Faculty of Medicine Health Economics and Policies ( ) The value of health. Hatim Jaber MD MPH JBCM PhD

Transcription

1 Faculty of Medicine Health Economics and Policies ( ) The value of health By Hatim Jaber MD MPH JBCM PhD

2 Introduction to course (cont..) Course Content Week 1 Introduction to Course introduction to Health: health value, health determinants. Week 2 Introduction to: Health care management Health Policy and Healthcare Delivery. Week 3 The scope of health economics :Economics And Health Economics. Week 4 Demand and Supply Demand for Medical Care. Supply of public health. Week 5 The Market for Health Insurance Week 6 Financing health care Economic in Health Policy Cost and price Week 7 Health systems performance analysis. Measurement and evaluation in health care Week 8 Midterm assessment (Exams.) Week 9 Public Goods, Market Failures, and Cost-Benefit Analysis. Week 10 Economic evaluation. Economics and efficiency cost analysis and cost effectiveness, Week 11 Economic effects of Bad habits including smoking and alcohol consumption Week 12 Quality Improvements in healthcare delivery Methods to improve health care delivery Week 13 Human resources in Healthcare delivery. Week 14 Health Markets and Regulation and Economic regulation of health markets Week 15 Final assessment (Exams.)

3 Week 1 Overview of course syllabus and time table. Health as social and economic issue. Determinants of health: Genetic factors, Socioeconomic factors, Environmental factors Determinants of (inequalities in) health: Exogenous determinants of health The social and economic environment and health The value of health: Health related quality of life Health vs. Welfare/Utility Value in Health and Health Care Measuring Value in Health Care Definition of health behaviors

4 Presentation outline The value of health: Health related quality of life Health vs. Welfare/Utility Value in Health and Health Care Time 08:00 to 08:20 08:20 to 08:30 Measuring Value in Health Care 08:30 to 08:40 Definition of health behaviors 08:40 to 08:50

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6 What is a value? Qualities, characteristics, or ideas about which we feel strongly. Our values affect our decisions, goals and behavior. A belief or feeling that someone or something is worthwhile. Values define what is of worth, what is beneficial, and what is harmful Values are standards to guide your action, judgments, and attitudes.

7 Direction: Values Goals Behavior Self-value Values give direction and consistency to behavior. Values help you know what to and not to make time for. Values establish a relationship between you and the world. Values set the direction for one s life.

8 Value, Cost and Health Care Cost Value Cost Cost of Test Cost includes cost of test and downstream costs, benefits and harms High-cost interventions may provide good value because they are highly beneficial Low-cost interventions may have little or no value if they provide little benefit or increase downstream costs

9 Benefits, Harms, Costs Test Benefit Harm Costs CT Angio Best sensitivity for identifying PE Contrast, radiation, incidental findings $ TTE $ EKG D-dimer Identify arrythmia, non-invasive Easy to obtain, helpful in ruling out PE if negative $79.18 Low specificity $65.88 BNP $18.75 Troponin (serial) Repeated phlebotomy $26.01 (x 1) ABG Arterial Stick $35.94 LE U/S Doppler Hypercoagulable work up no contrast, noninvasive Low yield in patient with clear risk factor for PE $ $79.18

10 Types of Values: Moral Material Aesthetic Intrinsic Extrinsic Universal Group specific values

11 Value-based health care delivery (VBHC) The central goal in health care must be value for patients, not access, volume, convenience, quality, or cost containment Value = Health outcomes Costs of delivering the outcomes The unit of analysis for VBHC is the complete cycle of care for treating a patient s medical condition.

12 An acute medical condition s complete cycle of care Patient problem: Knee pain Initial MD visit Treatment: medications, diet, exercise Recommend surgery Surgical consult Pre-op testing and evaluation Surgical prep Inpatient post-op care Operation Rehab Discharge Followup visit Measure Outcomes and Costs

13 The Value of Health Care Percentage of consumers rating each of the following a very good or fairly good value Generic prescription drugs 63% Medical devices OTC (non-prescription) drugs Doctors Pharmacies 43% 36% 35% 32% Hospitals Brand name prescription drugs Health insurance companies 14% 24% 21% Source: Harris Interactive/Wall Street Journal. Aug 19, 2003

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20 The Emerging Value Context Rising costs Rising cost shifting to consumers Evidence that Innovation makes a difference Expect more Innovation in long term although gaps in the short run Potential Paradigm Emerging High cost, High efficacy, High Customization but unaffordable The Quest for Value Balancing cost, quality, access and equity Evidence based medicine and evidence based benefit design Pay for Performance Value Purchasing

21 Percentage of consumers who say each industry does a good job serving their customers 1997 % 1998 % 1999 % 2000 % 2001 % 2002 % 2003 % Change since 97 Change since 02 Hospitals Banks Computer hardware companies 80* Computer software companies 80* Car manufacturers Airlines N/A Telephone companies Life insurance Pharmaceutical and drug companies How Consumers Rate Industries Oil companies Health insurance companies Managed care companies Tobacco companies * In 1997 computer companies were rated together (I.e. hardware and software companies were not measured separately ** Because airlines were not included in 1997, the trend for airlines is from

22 Who Pays for Drugs? Percent of Total National Prescription Drug Expenditures by Type of Payer 60% 50% 59.1% 56.2% 54.7% 52.7% 48.2% Private insurance 40% 30% 20% 10% 24.4% 16.6% 26.5% 27.3% 28.5% 32.1% 42.7% 37.1% 39.5% 40.0% 42.4% 36.8% 44.0% 45.3% 46.2% 34.9% 33.4% 32.0% 17.3% 18.0% 18.8% 20.1% 20.6% 20.8% 21.2% 21.3% 21.8% 19.8% Government programs Out-ofpocket Source: Kaiser Family Foundation and Sonderegger Research Center analysis of CMS data

23 The value of medicines to patients, healthcare systems and society PATIENTS ECONOMIES Patients live longer, healthier, more productive lives The biopharmaceutical industry generates essential economic value in terms of job creation, R&D investment, and medications that improve patient productivity HEALTHCARE HEALTHCARE SYSTEMS SYSTEMS SOCIETY Innovative medicines can put healthcare systems on a more sustainable path by reducing costs in other parts of the healthcare system such as hospitlisations Society benefits from health and wellness as individuals are able to continue being productive members of the community 23

24 Value to patients Patients all over the Europe are living longer, healthier and more productive lives thanks to innovative medicines developed by biopharmaceutical companies. 24

25 Value to healthcare systems Innovative medicines can put healthcare systems on a more sustainable path by reducing costs in other parts of the healthcare system such as hospitalisations and clinicians time. 25

26 Value to the Economy The biopharmaceutical industry generates essential economic value in terms of job creation, R&D investment, and medications that improve patient productivity 26

27 Value to society Innovation can deliver significant societal value as development is strongly targeted at societal disease priorities and patients are able to continue contributing to the community. 27

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29 Why measure health? Health is the product of health care not performed, no patients treated etc Clinical reasons - effectiveness Economic reasons - efficiency

30 Valuation versus Measurement Value is determined by benefits sacrificed elsewhere Valuation requires wade-off benefits measurement does not

31 What is Welfare Welfare economics is a branch of economics that uses microeconomic techniques to evaluate well-being (welfare) at the aggregate (economy-wide) level. The word "welfare" has two very different meanings in economics. The most familiar meaning to the general public is that it refers to a collection of government programs such as food stamps and Medicare, usually intended to help the poor.

32 What is utility Economics: Pleasure or satisfaction (value for money) derived by a person from the consumption of a good or service or from being in a particular place, and for the maximization of which all economic actions are motivated. Utility = satisfaction/well-being - reflects a consumers preferences It is the subjective or psychic return which cannot be measured in absolute or objective terms. Goods or services that have utility for one person may not have for another, and what may have utility for a person at a certain time or place may not have it at another. See also utility theory.

33 What is Health-Related Quality of Life (HRQOL)? For public health surveillance purposes, HRQOL was defined as an individual s or group s perceived physical and mental health over time. (Measuring Healthy Days, CDC 2000)

34 Unhealthy Days = days in the past 30 days when both physical and mental health were not good = Physically unhealthy day = Mentally unhealthy day = Healthy day

35 Measures of Health-Related Quality-of-Life

36 Measures of Health a quick typology Mortality-based measures death rates, life expectancies, etc. All the familiar stuff

37 Measures of Health a quick typology Mortality-based measures death rates, life expectancies, etc. Morbidity-based measures indicators Indicators: Single, countable things TB rate C-section rates % population who exercise Examples: Healthy People 2010 Leading Indicators WHO Core Health Indicators

38 Measures of Health a quick typology Mortality-based measures death rates, life expectancies, etc. Morbidity-based measures indicators health status measures disease-, organ-specific Health Status Measures Disease-, organ-specific... Created to be sensitive to changes in symptoms or functional impairment due to a particular disease process Examples: Arthritis Impact Measurement System (AIMS) Vision Function Questionnaire (VFQ-25) McGill Pain Questionnaire NY Heart Association Classification Some physician-reported, others patientreported

39 Measures of Health a quick typology Mortality-based measures death rates, life expectancies, etc. Morbidity-based measures indicators health status measures disease-, organ-specific generic Generic Health Status Measures Most famous: SF-36 health profile One questionnaire with many questions Several questions about each of 8 different domains of health multiple scales to cover broad scope of health, not tied to one disease or organ system Scoring: Arbitrary scales based on summing responses to multiple questions Separate scores for each subscale or health concept PF, RP, BP, GH, VT, SF, RE, MH PCS MCS

40 Measures of Health a quick typology Mortality-based measures death rates, life expectancies, etc. Morbidity-based measures indicators health status measures disease-, organspecific generic health-related quality-oflife (HRQoL) indexes HRQoL indexes Like generic health status try to comprehensively cover conceptual basis of health with multiple questions about health Scoring not simple sums--these are not psychometric scales! econometric methods used to elicit utility weights ( preferences ) for health states 0 = dead, 1= perfect health average preference weights from community sample of people

41 Health Behaviors

42 Health Promotion Overview: - the idea that good health, or wellness, is a personal and collective achievement - health promotion appears to be more successful and less costly than disease prevention

43 Health Behaviors Role of behavioral factors in disease and disorder: - successful modification of health behaviors can: - reduce deaths due to lifestyle related illnesses - delay time of death, increasing longevity - expand years of life free from chronic disease Reduce complications 3-43

44 Health Behaviors (cont.) Health Behaviors: - behaviors undertaken by people to enhance or maintain their health -health habits: - firmly established behaviors that are often performed automatically such as wearing a seatbelt, brushing one s teeth and eating a healthy diet - primary prevention instilling good health habits and changing poor ones 3-44

45 Health Behaviors (cont.) Practicing and changing health behaviors: Overview: Demographic factors Values Social influence Perceived symptoms Age Personal control Personal goals/values Cognitive factors Access to the health care delivery system 3-45

46 Health Behaviors (cont.) Barriers to modifying poor health behaviors: 1. not knowing when to intervene to change health habits 2. instability of health habits 3. health behaviors are elicited and maintained by 4. different factors for different people 3-46

47 Changing Health Habits Attitude change and health behavior: - educational appeals: - vivid communications - expert communicator - strong arguments at beginning and end - short, clear, direct messages - messages should state conclusions explicitly - caution with extreme messages - depending on the audience, communication should include favorable and/or non-favorable points - fear appeals - message framing

48 Thank You