It’s hard to escape facts, figures, and findings from health and social care research at the moment, isn’t it? The COVID-19 pandemic has brought such research to the fore, bringing with it serious challenges in a rapidly changing landscape. At the same time, new opportunities are emerging from the availability of routine data, and new methods are expanding the potential of health and social care research exponentially. In this blog, we reflect on some of the broader aspects of the economics of health and social care research.
Over the past few decades, funders in the UK (including NIHR) have consistently recognised and promoted the importance of incorporating economic arguments into health and social care research. Yet despite being an indispensable part of research for many funding bodies and programmes, health economics is still an enigma for many researchers. What are the economic questions to incorporate into our research? How do we answer them? This may be clearer when the research study is a randomised controlled trial, as the cost-effectiveness analysis is part of almost any application, especially for the NIHR Health Technology Assessment funding programme. But I frequently have a “what else?” discussion with applicants. If I had to give a tip, it could be summarised in one sentence: make an economic argument to support your clinical research question.
As a health economist, I am passionate about the economics of health in broader terms than the conventional cost-effectiveness analysis. A large part of health and social care research refers to new interventions, a new health technology, or a new way of providing an operation, a service, and so on. These research questions have a direct economic argument – ‘is it better and less costly?’ – and this is the foundation of the cost-effectiveness analysis. But the economics of health goes much deeper and further than that, from assessing not only the cost of an intervention but also the economic impact of potential implementation and the relevant investment and disinvestment decisions.
So, health economics is about exploring and quantifying the economic implications of research ideas on the health and social care system as a whole. The questions to ask to define the economic implications are: what? who? where? and for how long? This includes not only the provider but also the patients, personnel and society, and therefore the wider economy. Health economics research can therefore help policymakers’ decision-making by framing and articulating the economic arguments for/against treatments, interventions, investments and services.
Thus, my preferred definition of health economics could be “exploring, understanding and assessing the information and evidence that can inform health and social care decision-making, eventually adding to the social value of clinical research”.
However, the questions for the economics of public health, health promotion and disease prevention policies can go even further than conventional health economics questions. For example, the range of public health measures taken to lower COVID-19 transmission rates (such as the widescale closure of public places, schools, and workplaces, as well as advice to individuals on handwashing, social distancing and use of face masks) raise a plethora of economic questions: if they are effective, are they worth it? How do we decide what ‘worth it’ means? How do we measure the cost when it has been so multifaceted and has immediate as well as long-term implications? How do we reflect the widely varying costs at a personal level? Do these measures work equally well within and between communities and countries and how does the economic impact of these measures change in different settings? How do we weigh up these checks and balances? Is it possible to forecast meaningfully or are we destined to play catch-up?
My advice to researchers is to include a health economist early in the process of exploring your research idea and designing your study. Allow them to help you think about the specific economic issues for your research. Many funding bodies are interested to see applications that have incorporated a robust economic argument in support of the health or social care research proposal.
For more information and help with health economics advice as well as any other aspect of research design, do contact your local RDS.