorporate public preferences into practical decision making.
Many techniques for measuring public preferences fail to incorporate key concepts:
opportunity cost. What are people prepared to give up or have less of, in order to have more of something else? The public have to be asked to make trade-offs;
• The integration of health care is the defining theme of policy developments in the UK, US and New Zealand. The common element between the three countries has been the development of multipractice and multi-professional groups in primary care settings.
• International learning has become commonplace and has accelerated the introduction of innovations in the UK.
There is widespread criticism of organisational costs in the NHS. 'Reduce bureaucracy, release funds for patient care' has become a popular slogan. This so-called 'bureaucracy' may, however, be essential to delivering health care. The complexity of modern health care means that some organisational costs have to be incurred if the right health care is to go to the right people at the right time.
Disease management is a term with multiple and ambiguous meanings. For some, it is purely a form of managing care. For others, it is ‘strategic planning’ by the pharmaceutical industry to market its products in a different way. In between these two ends of the semantic spectrum are a wide variety of interpretations and usage. Forms of health care management exist that embody all the principles of disease management, but which are given a different label. In this report, we explore different notions of disease management and consider their relevance to the NHS.
The topic I have been asked to address, 'Doctors, Economics and Clinical Practice Guidelines: Can they be Brought Together', is both difficult and controversial. It is also timely. With the creation of the National Institute for Clinical Excellence (NICE), the National Service Frameworks, and the clinical governance project, the UK has an opportunity to develop systematic national solutions to problems that have challenged every society - how to balance the quality and cost of health care in a way that respects both people's humanity and their pocketbooks.
From 1 April 1999 the structure of the Health Services in the United Kingdom will look radically different. In England there will be Primary Care Groups (PCGs), in Scotland Primary Care Trusts, and in Wales Local Health Groups. The pattern in Northern Ireland is still awaited. These different solutions for England, Scotland and Wales have one thing in common; they are being introduced across the board for the whole population untried and untested.
The English, Scottish and Welsh National Health Service (NHS) White Papers published by the government in December 1997 and January 1998, have changed the tone of NHS policy. Co-operation is to replace competition; there is to be a statutory requirement to provide good quality health care; and performance benchmarking is expected to succeed where market forces failed in producing efficiency gains. The consultation paper ‘Fit for the future’ published by the Department of Health and Social Services in May 1998 implies that the same changes will apply in Northern Ireland too.
Benjamin Franklin remarked in 1789 that ‘in this world nothing can be said to be certain, except death and taxes’. To these two certainties the economist would add that of the scarcity of resources, as ‘the central economic problem for society is how to reconcile the conflict between people’s virtually limitless desires for goods and services and the scarcity of resources (labour, machinery and raw materials) with which these goods and services can be produced’.