Editor—Societal values on health care in the United States are profoundly different from those of the United Kingdom. Likewise health economics has developed in quite different ways.1,2
Americans fiercely defend their right to choose their doctor, value competition as a stimulant to medical advance, and are not ready to extend healthcare coverage to all Americans. Health economists in the United States have not focused in the same way as UK health economists on cost effectiveness analysis, since in a market based system, less emphasis is placed on the value for money of health care, and more on meeting consumers' demands. They have focused instead on measuring costs and productivity,3 on forecasting spiralling Medicare costs, and on the costs of malpractice litigation.4
In the United States, most, but not all, health economists adhere to the arguments in favour of market competition, reflecting deeply held US societal values that, like washing machines, health care can be most efficiently produced and consumer choice maximised through competition. Health economists in the United Kingdom have striven to develop methods of economic evaluation as a means to support policy makers. These policy makers face prioritisation decisions about what a universal, tax funded healthcare system, free at the point of access, can and cannot afford to provide.
In not stating her wholly UK perspective, Coast fails to convey that the development of methods of economic evaluation by UK health economists does in fact reflect deep seated UK societal values and commitment to socialised medicine.5
Competing interests: None declared.
References
- 1.Phelps CE. Perspectives in health economics. Health Econ 1995;4: 335-53. [DOI] [PubMed] [Google Scholar]
- 2.Williams A. Priorities and research strategy in health economics for the 1990s. Health Econ 1993;2: 295-302. [DOI] [PubMed] [Google Scholar]
- 3.Fishman PA, Hornbrook MC, Meenan RT, Goodman MJ. Opportunities and challenges for measuring cost, quality, and clinical effectiveness in health care. Med Care Res Rev 2004;61(3 suppl): 124S-43S. [DOI] [PubMed] [Google Scholar]
- 4.Burke S, Kingson R, Reinhardt U. Social security and medicare: individual versus collective risk and responsibility. New York: Brookings Institution Press, 2000.
- 5.Coast J. Is economic evaluation in touch with society's health values? BMJ 2004;329: 233-6. (20 November.) [DOI] [PMC free article] [PubMed] [Google Scholar]