Introduction to the Module

The module aims to explore issues surrounding the  health care economy , particularly in the UK. The nature of the NHS and private sector provision will be examined and linkages sought between resource inputs and health outcomes for both individual treatments and the system as a whole. The meaning of the concepts of effectiveness, benefit, cost and equity will be examined, and an attempt made to show how economists have used these in attempting to estimate the economic efficiency of treatments and programmes so that health care resources can be used more effectively. The module will examine the difficulties, limitations and usefulness of economists approaches to evaluating efficiency and equity.

No prior knowledge of economics is expected. The module will be presented via a series of lectures and seminars. Lectures will set the context, to be followed up by independent study and student group activity on particular questions or case studies. The course will include the topics listed on the next page. The full titles of the references are given later in this module handbook. Additional references will be given in lectures and tutorials where required.

For many students, economics represents a new and challenging way of thinking about our health care system and its problems. The lecture programme can provide only a skeleton of the key ideas and approaches used. To help your understanding and to gain most value from the module you will need to use not only the main course texts but also make extensive use of the additional references (given below) and read quality newspapers and weekly magazines (such as the Health Service Journal). You will also need to use the electronic resources identified at the end of this handbook including the module Web site in X-stream.

By the end of the module you should be able to discuss the use and abuse of economic analysis in health care and environmental health, and to comment in a constructively critical way on evaluations in your own area of interest in health or social care. In particular you should be able to:

” Locate, utilise and assess the value of measures of health care inputs, processes and outputs.
” Explain and evaluate recent developments in the structure of the NHS and the relationships between its component parts.
” Appreciate the key issues arising in the economic costing of services.
” Identify the major approaches to measuring outcomes in health care and clarify the role and limitations of each.
” Critically evaluate attempts to assess the efficiency and equity of services.


The module outcomes will be assessed formally by means of a report of up to 1500 words on the economic evaluation of a particular service or intervention

Report on the economic evaluation of an intervention.

You should EITHER i) identify a published report of an economic evaluation of a health programme or intervention of your choice and clarify and comment on what is being evaluated, how the costs and outcomes have been measured and the quality and value of the study for a health care decision maker.
OR ii) if you are interested in a programme which has not yet been evaluated, then clarify the main aims, and probable cost and outcomes of the programme, how they might ideally be measured, and indicate any difficulties and problems you might expect evaluators to face.

Your report should clarify the intervention or programme of interest (be specific), draw on the evidence available with respect to costs and effectiveness to make recommendations in relation to the particular intervention or service (eg midwife versus medical consultant led maternity wards; a particular approach to helping people to give up smoking, such as nicotine patches; whether to invest in treated mosquito netting; upgraded building regs to reduce noise penetration; new training requirements for catering staff, etc). You will therefore need to briefly outline the issue, describe and justify how you located relevant information (eg a published study), describe and evaluate the results, and make recommendations for practice taking into account the interests of the different stakeholders involved. You will need to show awareness of the extent to which your recommendations should be tentative or whether they have a very firm basis and can be put forward with a high degree of confidence. This will need slightly amended where option ii) is chosen  speak to tutor.

All reports should have a brief appendix (outside word limits) indicating the search strategy followed. This may include the question you were trying to answer, the databases searched (with reasons), the search terms used (with reasons) and reflections on the strengths and weaknesses of your search. This is an important exercise even if no directly relevant sources are located.

All sources (including sources relating to the methods of evaluation) need to be carefully cited in the text and referenced in the bibliography (again outside of word limits) using Harvard style.

Assessment criteria:

75% of marks for report will be available for the quality of the review or analysis, including:
” Clarity of question being addressed
” Understanding of nature, aims, methods and limitations of form of economic evaluation used
” Clarity and appropriateness of presentation of key points of evidence
” Appropriate guidance to reader on strength or weakness of conclusions or recommendations, and possible implications of adopting recommendations.

25% of marks for report will be available for the information and presentation skills deployed, including:
” evidence of a considered, systematic approach to locating evidence showing knowledge and understanding of appropriate information databases and other sources.
” ability to utilise sources appropriately depending on their nature (eg peer reviewed report of trial result in journal; abstract in bibliographic database; report of systematic review; Web page of unknown origin or quality; etc)
” meticulous adherence to conventions for referencing sources, including those accessed via the Web, as given in  Quote, Unquote
” presentation (eg word processed, spell and grammar checked, neat tables or diagrams used where appropriate, etc.)

The report should:

” contain up to 1500 words
” take care to demonstrate achievement of the criteria specified above
” aim to demonstrate a critical understanding of the evaluation approaches and issues discussed in the module
” be neatly presented and word processed
” demonstrate the level of information skills expected at level 3. This will include clear references to supporting work, whether used directly or indirectly (use Harvard system) and being clear about the nature and status of the sources referenced
1. Introduction to module and concepts in health economics

Mooney (2003) chs 1&2
Morris (1998)
Wonderling, Gruen and Black (2005) Section 1
Cohen D (2001)
As background, see also Belsey and Snell, What is Evidence-Based Medicine? Available at ebm.pdf
You should also read and attempt the exercises in The Economics of Health Care, a web resource produced by the Office of Health Economics, [available at CBA  the three main approaches.

Wonderling, Gruen and Black (2005) Section 5
Mooney (2003) chs 4&5
Morris, S (1998) ch 9&10-12
Jefferson et al (2002)
Drummond et al (2005)
And for weeks 3-5 consult the assoc