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HTA debate: Work in Healthcare Decision-Making

Prof.FS Mennini
CEIS Sanit - Centre for Health Economics and Management (CHEM) Faculty of Economics and Faculty of Science -University of Rome "Tor Vergata" Faculty of Statistics, University of Rome La Sapienza Kingston University, London, UK

Health and Wealth


ECONOMY
Production and Consumption Health is important for the wellbeing of individuals and society, but a healthy population is also a prerequisite for economic productivity and prosperity [1].

HEALTH
HEALTH CARE
Medicine

[1] Together for Health: A Strategic Approach for the EU 2008-2013, Brussels, 23.10.2007, COM(2007), http://ec.europa.eu/health-eu/doc/whitepaper_en.pdf (accessed 8 October 2011)

Yet the urgency of the situation is clear.


Unless we take action now to prevent a growing proportion of the EU workforce becoming too ill to be productive or remain active in the labour market, we will fall short of our goals of being a competitive and socially inclusive economy. The solutions lie less in technical approaches to evaluating the economic and clinical benefits of clinical and welfare interventions, and more in the framing of arguments which place a healthy and productive workforce at the centre of policy-making.

HTA is seen as a key tool to inform those decisions


Societal perspective will typically include concerns about the impact of a healthcare intervention on the patients ability to work, and may even be concerned about the ability of the patients carers to work too.

However, what the societal perspective really means


in practice is not clear based on the literature.

HTA is seen as a key tool to inform those decisions


This means that the way that HTA is approached is also influential. The rules that set how HTA can be conducted can either explicitly include or exclude consideration of work. This is usually set out in the perspective of the analysis. The rules for HTA may also specify the approach to consideration of work within HTA, where the perspective allows for its inclusion.

ADDRESSING THE KEY CHALLENGES


Potential bias investment towards those who are in work, or could work, and away from others (including those in unpaid work). A mismatch between the goals of Government as a whole for a prosperous and healthy country, and the goals of individual Government departments and other agencies [3]. Allowing for a wider perspective, such as including work as a cost saving in HTA, could result in more interventions being recommended for adoption in health care systems. Allowing for productivity cost savings could lead to an increase in the health care budget overall. Diversity of methods used

[3] Fit for Work, The place of work in health decision making: Insights from an expert roundtable , London, 2012

Inclusion of work in HTA


Although HTA is now widely practiced across the globe the precise approach and its influence differs both across and within countries. With limits on spending on health care a reality for most countries, and growth of economies a wider objective of many Governments, the inclusion of work in HTA becomes more compelling.

Given that HTA can (but is often not) widely applied, and given that the amount of funds available to spend on health care is unlikely to be increased, including work in HTA could be part of moving investment towards those interventions that lead both to improved health, but also to improved work outcomes: getting people back into, or avoiding early retirement.

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