When a disease or health problem hits the headlines, claiming a massive casualty count or economic cost, my first thoughts are often cynical.
Who is driving this and why?
When I investigate further, my cynicism is often reinforced. Often it’s a group lobbying for a particular treatment to be funded. Often the campaign is supported, whether directly or indirectly, by companies with an interest in promoting awareness and treatment of a particular disease.
Of course, there are also often well-meaning people involved who are sincerely motivated to improve the lot of their particular constituency.
But, as I argue in today’s Crikey bulletin, these disease wars – my casualty count is bigger than yours – are unhealthy because they encourage the sort of narrow thinking that is not necessarily conducive to good policy or practice. Don’t you think?
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In health economics, the companion methodological fight to the disease wars has been the ‘Cost of Illness’ (COI) approach versus ‘Cost Effectiveness’. The disease wars are based firmly in the COI camp. Colleagues, I have to tell you that the methodological war ended years ago. In health, cost of illness was vanquished – sent off to pasture. Instead we saw the rise of cost effectiveness analysis in Australia, the UK and many Western countries as the preferred approach to guiding public health care resource allocation. It is no accident that the PBAC or MSAC did not foramlly adopt cost of illness methods to decide what drugs or MBS items would get funded. COI is unable to answer even the most basic questions of what to fund and how much to fund.
So why do we pay any attention to these dollar-based disease wars? Could it be that we all respond to a good scare? Has anybody attempted to add up the total cost of each body organ/system covered in the Access Economics disease reports? That’s bound to provide a good scare.
Let’s stop paying attention to this dollar nonsense. It’s antithetical to good health policy and grossly inequitable.