Health Economics | Webinar | Coronavirus

Health Economics & Policy Research

In 1974, a classic book, Who Shall Live?, was published. Written by Victor Fuchs, a Stanford University professor, it marked the birth of health economics. It arrived at a moment when the post-war era of continued growth in public services was becoming unsustainable – just as treatment options for patients were expanding and the public expected more and more from their health services.

Governments and their healthcare systems were trying to respond – and Who Shall Live? gave them a framework. A famous example often quoted in my student days at the University of York in the early 1980s was renal dialysis. Though not widely known by the general public, many publicly funded healthcare systems rationed this treatment. Older patients sometimes missed out, reducing their life expectancy by a few years.

Thankfully, such drastic rationing has become rare – cropping up mainly with certain expensive late-stage cancer drugs. Yet as we address the COVID-19 crisis, this is changing.

Health economists think in terms of benefits from a course of action: lives saved, years of life saved and something we call quality-adjusted life years saved or QALYs. Yet in the present crisis, the data to make such calculations is likely to come too late. In a situation with (perceived) high risks and an immediate impact, there is a “rule of rescue” that says you decide now, still using rational reasoning, and worry about the QALYs later. So here’s my perspective as a health economist about the best way forward.