Author: Associate Professor Martin Hensher, Deputy Director, Deakin Health Economics, Deakin University.
When former Prime Ministers start suggesting that governments should think like health economists rather than trauma doctors, and the news is full of voices calling for greater use of the Quality Adjusted Life Year (QALY), AHES members might be forgiven for allowing a quiet smile of satisfaction to flicker across their faces. Although older and more cynical heads might equally begin to worry that an ambush or a policy smash-up may lie not far ahead…But what should the health economist on the tools make of this sudden focus on our trade, and how have we done so far?
Here at Deakin Health Economics, we have certainly been busy – and that is perhaps part of the challenge. Like so much of the world, we moved to working from home six months ago, moved all our teaching online, jury-rigged existing research projects to continue at a distance, wrangled kids and home-schooling, managed stress, experienced family crises or bereavements in other states or far-away lands that were suddenly unreachable ...you’ve all experienced it. We’ve dived into work on the economics of mental health, the role of COVID health apps, the implications of COVID for heroin users, how to respond aggressively to the health impacts of mass unemployment , and even what the badly broken economics of information and COVID might augur for a sustainable future – not to mention a growing line of business in evaluating telehealth services. With the help of Deakin’s own rock-star epidemiologist, we’ve even had a pop at inserting some actual health economists’ views into the increasingly interminable “lives versus the economy” non-debate.
But, but, but…have we as health economists (whether here or overseas) really managed to shape COVID-19 policy debates, or to deliver the kind of knock-down evidence that pierces through the fog of war? Have we followed up on our own and others’ exhortations to use QALYs or DALYs (or whatever is your personal favourite flavour) with working models that can actually answer the big questions policy-makers are struggling with? Have we offered decision-makers tools that reduce their uncertainty on wicked problems, and at least help them to reduce the number of unknowns they are juggling? This is harder to answer right now – and, of course, I can’t know about all the blockbuster secret weapons which readers might be hard at work on as I write. But I have a few ideas on why it’s been hard, if you will indulge me.
The biggest is perhaps the easiest to see and the hardest to solve – if you have to keep doing a busy day job (which has just been made exponentially more complicated by the pandemic), there’s only so much extra work you can fit in. If we need a health economics version of the Manhattan Project to tackle COVID-19, then we need (figuratively speaking) to ship our best people off into the desert where they don’t need to worry about teaching, grant-writing, finishing other projects, doing the laundry, or malfunctioning primary school homework apps. I‘m not sure that Australian universities’ current business model knows how to do that, even if they were willing.
Second, we need a seat at the table if we are to make our voices heard in shaping policy solutions. It’s hardly a surprise (nor, indeed, a criticism) that the response to a pandemic infectious disease will be run by public health and infectious disease specialists; as we have learned from the many nations which have suffered grossly botched responses, this is the very minimum prerequisite to avoid disaster. However, we need health economists inside those key agencies, and they need to be senior enough to drive policy and brief Ministers eyeball to eyeball. This is a job that it is hard for external academics to do well. Some have seen debates about whether federal and state / territory Health Departments should have a chief economist as tokenistic; I would argue that COVID-19 has vividly demonstrated why having these roles – at senior executive levels – is no longer a luxury, but a necessity.
Closer to home, health economists need to brush up on their macroeconomics and start building better alliances with other economic disciplines. We need to be able to offer sensible advice and evidence on more than just the finer points of economic evaluation in healthcare; the longer term impacts of COVID on health and healthcare will be systemic and macroeconomic, not down in the weeds of drugs or vaccines. Finally, we need not to be scared to lead deeper debates about future reform of the health system, as we enter what is likely to be a new era of economic, societal and environmental challenges. Health systems will be renewing themselves in the years ahead; health economists need to lead the charge with novel and robust evidence to help them meet new challenges with imagination and vigour.