A primary challenge for publicly funded health care is the distribution of resources and the setting of priorities. As the impacts of the recent economic slump are increasingly felt throughout government departments, the rationing of health care within the National Health Service is likely to become a matter of controversy and conflict. The basis by which we ration health care will come under increasing scrutiny.
To celebrate the success of our students during this year’s graduation ceremonies we have prepared a series of special Birmingham briefs written by our postgraduate students. These showcase the hugely important role postgraduate students play in the outstanding research conducted at Birmingham.
A primary challenge for publicly funded health care is the distribution of resources and the setting of priorities. As the impacts of the recent economic slump are increasingly felt throughout government departments, the rationing of health care within the National Health Service is likely to become a matter of controversy and conflict. The basis by which we ration health care will come under increasing scrutiny.
In England the National Institute of Health and Clinical Excellence (NICE) provides guidance on the provision of care that, in turn, is adopted by regional decision makers. The basis of this guidance is economic modelling of the relative health gains and costs associated with interventions. The recent extension of NICE’s remit to incorporate a public health function has raised questions about whether the current decision making template, with its exclusive concern with health based outcomes, is always appropriate. For example, an intervention to reduce obesity in children through physical activity may lead to greater social acceptance by peers and enjoyment, as well as the well documented improvements in the cardiovascular health of the child. Research continuing at the University of Birmingham is exploring the implications of a move away from the purely health based measure, towards a measure which looks at what people are able to do with their lives.
The focus on what people are able to do with their lives (their capabilities) in decision making derives from Amartya Sen’s Nobel Prize winning work on functioning and capability. Sen’s work moves away from traditional welfare economics, with its focus on incomes and preference, and advocates the evaluation of programmes based upon individuals capabilities. Work at the University of Birmingham has developed an index of capabilities: the ICECAP-A measure. This incorporates five dimensions of wellbeing: Feeling settled and secure; Love, friendship and support; Being independent; Achievement and progress; and Enjoyment and pleasure.
The objective of this research is to explore the feasibility, acceptability and validity of using the ICECAP measure in the assessment of health and social care interventions. It is anticipated that NICE will reappraise their methods guidance for technology appraisal around the date of completion of this research. This research is attempting to ensure that an informed debate around the use of capabilities can occur during this appraisal.
Tom Keeley (MRC Clinical Trials Hub member)
Health Economics Unit
The University of Birmingham
