There is a need for more and better information for private and public decisions about health technology. The development of health technology assessment (HTA) and economic evaluation are responses to this. Most European countries have established institutions to meet this need, but with few exceptions their impact on the allocation of resources has been limited. One of the reasons for this is that the economic aspects have been neglected in the studies that have been conducted. Germany is a good example of this. Health policy, when it comes to the economic aspects, has since decades been dominated by cost-containment acts with limited, and sometimes dysfunctional, effect on resource allocation. The German agency for HTA at DIMDI (http://www. dimdi.de), established in 2000, has produced many reports but with limited policy impact. The creation of the Institute for Quality and Efficiency in Health Care (IQWiG; http://www.iqwig.de) in 2004 was timely and welcome for several reasons. First because it was part of a new legislation aimed at improving the efficiency in the health care system. The purpose of the creation of IQWiG was to provide information for decisions about what should be funded within the statutory health insurance system, covering 90 per cent of the German population. Second, IQWiG was created as an independent body, which made it possible to give unbiased advice to the decision makers. Third, the mandate covered all health technologies, not only drugs. However, for some reason it was decided in the law that drugs should be assessed for benefits only and not cost-benefit. The drawbacks of this exception became obvious with the publication of the first methods paper (1), and the law was readily changed. The revised legislation, the German health care reform effective, 1 April 2007, also stated that the methods for cost-benefit analysis (‘‘kosten–nutzen analyse’’) should be based on ‘‘international standards’’. For the revision of the methods paper IQWiG commissioned an international group of experts, under leadership of a consultant from the US. While this was a rather surprising step, taking into account the number of qualified health economists that can be found in Germany, you would at least expect that the resulting publication would reflect the international standard in the field. The publication of the new guidelines is therefore a great disappointment (2). Not only because the document fails to give any guidance for the use of economic evaluation to support health policy decisions in Germany, but also because it pictures health economics, and economic evaluation in particular, as a subject totally void of theory and method. It is initially stated that there is no health care budget in Germany. That may be correct or incorrect dependent on the perspective, but it is simply irrelevant for the role of economic evaluation for health policy. The important introductory statement is that resources for health technologies are scarce in Germany as in all other countries, regardless of how the health care system is organized and financed. What is important in the German situation, similar to other countries with health insurance systems, is that it is not any more possible to increase contributions from employers, and that an increasing part of health care financing comes from general taxation. The methods paper thus fails to educate the payers, providers and patients about the choices they face and the potential contribution of health economics to achieve value for money. B. Jonsson (&) Stockholm School of Economics, Stockholm, Sweden e-mail: bengt.jonsson@hhs.se
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Jun 24, 2010
Marc Michelsen + 1
Open Access