Abstract
(Englisch)
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I. Target
The main target of the EUROMET survey was to determine, to which extent decision makers in health care are influenced by the results of health economic study results. The survey was conducted in the following countries. Austria, Finland, France, Germany, Netherlands, Norway, Portugal, Spain Sweden, and the United Kingdom. It is worth noting that an 'Official requirement for use of economic evaluation studies' is not considered to be an important incentive to use study results in any of these countries.
2. Summary and Conclusion
When analysing and comparing the survey results one has to bear in mind that the survey has been carried out in different surroundings with different traditions of economic evaluation in health care. In particular, one has to consider that the responsibilities of decision makers interviewed as well as the representativeness of responses given and the response rates differ in the countries surveyed. Also decision makers in different countries have a different set of incentives and constraints. Therefore, a sound basis for the comparison of results as normally required in statistical analyses must come into question, although all countries (besides Norway) used a Standard questionnaire of eight questions, and semi-structured interviews and focus groups were also conducted in a standardized manner. Therefore, it would be inappropriate to make firm conclusions about the extent of use of health economic studies and what their potential role could be. What can be presented here are the trends for the influence of economic evaluation studies of health Services and to what extent decision makers are sensitive to results of health economic studies in the decision-making processes.
Although the decision makers interviewed act under a wide range of conditions, in different political and cultural systems which provide different frameworks for health policy it can be seen that their attitudes towards health economics are very similar. Despite the general positive attitude toward and interest in economic evaluation, knowledge about the formal methodology is limited mainly to what they perceive to be Cost-Benefit-Analysis. The moderate knowledge could be attributed to the low percentage of respondents who had undergone training in health economics. Only in Norway had 50 % of the decision makers taken part in health economic courses.
Since the knowledge of the techniques of economic evaluation is quite low, it is also to be expected that the results of economic evaluation are not widely used in decision making. This is confirmed by the results to the question of whether the respondents had ever used the results of economic evaluation to help to make a decision about the adoption, use or financing of a health intervention or service. A third of decision makers at most said that they considered the results of a health economic study when making a decision. The low percentage of those who undertook studies themselves indicates that the involvement of decision makers in health economic studies is quite low. It is worth noting that an integration of decision makers from the very beginning of an evaluation process has certainly a big impact on the practical relevance of health economic studies.
Although the present use of results from economic evaluations is limited, there is room for wider use, as reflected the responses to the question of whether economic/cost considerations should influence medical practice. The potential use is given a high valuation, particularly by Finnish decision makers, but the majority of German, Spanish, Portuguese and French respondents also take the view that cost considerations should influence clinical practice, al least to some extent. The results illustrate that among decision makers interviewed a positive attitude exists towards economic aspects in health policy decision making. In all countries surveyed, economic consideration in health policy decision-making is regarded äs important and the level of acceptance is high. In general, it can be stated that there is a willingness to allow for economic aspects when deciding about the provision of health care services. It is acknowledged that there is much more room and need for economic evaluations in health care decision-making and that economic consideration should affect clinical practice more than in the present situation. All the interviewed groups are aware oft the existence oft the efficiency criterion and think that once some obstacles are removed it will become an additional tool with which decisions can be made.
The institutional dimension which limits the use of health economic studies has been emphasized by the majority of decision makers interviewed. In addition to these structural barriers, factors which question the understanding and credibility of studies had been mentioned. The research demonstrates that in order to achieve a higher influence of health economic studies not only the quality and credibility of economic evaluations has to be improved, but also the political and institutional settings have to be focused on. Consequently, the legislation and organisation of the health care systems are mainly dealt with. It must be debated whether health care systems provide an optimal framework for the use of economic evaluation studies in making decisions about the provision of health care services.
Consistently, when analysing the factor, which might encourage the use of studies, more flexibility in health care budgets seems to be important to the decision makers. Moreover, factors which might improve the access to economic evaluation study results score highly. This suggests that more consideration should be given to the dissemination of study results. The majority of respondents feel that is important to explain the practical relevance of results. It seems to be that the transfer of studies' results to practical settings causes some difficulties.
In contrast, factors which might improve the methodological abilities are not given a high priority. Apparently, decision makers do not attribute the little use of studies to The lack of knowledge in economic evaluation techniques. In those countries where the question of standardization of methodology and development of guidelines have been raised these issues are thought to be of high priority.
The issues raised are not insuperable. However, the analysis of results obtained demonstrates that much remains to be done until economic evaluations are fully accepted and used in rational and explicit health care decision making. If health economics is increasingly sought to assist health policy decision-making the factors, which might reduce or improve their impact, have to be taken up and considered through increased collaboration between health economists and decision makers.
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