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Education And Debate Personal paper

Has health economics lost its way?

BMJ 1998; 317 doi: (Published 18 July 1998) Cite this as: BMJ 1998;317:197
  1. D P Kernick (, general practitioner
  1. St Thomas' Health Centre, Exeter EX4 1HJ
  • Accepted 5 May 1998

Until recently, medicine was fairly straightforward. The doctor had limited therapeutic options, patients did as they were told, and mortality was an unequivocal outcome. Now medicine has become health care, an amalgam of psychology, physiology, anthropology, epidemiology, education, management theory, and politics. Economics has been the latest candidate for the melting pot, on the back of a simple message: when resources are limited, relating the cost of an intervention to its benefits can facilitate the difficult choices that have to be made between competing options. In Britain, with the development of a primary care led service, 1this approach will be of particular relevance to general practice.

Although the difficulties of applying traditional economics to health care and the uncertain relation between health care and health is well recognised, the introduction of internal market reform in Britain in the 1980s gave health economists a chance to establish their credentials and assert their influence on the way health care is delivered. But the early optimism that health economics could provide an explicit framework which could facilitate an ethical approach to the inevitable rationing of health care has proved illusory. And although the importance of economic information is clearly recognised,23 economic studies have little impact on healthcare decisions, which continue to be made with little or no evidence of cost effectiveness.4Why should this be?

Summary points

  • Relating the outputs of a health intervention to the resources that are used is important in choosing between competing interventions

  • Health economics has not made a substantial impact on decisions in health because of problems with acquiring evidence, recognising the relevance to the decision maker, and implementing the message

  • Approaches should be developed that are acceptable to and assessable by end users and which reflect local …

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