Even before COVID-19, OECD countries allocated an average of 7.9% of their GDP to public spending on health (6.1% in Spain) [see Government at a Glance report, OECD 2019]. After pensions and social benefits, health spending is the most important item of public spending in all countries. For responsibility, transparency and common sense, it is important to know and analyze what health resources are used for and evaluate the results obtained thanks to your investment.
The evaluation of health policies is defined as that activity that allows evaluating the performance of public action. It requires evidence regarding its design, implementation, costs and results. It must serve to determine the degree of achievement of the proposed objectives, improve the implementation of policies, contribute to their scientific basis and be accountable to the public. Its value in the public sphere lies in ensuring truthful and consistent information, guiding budget allocation, assessing the quality of spending and helping to define new priorities. At the same time, it responds to citizen demands for greater transparency in public action and accountability. It is known that improving the quality and transparency of the health government has an impact on the health of the population through policies, organizational management and clinical practice (see this article by García-Altés and Argimon ).
The economic evaluation is relevant at the three levels of organization of the health system. Let us see some recent cases that have occurred in the Catalan sphere. At a macro level, referring to health policy allows knowing the social return of the resources allocated to it: for example, the analysis of the resources allocated to massive screening for COVID-19 in asymptomatic citizens. At the intermediate level, that of health management, the evaluation helps to know the impacts of the organizational changes of the institutions, allowing detection of the best practices and thus extending them to the rest of the system. We know that the comparison between centres and the feedback of the results in a transparent way to the professionals and the public contribute directly to an improvement in the results. For example, the analysis of the paediatric home care program of the Hospital Sant Joan de Déu. Finally, at the micro-level, in the field of clinical management, economic evaluation allows knowing the most efficient therapeutic alternatives, making it easier to relate the cost to the clinical results obtained. See, for example, this article that analyses the reduction of pharmaceutical spending through the adequacy of medications in multi-medicated elderly. In this context, it is worth highlighting the highly praiseworthy work of the clinical practice adaptation commissions, which are being extended to various health centres.
In the current economic situation of scarce resources and underfunding, attention should be turned more than ever to economic evaluation as a tool to inform resource allocation. It is a tool that is as useful as it is necessary to provide information and thus help clinicians and managers to improve decision-making, measuring and comparing the allocation of resources from one intervention to another, as well as assessing its impact, scalability and sustainability, always with a holistic vision, considering the effects on all possible actors and accompanying it with complementary perspectives.
As a “veni, vidi, vici”: let's evaluate, learn and improve. Citizen health will benefit by ensuring that economic evaluation is incorporated into the decision-making process, variability in clinical practice is reduced, and evidence-based policies are implemented. The social return is clear, so we will all win if we invest in the economic evaluation of health policies.
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