Costing health: the first history of UK health economics

Hospital corridor

Health services globally now rely on health economics – to allocate resources, support decisions on new technology, and even how to manage individual patient experiences. But the discipline is surprisingly new – it’s only been in existence for around sixty years.

A select group of pioneer economists came together for a ‘witness seminar’ organised by the University of Liverpool on 27 October 2017 to discuss what motivated the origins of health economics, especially in the UK, and why the University of York and its Centre for Health Economics (CHE) has proved so influential.

The seminar was part of the Wellcome-funded project: The Governance of Health – Medical, Economic and Managerial Expertise in Britain since 1948. Key witnesses included Professors Tony Culyer, Anne Ludbrook, Mike Drummond and Ron Akehurst who spoke about the vital role played by English and Scottish government departments in facilitating the growth of health economics, by research funding, especially academic units. Alan Maynard, who was unable to be there in person, contributed by Twitter. Government economists Keith Derbyshire and Brian Ferguson provided a valuable perspective on how policies have increasingly relied on academic expertise. This was supported by written submissions from economists Jeremy Hurst, David Pole and Clive Smee who all held senior civil service positions from the 1970s. Professors Ron Akehurst and Mike Drummond reflected on how training schemes for health economists became a growth industry from the 1980s, and supported new posts in the pharmaceutical industry and the rise of health economics consultancy.

Project director Sally Sheard said:”‘We are delighted to have the support of so many health economists in this research. We are producing first detailed history of the development of health economics in the UK, and this interactive event was vital to capturing the competing views on where these ideas have come from and how they have shaped the NHS.”

Key lessons that emerged from this event included the impact of economic crises in creating demand for new types of health policy expertise, tools and systems, for example the development of the Quality-Adjusted Life-Years index (QALY) in the 1980s and the NHS Internal Market which brought in competition and GP fundholding after 1991. Tony Culyer highlighted the creation of the National Institute for Health and Care Excellence (NICE) in 1999 as ‘the single most important event for health economics in the United Kingdom since everything began’.

The witness seminar transcript, as well as transcripts of other seminars organised by the project, is available here and a blog post discussing the event was written for the Academic Health Economist.

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