https://orcid.org/0000-0002-8370-9562
1. Introduction
Health economics is a field within the realm of economics that focuses on aspects concerning efficiency, effectiveness, value, and behaviour in relation to the production and consumption of health and healthcare. It plays a role in determining how to enhance health outcomes and lifestyle choices through interactions between individuals, healthcare providers, and clinical settings. This discipline encompasses the study of how healthcare systems function as well as the impact of behaviours like smoking, diabetes, and obesity on healthCitation1. The scope of health economics can be categorized into eight topics: factors influencing health beyond healthcare itself; defining and valuing health; understanding the demand for and supply of healthcare services; conducting economic evaluations at the treatment level; achieving market equilibrium for optimal outcomes; evaluating healthcare systems at a broader level; as well as planning, budgeting, and monitoring mechanismsCitation1.
Globally, healthcare expenditure has long been a significant component of national economies. In the United States, for example, health spending as a share of GDP surged from 5.0% in 1960 to 18.3% by 2021Citation2. In Europe, the increase in healthcare expenditure from around 4% of GDP in the 1950s to approximately 10% by 2017Citation3 significantly reflects the growing societal emphasis on health and wellbeing. These trends highlight the rising importance of healthcare compared to other goods and services, indicating a shift in societal priorities and values.
Current health economic research is multifaceted, ranging from integrating technology and innovation in healthcare, such as employing machine learning for patient care optimizationCitation4, to exploring the economics of health inequalities, including the impact of socio-economic factors on health outcomes and access to care. Particularly, cost-effectiveness analyses have garnered special interest, focusing on ensuring optimal resource allocation for the maximal health benefitCitation1.
Despite the rich body of existing research, there remain significant gaps in our understanding. Particularly, the real-world application of health economic theories often encounters unforeseen challenges. This editorial aims to tackle these challenges encountered in health economics research by drawing insights from real-life examples. It seeks to address the difficulties in applying theoretical frameworks to practical situations, assess the effectiveness of current methodologies, and explore potential future research avenues.
2. Discussion
Health economics research encompasses various interconnected areas, each presenting unique challenges. One key area is the analysis of healthcare financing and policy, which involves understanding the complexities of funding and policy decisions in healthcare systemsCitation5,Citation6. This analysis is particularly challenging due to the intricate task of efficiently allocating limited resources and aid. Efficient resource allocation is critical in healthcare financing, but it also poses significant challenges for research. It requires detailed examination of how funding decisions impact healthcare outcomes and the sustainability of healthcare systems. Researchers must navigate complex data and varying contexts to assess the effectiveness of different financing strategies. Additionally, the field also covers the assessment of health technology and economic evaluation, focusing on the cost-effectiveness and impact of healthcare technologies; the exploration of health systems and services, which examines organizational structures and performance measures; and the study of health behaviour and lifestyle economics, analysing the economic impacts of lifestyle choices and health-related behaviours.
Additionally, the field addresses the economics of global health and infectious diseases, which explores economic factors in global health challenges; public health economics, evaluating the economics of public health programs; and the examination of health inequalities and social determinants of health, which looks at economic aspects of disparities in health. Furthermore, the research into healthcare innovation and technology economics investigates the economic implications of new healthcare innovations. Each of these areas, while unique in their challenges, collectively contribute to understanding the complex and multidimensional nature of health economics.
2.1. Challenges faced during the analysis of healthcare financing and policy
The analysis of healthcare funding and policy highlights challenges, which are made more intricate by the diverse nature of health systems worldwide. This complexity stems from factors beyond income levels. It includes a range of funding sources, different types of payers, and the involvement of entities like pharmaceutical benefits managers who play roles. Additionally, there are mechanisms for reimbursing healthcare services. The United States serves as an example of this landscape with its payer system and complicated reimbursement schemes involving rebates and intermediaries. Conducting research and analysis in this field faces obstacles due to diversities not only in high-income countries like the U.S. but also across low and middle-income countries (LMICs).
The World Health Organization (WHO) emphasizes the role that health financing plays in achieving Universal Health Coverage (UHC). However, it recognizes that reforms need to be tailored according to each country’s context, highlighting the absence of a one-size-fits-all solution. The WHO’s approach focuses on generating revenue, pooling funds together, and strategically procuring services. Addressing fragmentation and promoting procurement is essential when dealing with the complexity and diversity found within health financing systems. This further emphasizes the challenges associated with conducting analyses and formulating UHC policiesCitation7.
In addition to the complexities of the system, one crucial aspect of researching health policy and financing reform is effectively involving stakeholders. It is important to understand and incorporate their participation during the design, data collection, and dissemination phases. However, ensuring that stakeholder engagement is meaningful remains a challengeCitation8.
A major obstacle lies in the limited use of policy theories and conceptual frameworks in health policy and systems research (HPSR) in LMICs. While theories on policy processes provide insights into stakeholder engagement, decision-making dynamics, and the socio-political context surrounding health policies, their application in health economics is not fully utilized. Systematic reviews highlight this underutilization when it comes to explaining and describing health policy phenomenaCitation9.
In the field of health economics, the challenge lies in the fact that health policy theories provide insights into the nature of policymaking. These theories offer perspectives on stakeholder engagement, decision-making processes, and the socio-political context within which health policies operate. For example, Kingdon’s Multiple Streams Framework explains how problems, policies, and politics interact to create opportunities for policy changeCitation10. Understanding this interplay is crucial for health economists as it informs the context within which economic evaluations and decisions are made.
The gap between health policy theories and their practical application in health economics is particularly troublesome in LMICs, where complex socio-economic dynamics need to be considered when formulating healthcare policies. The limited utilization of these theories in the field of health economics may result in analyses that do not consider the aspects of implementing policies and governanceCitation11. This lack of connection can lead to policy suggestions that are financially sensible but politically unrealistic or socially unsuitable for the intended population.
A major challenge in the field of health economics research revolves around funding sources, which greatly impact the research agenda and priorities. Funding bodies often dictate these priorities, taking into account factors such as social and economic considerations. Another significant concern is the issue of industry influence in Health Technology Assessment (HTA). Industry capture refers to a situation where the industry has an influence on HTA processes and outcomes, potentially leading to evaluations that favour the interests of the industry. Consequently, funding may continue to support interventions that are not cost-effective or beneficial for patients. Furthermore, criticisms have been raised regarding both health economics and HTA for their limited focus on de-implementation research. De-implementation research investigates ways to reduce or halt ineffective, overused, or low-value healthcare services. Such research is essential for optimizing resource allocation and improving outcomes by eliminating practices that do not offer valueCitation12. Additionally, there is a pressing need for investigation into phasing out low-value care within healthcare systems. This involves identifying and discontinuing interventions and technologies that are not cost-effective or could potentially harm patients. It is essential to have strategies in place for resource allocation in healthcare systems to ensure that patients receive high-quality care.
Lastly, Ethical Considerations are paramount. Balancing privacy concerns with research needs, especially when accessing and utilizing sensitive healthcare data, requires adherence to strict ethical principles and consideration for patient confidentialityCitation13–15. Equity and justice concerns are also crucial, particularly in analysing the implications of healthcare financing and policy for vulnerable populations and ensuring equitable access to care. Additionally, researchers must remain vigilant against potential biases in data collection, analysis, and interpretation that could skew policy recommendations.
2.2. Challenges in health technology and economic evaluation
Assessing health technology and conducting evaluations in the field of health economics for medical devices presents unique challenges. Unlike pharmaceuticals, medical devices have a range of applications and varying usage patterns. These variations can affect the standardization and collection of efficacy data, making it more complex to conduct evaluations. Moreover, the absence of standardized outcomes of interest in the medical device field further complicates their assessment. Unlike pharmaceuticals, which can often be measured using clinical endpoints to determine efficacy, medical devices may have diverse and less quantifiable impacts on patient outcomes. As a result, a flexible and nuanced approach is necessary when evaluating them, focusing on a range of clinical and functional outcomes to accurately determine their value and impact on healthcare. Economic evaluation of health technologies, particularly medical devices, also poses unique challenges in their integration into regulatory and reimbursement processes. Integrated assessments must ensure that evaluations are relevant and applicable to decision-making environments, such as clinical practice. However, achieving this integration has been methodologically challenging, as indicated by studies from Ciani et alCitation16. This integration is crucial to ensure that evaluations effectively inform healthcare decisions and policies.
Moreover, HTA processes need to be adaptable to public health emergencies (PHEs). The COVID-19 pandemic underscored this necessity, with HTA principles playing a crucial role in guiding policy responsesCitation17. For example, Thailand’s response to allocating critical care resources during the pandemic was informed by these principlesCitation17. Such adaptability is essential for legitimizing government decisions and fostering public trust during emergencies.
2.2. Challenges in health systems and services research
Health systems and services research faces numerous challenges, varying significantly based on factors such as a country’s Human Development Index (HDI), specific health crises like the COVID-19 pandemic, population migration trends, and the need for resilient healthcare systems. Addressing these challenges requires an individualized research approach that considers the unique circumstances and needs of different regions and populationsCitation18.
Researchers must address the variability in HDI by understanding and tackling diverse issues across high and low HDI countries. High HDI countries often grapple more with service delivery challenges, while low HDI countries face more direct human resource constraints. Context-sensitive methodologies, accounting for the resource availability and developmental stages of different countries, are essential. This approach requires a global perspective combined with adaptable studies tailored to local needs and conditions.
The COVID-19 pandemic, particularly in the United States, has exposed significant gaps in healthcare systems, highlighting deficiencies in public health infrastructure and policy effectivenessCitation19. This crisis underscores the need for research that balances specialized care with robust primary and preventive strategies. Researchers are challenged to analyse policies and develop health economics models to better equip health systems for future crises. Additionally, there’s a need to reevaluate research priorities to strengthen public health infrastructure and revalorize prioritization processes within healthcare services.
Global population migration introduces unique complexities to health systems. The movement of large populations within and across borders increases the demand for research focused on public health, epidemiology, and social determinants of health. The current lack of robust evidence on effective interventions for displaced populations highlights an urgent research gap. Addressing this gap is crucial for designing comprehensive health strategies that effectively meet their needs.
Finally, today’s global landscape, characterized by rapid digitalization, security concerns, and pandemic threats, requires resilient and adaptable health systems. Researchers should adopt new methodologies that incorporate diversity and equity into health policy and systems research paradigms. These paradigms should address issues of inequity, poverty, and disadvantage. The aim should be to form inclusive partnerships capable of responding efficiently to changing world conditions.
2.3. Other challenges
Health economics is a field within healthcare but does not cover all aspects of healthcare, especially socio-cultural aspects. This limitation exists because health economics primarily focuses on efficiency, effectiveness, value, and behaviour related to health and healthcare. However, effectively addressing health issues requires insights from various disciplines, highlighting the significance of using multi- and interdisciplinary approaches in health economics researchCitation20.
The real world studies in the literature reported various challenges limit its execution, data analysis, and interpretation of findings. A bibliometric analysis using Web of Science data highlighted the importance of knowledge mapping in understanding health economics research trends and gapsCitation1. Collaboration between health economists and implementation researchers revealed challenges such as methodological differences and disciplinary misperceptions, impacting the real-world application of researchCitation21. Studies employing target trial emulation to evaluate interventions, like COVID-19 vaccine effectiveness using real-world data (RWD), faced challenges in controlling for selection bias and confounding, emphasizing the need to improve RWD qualityCitation22. Additionally, the increasing use of machine learning techniques for predictive modelling in health economics has to contend with issues of data quality and standardization, as well as the need for innovative methods to adjust for potential confounders in RWDCitation22.
3. Conclusion
Health economics plays a role in improving healthcare systems and outcomes. It faces various challenges that hinder its effectiveness. This editorial has explored these challenges, recognizing the complexity of healthcare financing systems and the importance of resource allocation across situations. One major concern is the limited use of policy theories, which restricts our understanding of policy dynamics and stakeholder involvement. Moreover, funding sources and industry influence can sometimes introduce biases in research priorities. The field also grapples with the lack of research focused on the de-implementation of ineffective interventions and addressing low-value care. Ethical considerations, particularly balancing research needs with data privacy concerns, as well as equity and justice considerations, add another layer of complexity. Health technology assessment poses challenges too, especially when evaluating devices and integrating them into policies. Health economics must adjust to the diversity in health systems, while considering disparities in the HDI and public health infrastructure. It should also address the healthcare requirements of migrant populations, where evidence may be limited. The need for research approaches becomes more critical as we strive for resilient health systems capable of responding to a rapidly changing global landscape.
Transparency
Declaration of financial/other relationships
The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Author contributions
AZA developed the study design, performed data extraction, manuscript drafting and reviewing.
Acknowledgements
None stated.
Additional information
Funding
References
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