Does the approach to economic evaluation in health care depend on culture, values, and institutional context?

Excerpt

The question of why the attitudes towards economic evaluation in health care differ so much from one jurisdiction to another has long been a source of discussion among scholars. Differences are observed both in whether economic evaluation plays a significant role in decision-making and the methods employed. In some countries, such as the Netherlands, Sweden, and the United Kingdom, the use of economic evaluation is extensive and focuses on the quality-adjusted life-year (QALY) as a measure of health gain. However, in Germany and the United States, the use of economic evaluation is limited, and QALYs are not favored. In commenting on the use of economic evaluation, within the broader activity of health technology assessment (HTA) by the National Institute for Health and Care Excellence (NICE) in the United Kingdom (UK), Le Pen [1] noted that there may be two reasons why similar bodies on the continent of Europe, such as HAS in France and IQWiG in Germany, might adopt a different approach. First, there are classical distinctions between NHS-based (‘Beveridge’) systems and social insurance-based (‘Bismarck’) health care systems. Secondly, they may be more philosophical differences relating to concepts of illness, health, and medicine that cause continental countries to reject the ‘Anglo-Saxon’ methods of assessing health care. …