Economic Evaluation In Public Health - Essay Example

 Table of Contents 1. INTRODUCTION 1 2. HEALTH ECONOMIC DEFINATION 1 3. NICE BACKGROUND AND ROLE 1 4. HOW NICE GUIDANCE ENCOMPASSES THE FORMULATION OF GUIDELINES WITHIN DIFFERENT AREAS 2 5. MENTION THE PREFERRED OUTCOME USE BY NICE WHEN APPRAISING TREATMENT IN THE QUALITY ADJUSTED LIFE YEAR (QALY). 3 6. NAME FIVE AREAS OF PUBLIC HEALTH GUIDANCE STATING THE TOPIC, DOCUMENT REFERENCE NUMBER AND THE DATE ISSUED. 3 7. TALK BRIEFLY ON EACH ONE 4 8. DISCUSS ONE AT LENGHT STATING THE ROLE OF NICE IN PRODUCING THE GUIDANCE, OTHER ORGANISATIONS INVOLVED AND THEIR ROLE 4 Obesity in Adults and Children 4 a. Role of NICE in providing guidance 5 b. Role of other organizations 5 9. DISCUSS CENTRE FOR PUBLIC HEALTH EXCELLENCY, PATIENT AND PUBLIC INVOLVEMENT PROGRAMME 6 10. EVIDENCE PROVIDER SUCH AS THE CPHE AND PHIAC IN ASSESSING AND REVIEWING EVIDENCE 7 11. PUBLIC HEALTH GUIDANCE DEVELOPMENT PROCESS 7 12. EVALUATION OF SOCIAL, POLITICAL, ECONOMIC AND ENVIRONMENTAL CONTEXTS FACILITATING SOCIAL AND EMOTIONAL WELLBEING. 8 a. Social contexts 8 b. Political and legal problems 8 13. DISCUSS COST EFFECTIVENESS OF GUIDANCE 9 14. IMPLICATION OF GUIDANCE FOR PUBLIC HEALTH. 9 List of important Organizations 10 REFERENCES 11 1. 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 variation in 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 (Nice International, 2014). 2. HEALTH ECONOMIC DEFINATION Health Economics is a branch of study that supports the methodical and accurate evaluation of the issues that cause hindrance towards promoting health. By applying financial theories of consumer, producer and communal pick, health economics intends to be aware of the behavior of individuals, health care providers, private and public associations and governments. An adequate study regarding economic evaluation leads to assessment of new technology, anti-trust policy, strategic behavior, optimal and private investment, etc. This eventually leads to positive results improving lifestyles of many individuals maintaining a healthier society. Health economics can be used directly to inform the government of the necessity actions that need to be put in action. These include actions with concern to national health packages and guidelines. 3. NICE BACKGROUND AND ROLE NICE (National Institute for Clinical Excellence) was set up in 1999. Following the Health and Social Care Act 2012, NICE was renamed the National Institute for Health and Care Excellence on 1 April 2013 highlighting its new duties for social care, and switched from a special health authority to a non-departmental public body. Government usually takes decision in generous way and tries to spread over health facilities across all individuals of the society. In corporation with NHS in England and Whales, NICE had been keen in producing effective guidelines concerning clinical equipment. Appropriate equipment is preferred when it comes down to specific diseases and conditions. The guidelines are produced with effective evidence. In this way, a positive outcome is guaranteed. 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. 4. HOW NICE GUIDANCE ENCOMPASSES THE FORMULATION OF GUIDELINES WITHIN DIFFERENT AREAS NICE also provide some basic measures to be taken to improve the institution concerning diagnosis and treatment of the patients and establish a baseline with the intention of assure others that such guidelines are necessary to improve the health care. The first step is the collection of data of all severs sepsis patients who are in intensive care. Seek the improvement in emergency department and intensive care unit (ICU) staff and doctors, nursing staff and medical technician. Introduce Surviving Sepsis Campaign (SSC) protocol which comprises of all features and take feedback from all stakeholders to upgrade the SSC protocol. Invite suggestions and comments regularly. Tolerate failure but remediate error in the system and weaknesses every month. This data base can create graphs and reveal the areas where improvement is vital. Database also identifies the causes of failure. To get the better result from a team that must be interdisciplinary and must include physician, staff nurses laboratory technician and supervisor etc. The setting of aim like improving the patient care is the main step for the success of institution. (Medscape.com, 2014) 5. MENTION THE PREFERRED OUTCOME USE BY NICE WHEN APPRAISING TREATMENT IN THE QUALITY ADJUSTED LIFE YEAR (QALY). The quality adjustment life year (QALY) covers both quantity and quality of life made by healthcare interventions. It is an arithmetic product of life expectancy and quality of remaining life years. 1 stand for perfect life and 0 for death, however some countries even have negative score i.e. less than 0. QALY is used to assess the health related benefits including cost. It provides good comparisons between interventions and primacies. The outcomes from treatment and other health care activities have two basic modules i.e. quality and quantity of life. NICE has defined QALY as a degree of length of life. QALY can also be used to assess the economic perception. For chronical diseases, QALY will be difficult to accommodate as the quality of life is considered a major issue. Similarly, QALY cannot quantify preventive measures on health because mainly health depends on age and life environment. The comparison between athlete and common person in terms of health condition is very difficult. (Medicine.ox.ac.uk, 2014) 6. NAME FIVE AREAS OF PUBLIC HEALTH GUIDANCE STATING THE TOPIC, DOCUMENT REFERENCE NUMBER AND THE DATE ISSUED. 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. 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. A guideline produced by NICE regarding Cancer was published in August 2005.The guideline covers all the basic needs of cancer patients and necessary steps for their early recovery. In November 2005 a guideline was published highlight obesity. It marked several issues concerning patients with obesity. Another guideline published in March 2012 mentioned Tuberculosis. A guideline was published in September 2009 concerning Immunizations. In August 2002 a guidelines put women into spotlight by discussing the steps needed for healthier breasts. (Nice.org.uk, 2008) 7. TALK BRIEFLY ON EACH ONE Guideline concerning Tuberculosis was for the 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, the guideline for immunization remains very effected. The guidance is for NHS and other accountable for the immunization of children under the age of 19. Concerning this important issue of women breasts certain recommendation were made these included the need for multidiscipline teams, the idea of women being treated promptly, consistent services, etc. This guidance regarding obesity focuses on the prevention of overweight and obesity. The recommendations may also assist people who are already overweight or to stop them from putting on more weight. It does not include clinical management for people who are already overweight. (Nice.org.uk, 2002) 8. DISCUSS ONE AT LENGHT STATING THE ROLE OF NICE IN PRODUCING THE GUIDANCE, OTHER ORGANISATIONS INVOLVED AND THEIR ROLE 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 (NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE, 2006). 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 (WEINSTEIN, et al., 2001). a. 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. 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 (JOHANNESSON, 1996). Furthermore, NICE enlists guidelines enveloping the importance of physical education among adults and children. Further guidelines include community engagement, maternal and child sustenance, etc. b. 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 (POWELL, 1997). 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, exercising regularity, 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 (EDGE & GROVES, 2006). Moreover, the plan is looked over at fixed times. World Health Organization (WHO) is also an important figure among health care (Tessa, 2003). 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. W.H.O 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 (WORLD HEALTH ORGANIZATION, 2010). 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 (STROUP & TEUTSCH, 1998). It also tries to lessen risk issues for health conditions associated with use of alcohol and drugs and other harmful elements. 9. DISCUSS CENTRE FOR PUBLIC HEALTH EXCELLENCY, PATIENT AND PUBLIC INVOLVEMENT PROGRAMME There are many health programs framed by many institutions as well as by different governments. Mexico has been successful in doing effective work in health economics. A program initiated in 2004 had pondered over many issues which cause hindrance towards a healthy lifestyle. It achieves universal health coverage enveloping about 52.6 million people within half a decade. Even with unstable economy, Mexico never compromised on the health of its citizens. 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 (COGGON, 2012). 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 Saguaro 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 (Black, 2013). 10. EVIDENCE PROVIDER SUCH AS THE CPHE AND PHIAC IN ASSESSING AND REVIEWING EVIDENCE PHIAC mean private health insurance administration council. It is developed by Australian government. The significance of this insurance system is that it provides the comprehensive range of public and private health services. This is a fund providing mechanism in and out the hospital. It also cover wide range of health services and Australian can choose any kind of health services. CPHE is center for health education which is located at Stony Brook University New York, USA. It is a training institution which provides training to that health worker who is engaged with people living with HIV patients. (School of Health Technology & Management, 2014) 11. PUBLIC HEALTH GUIDANCE DEVELOPMENT PROCESS 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 (CATTERALL, 1985). 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. 12. EVALUATION OF SOCIAL, POLITICAL, ECONOMIC AND ENVIRONMENTAL CONTEXTS FACILITATING SOCIAL AND EMOTIONAL WELLBEING. a. Social contexts 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 observations are still exceptional. The perceptions concern and guidelines for measuring different characteristics of socioeconomic position (e.g. income, poverty, deprivation, wealth, and education) need to be reviewed. Guidelines should be made effectively enveloping not only adults but children too. The data collected for further processing needs to cover every factor such as gender, race and social class. Minute variations need to put into consideration too. This however, results into effective guidelines. In this way social equity is observed in the field of heath economics. (Nice.org.uk, 2014). 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 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. b. 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 are enormous. Patients and hospitals support the regional services. 13. DISCUSS COST EFFECTIVENESS OF GUIDANCE 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 (KRAHN & GAFNI, 1992). 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 (Siegel, 1996). NICE provides method and way who to involve community in different health program. NICE used two terms in guideline like community engagement and community developments. Both are different and it is not possible to make same recommendation. The community engagement means that community involve in decision making. These decisions could be for the planning and management to improve the health services. There are many ways to involve community in decision making. It can be panel or people forum etc. (Nice.org.uk, 2014) 14. 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 (DICLEMENTE, et al., 2002). List of important Organizations • The Patient and Public Involvement Program (PPIP) at NICE • Guideline Review Panels • Guideline Development Groups (GDGs) • The National Collaborating Centers (NCCs) • Experts reviewer REFERENCES Black, N., 2013. Patient reported outcome measures could help transform healthcare. BMJ, p. 346. CATTERALL, J. S., 1985. Economic evaluation of public programs. San Francisco: Jossey-Bass. COGGON, J., 2012. What makes health public?: A critical evaluation of moral, legal, and political claims in public health. Cambridge, UK: Cambridge University Press. DICLEMENTE, R. J., CROSBY, R. A. & KEGLER, M. C., 2002. Emerging theories in health promotion practice and research strategies for improving public health. San Francisco: Jossey-Bass. JOHANNESSON, M., 1996. Theory and methods of economic evaluation of health care. Dordrecht: Kluwer. Medicine.ox.ac.uk, (2014). [online] Available at: http://www.medicine.ox.ac.uk/bandolier/painres/download/whatis/QALY [Accessed 26 Jul. 2014]. Medscape.com, (2014). NICE Medical Technology Guidance: Devices and Diagnostics. [online] Available at: http://www.medscape.com/viewarticle/751642 [Accessed 26 Jul. 2014]. Nice.org.uk, (2008). Community engagement | 1-Public-health-need-and-practice | Guidance and guidelines | NICE. [online] Available at: http://www.nice.org.uk/guidance/ph9/chapter/1-Public-health-need-and-practice [Accessed 26 Jul. 2014]. Nice.org.uk, (2014). [online] Available at: http://www.nice.org.uk/guidance/cg177/resources/osteoarthritis-update-stakeholder-lists-and-how-to-register2 [Accessed 26 Jul. 2014]. Nice.org.uk, (2014). NICE and social care | NICE communities | About | NICE. [online] Available at: https://www.nice.org.uk/About/NICE-Communities/Social-care [Accessed 26 Jul. 2014]. POWELL, M. A., 1997. Evaluating the National Health Service. Buckingham: Open University Press. School of Health Technology & Management, (2014). The Center for Public Health Education. [online] Available at: http://healthtechnology.stonybrookmedicine.edu/cphe [Accessed 26 Jul. 2014]. Siegel, J., 1996. Recommendations for Reporting Cost-effectiveness Analyses. JAMA: The Journal of the American Medical Association, 276(16), p. 1339. STROUP, D. F. & TEUTSCH, S. M., 1998. Statistics in public health: quantitative approaches to public health problems. New York: Oxford University Press. WEINSTEIN, M. C. et al., 2001. Modeling for Health Care and Other Policy Decisions: Uses, Roles, and Validity. Value in Health. Value Health, 4(5), pp. 348-361. WORLD HEALTH ORGANIZATION, 2010. Gender, women and primary health care renewal a discussion paper. Geneva: World Health Organization. Read More