Economic Evaluation in Public Health - Case Study Example

Economic Evaluation in Public Health Introduction We are living in the world where differences in the income affect the health facilities to the individuals. This inconsistency is growing among those groups of society that are facing socioeconomic challenges. The major challenge is extraordinary differences of social variationin public health facilities. Such issues led to the health economics which further set out the tools of economics evaluation for the public health. It is common in the welfare governments to make economic analysis to assess the health care benefits by the monitoring measures. Generally, public health economic evaluation is a welfare analysis. Government usually takes decision in generous way and tries to spread over health facilities across all individuals of the society.The United Kingdom based organization ‘NICE’ support the technical evaluation method for the evaluation of cost threshold for the individuals, Edwards et al, 2003. NICE clinical guidelines are recommendations on the appropriate treatment and care of people with specific diseases and conditions within the NHS in England and Wales. They are based on the best available evidence and aim to improve the quality of healthcare by changing the process of healthcare and improving peoples chances of getting as well as possible. The main responsibility of NICE is to guidelines to institutions and government how to deal with particular health condition. It also provides information how the best health services can be provided to general public in best way. NICE deliberate whether treatment will be cost effective and benefits to patients. Such valuable guidelines helps to organizations related to medical sciences to treat the disease and health condition in appropriate manner. a. NICE however provides guidance for many factors among which some common ones are: I. Obesity in Adults and Children II. Cancer in Adults and Children. III. Donor Breast Milk Banks IV. Attention Deficit Hyperactivity Disorder V. Neonatal Jaundice. Obesity in Adults and Children Childhood obesity has both instant and long-term effects on health. Immediate health effects are like increasing risk factor for cardiovascular disease. This happened due to increase high cholesterol in the blood which may cause heart disease. In USA 70 % of obese young people has at least one risk factor for heart disease. It also causes diabetes. The obese children and older people are at greater risk for bone and joint problems. The long-term health effects are several types. The person may also involve in cancer, kidney, pancreas, and ovary problems. This can be prevented by adopting healthy lifestyle habits including eating and physical activities. b. Role of NICE in providing guidance NICE actively carries out measurements to cease obesity and its negative outcomes. In 2009,the Department of Health (DH) asked NICE to work on this factor. Later in November 2010, the work was put on hold.NICE has encouraged the involvement of local communities. NICE provided guidelines for the local executive directors of local health service, directors of public health, elected members (particularly in health cabinets) commissioners,policy makers and health communities. The guidance aims to produce operative and viable sources to overcome obesity among adults and children. The endorsements highlight planned management, involvement of local communities and business enterprises, communication, inspection and liability, cost effectiveness, etc. Moreover, several guidelines have also been published. Obesity control among pregnant women has been highlighted too which focuses on the women who are planning pregnancy or mothers who have had a baby for the last two years. It highlights the importance of healthy pregnant women. It recommends how to help all pregnant women eat healthily and keep materially energetic and lively. Furthermore, NICE enlists guidelines enveloping the importance of physical education among adults and children. Further guidelines include community engagement, maternal and child sustenance, etc. c. Role of other organizations National Health Service (NHS) is an important organization regarding health issues. Nhs has provided guidance regarding several aspects such as breast feed. These guidelines include significant issues such as, preparation of breast feed before the birth, things to do after the baby is born, how frequently should the baby be breastfeed, building up the milk supply, etc. NHS is also keen in promoting care plans for a healthier lifestyle. The care plan covers areas such as eating habits, medicines, exercisingregularity, emergency numbers such as who to communicate if you become very ill and you cannot reach your doctor, etc. The care plan is however given much importance as it reminds people about the necessities they need to practice for a healthier lifestyle .Moreover, The plan is looked over at fixed times. Care plan review can be done at least once a year. The person can ask for one if felt that the care plan isnt working. World Health Organization (WHO) is also an important figure among health care. Every year the organization practices World Health Day reminding people about the significance of health. Moreover, several occasions are held too for the discussion of health promotion topics. Numerous diseases have been pondered over such as Polio and Malaria. WHO emphasizes the local people to make available proper sanitation, availability of clean water pipes, improvement of nutrition, lifestyle, recreation and housing and other aspects of environmental hygiene. WHO works to reduce illness and mortality and improve health during key stages of life, which includes pregnancy, childbirth, the neonatal period, youthful and adolescence, and improve sexual and reproductive health for all individuals. It also tries to lessen risk issues for health conditions associated with use of alcohol and drugs and other harmful elements. Public Health Guidance Involved NICE has been keen in producing numerous guidelines. A systematic process is however involved. NICE have set up numerous National Collaborating Centers include royal medical colleges and qualified organizations which deduce the guidelines. The centers are the National Collaborating Centre for Women and Children´s Health  National Collaborating Centre for Cancer, the National Clinical Guidelines Centre for Acute and Chronic Conditions, A clinical guideline is set up by Guideline Development Group.. This group includes experienced workers who work together to evaluate the guideline topics. Stake holder organizations present reviews and their comments are put into account. National Collaboration Centre presents the final guideline which is submitted to the NICE. Communicable diseases have been put into consideration. Immunization is thoroughly discussed. A guideline was published in September 2009 concerning this. The guidance is for NHS and other accountable for the immunization of children under the age of 19. Another guideline published in March 2012 mentioned Tuberculosis.It is for providers of TB services and other legal and intended organizations that work for it. Different groups of people such as prisoners, weak migrants, homeless and needy, etc. are focused. Moreover, another guideline followed in February 2009 which discussed the issues based on the inadequate use of needle and syringes. This guidance make references on needle and syringe programs, together with those provided by pharmacies and drugs services for adults and young people .The major plan of needle and syringe programs is to lessen the spread of blood-borne viruses caused by sharing injecting equipment, such as HIV, hepatitis B and C. This will result into reduction in the occurrence of blood-borne viruses. Thus, helping our society. Whether the guidance is cost-effective or not? NICE, however intends to spend its money fairly due to finite resources. The budget is put into consideration before carrying out any work. NICE wishes to sponsor researches which have a good outcome. NICE intends to deduce the cost–effectiveness of probable expenditures under the NHS. How cost-effective are public health interventions? This is surely an important question which envelops the peoples’ mind. It is, undoubtedly put into consideration by NICE too. Researchers from the University of London and NICE pondered over a wide variety of public health interventions to decide whether they are cost-effective or not by carrying out and analysis. The guidance is surely considered to be pretty cost-effective. These guidelines create awareness among people. The guidelines provide further knowledge to people concerning health issues. People become more careful and prefer to overcome the health issues before the issue gets serious. In this way, the visits to the clinic are reduced effectively. Home medication is carried out which is surely cost-effective. d. Implication of guidance for public health NICE guidance and clinical guidelines are vital to a standards-based healthcare scheme.They are necessary in improving the lifestyles. The purpose of NICE is not just to achieve national targets but also to deliver high quality standards. Applicability of NICE guidance in the UK includes countries as follows: England Wales Scotland Northern Ireland Several elements are also highlighted which help in the implementation. These include strong hold up and clear management, support from multidisciplinary team, a methodical approach to fiscal planning, a process to assess uptake and feedback, etc. The most successful implementation models have strong multidisciplinary teams providing coverage .The team often have other functions within the organization such as medical authority. Frequent meetings by the team provide opportunity to discuss important factors which contribute to easy and efficient implementation. e. Growing social disparities in health area in the world, coupled with growing imbalances in income of the general masses, is the main emphasis on public as a key element of population health. The common analysis of public health by using rational and reliable measures of socioeconomic problems in US as well as in western countries, public health research and observationsare still exceptional. The principles regarding public health, social responsibility must be framed at the institutional and individual levels. Theperceptionsbconcern and guidelines for measuring different characteristics of socioeconomic position (e.g. income, poverty, deprivation, wealth, and education) need to be reviewed. Such data should be collected at the individual, domestic, and locality level, to characterize both childhood and adult socioeconomic position.The variations in economic resources in the society should also be considered.The data based on census are recommended for the analysis involving gender, race and social class. This research on socioeconomic measures is useful for the providing the steps toward social equity in health sector. In the society, the assessments of vulnerability associated with human-environment interactions are equally important. The vulnerability assessments could address precisefeatures like socioeconomic, biophysical, cultural and political for different regions of the world. There is an important question for specialists in the fields of public health law ‘why public health is owned by government’.Why some laws are necessary. There is need to develop a large scale public policy in public sector. Coggon, 2012claims that questions of public health ethics, including the fundamental question of when health is a matter of public rather than private concern, depend on the development of a “complete” political theory.It is common in all countries that public health problems and practice influence the political policies of the country as the public has direct concern with health issues. The health policy is usually the main political issues which contribute the success of any political government. The Coggon’s argument, including the terms “health,” “public health,” “public health ethics,” and “public health law,” could be review according to the country socioeconomic conditions and ultimately becomes political theory of the country. POLITICAL AND LEGAL PROBLEMS There could be many political difficulties if those who fund and manage the health services do not revisit health policies time to time.Sometime researchers are blocked by private sector that faced a major loss of income as health insurance companies would no longer reimburse them. In the developed societies, the doctors could face legal trial while operating the patient.For example, a current agreement is that hospitals treating a high volume of patients achieve better results than those treating a low volume. The policy implications for the health services areenormous. Patients and hospitals support the regional services. f.There are many health programs framed by many institutions as well as by different governments. Mexican health program achieves universal health coverage, enrolls 52.6 million people in less than a decade in spite of economic downturns and crisis, Mexico recently achieved a substantiallandmark. This program was started in 2004. The important features were that this program was launched in middle income country and transforms its health system and successfully achieve health coverage in one decade. The objective of this program was to ensure that poorest people must have access to the medical treatment and preventive health care such as vaccinations and diabetes screening. The government ensures the treatment of chronic disease close to the society. Due to this program health indicator in Mexico increased. The proposed public health care system is based on the reimbursement of the cost of treatment by health insurance. But it cannot be cost effective, however, it ensure the treatment of any chronic disease in any case. Different health policies have different advantages. The program like Seguro of Mexico, fully government funded could not sustain for long time. The health program based on health insurance policy could sustain, of course, it could be expensive for low income people. It is proposed that government should share some portion of public health insurance to ease the burden of common people. References National Institute for Health and Care Excellence (formerly National Institute for Health and Clinical Excellence): Guidance: London: National Institute for Health and Care Excellence (UK); 2003- Guide to Analyzing the Cost-Effectiveness of Community Public Health Prevention Approaches, March 2006. By WilmaTilson, M.P.H. Office of the Assistant Secretary for Planning and Evaluation U.S. Department of Health and Human Services. http://www.who.int/trade/glossary/story076/en/ What Makes Health Public? A Critical Evaluation of Moral, Legal, and Political Claims in Public Health (Cambridge Univ. Press, 2012) Why we need observational studies to evaluate the effectiveness of health care. Nick Black, professor of health services research, Accepted 7 March 1996. Recommendations for Reporting Cost-effectiveness Analyses Joanna E. Siegel, ScD; Milton C. Weinstein, PhD; Louise B. Russell, PhD; Marthe R. Gold, MD, MPH JAMA. 1996;276(16):1339-1341. doi:10.1001/jama.1996.03540160061034. Discounting in the Economic Evaluation of Health Care Interventions. By KRAHN, MURRAY MSC MD; GAFNI, AMIRAM PHD, Medical Care: May 1993 Mexico achieves universal health coverage, enrolls 52.6 million people in less than a decade,August 15, 2012 Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. Journal of the American Medical Association 2014;311(8):806-814. National Center for Health Statistics. Health, United States, 2011: With Special Features on Socioeconomic Status and Health. Hyattsville, MD; U.S. Department of Health and Human Services; 2012. National Institutes of Health, National Heart, Lung, and Blood Institute. Disease and Conditions Index: What Are Overweight and Obesity? Bethesda, MD: National Institutes of Health; 2010.  Krebs NF, Himes JH, Jacobson D, Nicklas TA, Guilday P, Styne D. Assessment of child and adolescent overweight and obesity. Pediatrics 2007;120:S193–S228. Read More