Choice and accountability in health promotion: the role of health economics

Choices need to be made between competing uses of health care resources. There is debate about how these choices should be made, who should make them and the criteria upon which they should be made. Evaluation of health care is an important part of this debate. It has been suggested that the contribution of health economics to the evaluation of health promotion is limited, both because the methods and principles underlying economic evaluation are unsuited to health promotion, and because the political and cultural processes governing the health care system are more appropriate mechanisms for allocating health care resources than systematic economic analysis of the costs and benefits of different health care choices. This view misrepresents and misunderstands the contribution of health economics to the evaluation of health promotion. It overstates the undoubted methodological difficulties of evaluating health promotion. It also argues, mistakenly, that economists see economic evaluation as a substitute for the political and cultural processes governing health care, rather than an input to them. This paper argues for an economics input on grounds of efficiency, accountability and ethics, and challenges the critics of the economic approach to judge alternative mechanisms for allocating resources by the same criteria.Choices must be made between competing uses of health care resources. There is debate, however, over how such choices should be made, who should make them, and the criteria upon which they should be made. The evaluation of health care is part of the debate. Some argue that health economics can make only a limited contribution to the evaluation of health promotion. That position, however, both misrepresents and misunderstands the contribution of health economics to the evaluation of health promotion. It overstates the methodological difficulties of evaluating health promotion and mistakenly argues that economists see economic evaluation as a substitute for the political and cultural processes which govern health care, rather than as an input to them. The authors argue for an economics input on grounds of efficiency, accountability, and ethics, and challenge critics of the economic approach to judge alternative mechanisms for allocating resources by the same criteria.