Colloque HAS - L'évaluation économique en santé

Ensemble, améliorons la qualité en santé

2 Ensemble, améliorons la qualité en santé

• Traduction simultanée

Simultaneous translation

• Français / French : canal 2

• Anglais / English : canal 3


Allocutions d’ouverture

Jean-Paul Delevoye, président, Conseil économique,

social et environnemental

Jean-Luc Harousseau, président, Haute Autorité de Santé


Première session

Les choix en santé :

qui choisit, pour qui ?

Modérateur

Alain Cordier, membre du Collège,

Haute Autorité de Santé

Liste des intervenants

Yves Daudigny, rapporteur général, commission des affaires

sociales, Sénat

Alexander Eggermont, directeur, Institut Gustave Roussy

Hervé Gisserot, président, LIR

Christian Saout, président, Collectif interassociatif sur la santé

Erik Schokkaert, Professeur d’économie publique,

Ku Leuven (Belgique)

Les choix en santé : qui choisit, pour qui ? 5

Erik Schokkaert

Professeur d’économie publique,

KU Leuven (Belgique)

6 Les choix en santé : qui choisit, pour qui ?

Les apports

de la justice sociale

7 Les choix en santé : qui choisit, pour qui ?

Introduction

Should an economist

talk about ethics, i.e.

about justice and solidarity

in health care?

•Les choix en santé : qui choisit, pour qui ? 8

1. Increasing health care expenditures

Strong concern about the budgetary consequences of

sharply increasing health care in collectively financed

health care systems.

Innovation is the main cause of the strong increase in

health care expenditures (>50%).

Cutting expenditures not necessarily welfare-optimal.

Obvious that one should compare costs and benefits.


A welfare criterion

QUESTION: “From a social welfare standpoint, how

much should the nation spend on health care, and what

is the time path of optimal health spending?”

Trade-off between health (care) expenditures and other

uses of the available resources.

“Willingness to pay” as a criterion (but be aware of

distributional consequences!)


Argument 1: "as we get older and richer, which is more valuable: a third car, yet another television, more clothing – or an extra year of life?" (Hall and Jones, Quarterly Journal of Economics, 2007).

Argument 2: complementarity – "Improvements in life expectancy raise willingness to pay for further health improvements by increasing the value of remaining life. This means that advances against one disease, say heart disease, raise the value of progress against other age-related ailments such as cancer or Alzheimer's" (Murphy and Topel, Journal of Political Economy, 2006).


2. The challenge of solidarity

Willingness-to-pay for social insurance is not evident:

• limited transparency of collective financing: insurance element not

always sufficiently clear.

• compulsory systems of health care financing impose a degree of

solidarity that goes well beyond “enlightened” self-interest.


A double challenge

If we fall back on private financing, huge inequalities will

emerge.

Necessary to “mobilize” willingness to pay of the

citizens:

• emphasize the insurance aspect.

• increase the efficiency of the system.

• strengthen solidarity and make it more transparent: explicit priority-

setting is necessary to safeguard solidarity.


3. Solidarity: general principles?

Argument: "life and health are priceless". Leads to

unacceptable policy prescriptions:

• Should we really spend all available resources on health care

until the last Euro would buy no gain in health (or life expectancy)

at all?

Some general principles?


Some general principles

1. Health care is only important as an input in health:

• certainly for the low SES-groups other policy domains might be more

important: education, housing, environment.

• even from a health perspective, it may therefore be optimal to slow

down innovation (e.g. in medicines).


2. Health is only important as one dimension of well-

being:

• how to trade off the different dimensions of life against each other?

• preferences of individuals (and of nations) have to be respected.

• the relative importance of material consumption will be larger for poorer

individuals/societies.


3. Not everything is possible. Choices within health care

system should be guided by effect on well-being,

taking into account distributional issues. Solidarity

implies that a larger weight is given to the poor.


Need for transparency

Not being explicit about priorities leads to gross

injustices:

• better organized patient groups are better treated;

• short run political considerations (media influence) play an important

role in the decisions;

• emotional arguments supersede informed ethical choices.

Secrecy makes the “solidarity” concept less credible

for the citizens.


Transparency and taboo trade-offs

Psychological research has pointed to the distinction

between so-called "sacred values“ and “vulgar values”:

• routine trade-offs

• tragic trade-offs

• taboo trade-offs

"Opportunity costs be damned, some trade-offs should never be

proposed, some statistical truths never used, and some lines of

causal/counterfactual inquiry never pursued" (Tetlock, 2003).


Psychological and social mechanisms to avoid explicit

taboo trade-offs:

• smoke screens and “secret” committees;

• presentation of difficult ethical choices as if they are technical (cost-

effectiveness analysis and economic evaluation);

• rhetorical tricks to transform taboo trade-offs in one of the other forms;

• introduction of a strict distinction between “economic” and “ethical”

issues.


4. Implications for priority-setting

Explicit priority setting is needed to answer two

(linked!) questions:

a. What share of GDP should go to collective health insurance?

b. Which treatments should be included in the collective insurance

package?

Solidarity requires that we reason within a coherent

framework, specifying different weights for different

groups of people (larger weights for the poor and for

the severely ill).


1. Role of the medical profession?

TWO DIFFERENT ROLES:

Global decision making

• Medical specialists are obviously indispensable to judge the

effectiveness of different treatments.

• Yet, these evaluations should be integrated in a global context:

available means are not unlimited.

Individual provider-patient relationship

• Ideally, individual providers should NOT be confronted with “rationing”

decisions.


An example

•"How much will Herceptin really cost?"

Bron: Barrett et al., BMJ, 2006


2. Role of the patient groups?

Patient groups should be represented in the process of

decision-making.

Two functions:

• Provide information about their real-life situation: presence of patients

essential to go beyond “accounting” decisions.

• Take reimbursement decisions:

Balanced representation necessary. Unequal lobbying powers may lead to gross

inequities.

One-sided decisions should be avoided: other agents (payers) are equally important.


3. Role of the economists?

Collection of information on effectiveness and cost-

effectiveness is essential for a thorough evaluation of

new medicines.

Yet, the present methodology of cost-effectiveness

calculations is deeply unsatisfactory (despite the fact

that cost-effectiveness studies have become a small

industry). Too soon for codification!


Questions

The two crucial questions are not adequately tackled

with the presently used techniques:

• what is the optimal size of the health care budget?

• how to integrate equity considerations into the analysis?

Priority setting is not a technical, but an ethical and

political issue.


4. Role of the political decision-makers?

Organize an open debate on (the limits of) solidarity with

well-defined and transparant procedures.

“Accountability for reasonableness” (Norman Daniels):

• Decisions and their rationales must be publicly acessible.

• There must be opportunities for challenge and opportunities for revision

of policies in the light of new evidence.

• Rationales for priority-setting should aim to provide a reasonable

explanation, i.e. an explanation appealing to evidence, reasons and

principles accepted as relevant by fair-minded people.

• There must be public regulation of the process to ensure that the other

conditions are met.


Conclusion

The main challenge for the future is solidarity.

In a context with increasing pressure on government budgets, protecting solidarity implies making it transparent.

In a civilized society, there should be an open debate: all players should try to be as explicit as possible about their understanding of the concept of solidarity (no smoke screens).

Policies should be transparent, and techniques should be developed which aim at coherency and at the removal of ad-hocery.


Table ronde




Yves Daudigny, rapporteur général, commission des affaires

sociales, Sénat

Alexander Eggermont, directeur, Institut Gustave Roussy

Hervé Gisserot, président, LIR

Christian Saout, président, Collectif interassociatif sur la santé

Erik Schokkaert, Professeur d’économie publique,

Ku Leuven (Belgique)


Alain Cordier

Modérateur membre du Collège,



• Traduction simultanée

Simultaneous translation

• Français / French : canal 2

• Anglais / English : canal 3


Deuxième session

Comment choisir ?

La place de l’évaluation économique

Modérateur

Lise Rochaix, membre du Collège,



Luc Baumstark, conseiller scientifique, Commission QUINET, Centre

d’analyse stratégique – économiste, Université de Lyon

Josep Figueras (représenté par Peter Smith), coordinateur,

Observatoire européen des systèmes et des politiques de santé, OMS

Gilles Johanet, procureur général, Cour des comptes

Mark Sculpher, professeur au centre d’économie de la santé, Université

de York (UK)

Peter Smith, professeur de politiques de la santé,

Imperial College London (UK)

Jérôme Wittwer, professeur, Laboratoire d’Économie de Dauphine –

Laboratoire d’Économie et de Gestion des Organisations de Santé

Comment choisir ? La place de l’évaluation économique 35

Josep Figueras (représenté par Peter Smith)

Coordinateur, Observatoire européen

des systèmes et des politiques

de santé, OMS

36 Comment choisir ? La place de l’évaluation économique

Choix en santé :

exemples dans les systèmes

de santé européens


Financial Crisis in the EU: The Health Systems Response/The Good, the Bad & the Ugly

“Ladies and Gentlemen we have no money!

Now we need to think!“

38 •Comment choisir ? La place de l’évaluation économique

The options

1. Raise extra statutory revenues ...

2. Ration coverage: Shifting to private expenditure?

3. Improve performance: Squeeze efficiency?

4. Protect the health budget: Health & Wealth?

5. Act on health determinants: Health in All Policies?

6. Concluding: the Good, the Bad & the Ugly


Wealth Health

Health Systems

Societal Well-being

Health budget Health Impact on Economic Productivity

Effects of ill health on economic growth

Direct contribution

to the economy Demonstrate performance!!!

Figueras J, McKee M 2011


Rationing Health Services

Coverage dimensions


Lusardi et al. 2010

“Reductions in routine care today might lead to undetected illness tomorrow

and reduced individual health and well-being in the more distant future.”

User Charges Impact on Costs & Health


Improving purchasing

Supply side reforms have more scope for cutting costs and increasing efficiency than demand side policies

Many EURO strengthened policies to reduce the prices of medical goods or improve the rational use of drugs • Austria, Belgium, Belarus, Bosnia and Herzegovina, Croatia, the Czech

Republic, France, Estonia, Greece, Iceland, Ireland, Hungary, Latvia, Lithuania, FYR Macedonia, Malta, Moldova, Poland, Portugal, Romania, Russia, Serbia, Slovakia, Slovenia, Spain, Turkey

• Wide variety of measures generic substitution

Improve quality of prescribing

claw-back mechanisms

negotiations on prices


More difficult reforms to implement:

Rationalising hospital services, stronger PHC • closures, mergers and centralisation (Denmark, Greece, Latvia,

Portugal, Slovenia) • shift towards outpatient care (Belarus, Ireland, Greece, Lithuania) • Increased shift from inpatient to ambulatory and/or primary care

(Ireland, Greece, Hungary, Lithuania, Netherlands) • Improve coordination with or investment in primary care (Lithuania,

Netherlands)

Reforms in purchasing & payment systems • Introduce case mix / payment for performance e.g. Austria, Hungary,

Bosnia and Herzegovina, Bulgaria, Czech Republic, Moldova • Reduce/freeze prices paid to providers, reduction of salaries of health

professionals e.g. Cyprus, France, Greece, Ireland, Lithuania, Romania, England, Portugal, Slovenia

Improving purchasing 2


Improve performance

Restructuring care delivery • Hospital closures, mergers,.. DK, GR, LT, PT, SI • Shifting to outpatient settings IR,GR, LT • Strengthen primary care LT,NL

Restructuring Admin. SHI & MoH - 8 countries

Pharmaceuticals & medical devices -18 countries • Price reduction, procurement reforms • Strengthening prescribing, promoting generics • Positive lists, public awareness campaigns

Mladovsky P. Thomson S. Evetovits T. Cylus J. Karanikolos M. McKee M. Figueras J. 2012


Improve performance (2)

Reduced / freeze professional salaries & pensions • CY, FR, GR, IE, LT, ROM • EN, PT, SI • Hospital closures, mergers,.. DK, GR, LT, PT, SI

Reform provider payment methods • Reduce price for services EE, IE, RO, SI • Introduce DRGs in BG, CZ • Pay for Performance & Capitation in PHC

Mladovsky P. Thomson S. Evetovits T. Cylus J. Karanikolos M. McKee M. Figueras J. 2012


Concluding

The Good: contain costs & enhance performance • Countercyclical spending • Pharmaceutical policies (prices, prescribing guidelines,..) • Provider payment systems • Health worker remuneration BUT migration & low moral • Prioritizing PHC • Restructuring hospital sector BUT savings not immediate

The Good – but missing..... • Protecting the budget (argue for Health & Wealth) • Strengthening Public Health


Concluding …

The Bad: contain costs but undermine performance • User charges • Ration coverage • Public health reductions

The Ugly: lowers health and efficiency • Large budget cuts regardless of effects The Troika & Self imposed austerity

• Large coverage reductions • Target cost cutting to vulnerable groups


Conclusion

Short-term solutions during crisis, but….

Aim for sustainable efficiency gains

Crisis unprecedented opportunity for change

Preparedness, political vision & leadership

The political economy / implementation


Peter Smith

Professeur de politiques de la santé,



Principes économiques

pour l’élaboration des choix

en santé


Why efficiency matters in health care

Conventional market disciplines are weak in healthcare

Without attention to efficiency, producers have few

constraints on pricing

Excessive spending places a possibly unsustainable

burden on public finances (social insurance, taxation)

Intergenerational equity (will young people enjoy the

benefits that older people currently enjoy?)

•Comment choisir ? La place de l’évaluation économique 52

Efficiency: some preliminary issues

Efficiency as a ratio of valued outputs to costly inputs

Inefficiency often considered a ‘residual’ after all other legitimate explanations of variation have been taken account of

Need to distinguish between efficiency and expenditure control

• Improved efficiency can arise from higher levels of attainment at the

same cost, as well as lower expenditure for the same attainment.

Often a need to adjust for uncontrollable constraints on better attainment

• E.g. diet; smoking; geography


Future healthcare spending

The US Congressional Budget Office (2007) estimates

that – with no policy change – total spending on health

care will rise from 16 percent of the US economy in 2007

to

• 25 percent in 2025

• 37 percent in 2050

• 49 percent in 2082.

Congressional Budget Office. 2007. The Long-Term Outlook for Health Care

Spending. Washington DC: Congress of the United States.


OECD Rankings

Determinants of life expectancy • Health care spending

• Education

• GDP

• Pollution

• Alcohol

• Tobacco

• Diet

Residual is health system efficiency

Joumard, I., C. Andre, C. Nicq and O. Chatal (2008) Health status determinants: lifestyle, environment, health care resources and efficiency. Economics Department WorkingPaper 627. Paris: OECD.


Country-specific effects (life years)

Joumard et al (2008)

-5 -4 -3 -2 -1 0 1 2 3

United StatesHungaryNorwayDenmarkTurkeyGermanyAustriaSwitzerlandNetherlandsCzech RepublicUnited KingdomIrelandBelgiumFranceSwedenPolandFinlandCanadaGreeceKoreaNew ZealandAustraliaIceland


Two fundamental challenges

Ex ante assessment of priorities. What will be provided

from the statutory package of health care?

• What services are covered?

• What limitations are placed (appropriateness)?

• Are there any copayments?

Ex post assessment of appropriateness, quality and

cost-effectiveness.


Assessing priorities

There will always be excess demand for health services

that are free (or low cost) at the point of delivery:

Natural tendency of patients to demand more care when

they do not bear the full cost

Natural tendency of providers to offer more care when

income depends on volume of treatment

So mechanisms are needed to curb expenditure growth

and inefficiency

Methods need to ensure that limited funds are spent to

maximum effect


Is cost-effectiveness analysis ‘the only show

in town’?

Coherent and robust approach to setting priorities and limiting growth in utilization of health services and healthcare costs Assumes objective of the health system is to • maximize production of health;

• and (possibly) address health disparities.

Can act as a guide to: • Selection of the ‘health basket’

• Creation of treatment guidelines

• Setting appropriateness rules (who gets treatment)

• Setting copayment rates

Reflected in national health technology assessment agencies in Australia, England, Germany, Sweden, etc.


Interest groups include

Geographical interests

Age groups

Social groups (income, ethnicity)

Taxpayers

Voters

Patient groups

Clinical professionals

Provider organizations

Pharmaceutical companies

Governments


Cost-effectiveness analysis as a ‘referee’

Sets explicit ‘rules of the game’, for delegation to a regulator (NICE etc)

Removes politicians or managers from involvement in case-by-case decisions

Allows pursuit of health system objectives • Effectiveness (maximizing health gain)

• Equity (equal access for those in equal need)

• Politics (resolves the resource allocation debate)

• Cost containment (limits size of the health basket)


Impact on practice

Most direct impact • Israel

• New technology assessment

• Oregon

• Continuing processes for the

Medicaid ‘health basket’

• New Zealand

• ‘Best example of effective

review and evaluation’

• United Kingdom

• NICE for new technologies

Little direct impact • Denmark

• Netherlands

• Sweden

• Norway

• Emphasis on principles rather

than detail

• Reluctance to confront ‘hard’

issues

Sabik, L. M. and Lie, R. K. (2008), “Priority setting in health care: lessons from the experience in eight countries”, International Journal for Equity in Health, 7(4), doi:10.1186/1475-9276-7-4


Purchasing wisely: most promising

mechanisms?

National level • Best practice guidelines

• Quality standards, information and public reporting

• Payment mechanisms

Local level • Better purchasing of health care

• ‘Nudging’ clinicians (eg IT expert systems)

Patients and caregivers • Better information

• User charges and financial incentives

• Personal healthcare budgets


How can the biggest efficiency gains be secured? Some tentative thoughts.

Reconfiguration of services • New service delivery models, especially for chronic disease • Coordination of care, including social care

Information • Better guidelines • Comparative performance data

Funding mechanisms • Provider payment – P4P? • Bundling services – eg ‘year of care’

Health-related behaviour • Lifestyle • Use of health services

Competition • Especially in ambulatory services


Some concluding observations

Health care priority setting an intensely political process

Numerous interest groups (and subgroups)

Health systems need a systematic method of reconciling

competing claims

Cost-effectiveness analysis currently the ‘best’ tool for

the process

But some major challenges remain!


Mark Sculpher

Professeur au centre d’économie

de la santé, Université de York (UK)


Méthodes d’évaluation :

enjeux de la médecine

personnalisée


Resource

constrained

health care

system

New technologies

- Benefits gained

- Additional Cost

Displaced services

- Benefits forgone

- Resources released

Is the benefit gain from the new treatment greater than the benefit

foregone through displacement?

• Therapeutics

• Diagnostics

• Care

• Service and delivery

The challenge of health care decisions


Measuring costs – Reflux example


Assessing benefits

A generic measure of health gain

Preferences

Decision

making

Surgery Care of the elderly Paediatrics O&G General practice Oncology

Pain Physical function Mental wellbeing Social function Life expectancy


Assessing benefits – example of primary angioplasty


Incremental cost

effectiveness ratio

Assessing benefits – example of primary angioplasty (average patients)


Assessing benefits – example of primary angioplasty (patient sub-groups)


Cost effectiveness and personalisation – management of angina


Estimating the cost effectiveness threshold

http://www.york.ac.uk/che/research/teehta/methodological-research/#tab-4


Results from draft report

0.00

0.20

0.40

0.60

0.80

1.00

£0 £10,000 £20,000 £30,000 £40,000

Pro

babi

lity

Cost per QALY threshold

11 PBCs

23 PBCs

• Central ‘best’ estimate: £18,317 per QALY

• 0.64 probability that threshold is less £20,000 per QALY

• 0.92 probability that threshold is less £30,000 per QALY

• Major structural uncertainties


Summary

Cost effectiveness analysis widely used internationally to inform funding/reimbursement decisions

Critical review of clinical and economic evidence still essential

Generic measure of benefit key element

• QALY imperfect but the best on offer

Extensive methods research to extend the QALY

Deliberation to reflect range of scientific and generic value judgments inevitably needed for evidence-based decision making


[email protected]

http://www.york.ac.uk/che/staff/research/mark-sculpher/


Luc Baumstark

Doyen de la faculté de sciences

économiques et de gestion,

Université de Lyon

Conseiller scientifique,

Centre Analyse Stratégique


Calcul économique public :

donner une valeur

à ce qui n’a pas de prix


Une histoire ancienne

« Comment mesurer l’utilité publique, tel sera l’objet de nos recherches »

“ Des enquêtes plus ou moins multipliées, des lois, des ordonnances ne feront

pas qu'une route, un chemin de fer, un canal soient utiles, s'ils ne le sont pas

réellement. La loi ne devrait, pour ainsi dire, que consacrer les faits démontrés

par l'économie politique. Comment doit se faire cette démonstration ? Sur

quelles données, sur quelle formule repose-t-elle ? Comment, en un mot, doit

se mesurer l'utilité publique ? Tel sera l'objet de nos recherches ”

Jules Dupuit, De la mesure de l'utilité publique, Annales des Ponts et

Chaussées, N°116, 1844


D’une intuition simple à un outil de calcul opératoire complexe

•Comment choisir ? La place de l’évaluation économique

0

1 1

nt t

tt

A CVAN I

a

Les investissements initiaux

Les coûts

Les avantages

Avantages et coûts sociaux

Une mesure dans l’incertain

et face à l’imprévisible

Risques et Incertitudes

- Calcul probabiliste

- Prime de risques

- Valeurs d’option

- etc

La valeur sociale créée

est-elle positive

Le taux d’actualisation Prendre en compte le temps

84

Les malentendus et l’ambition

Les malentendus « entretenus » • Un calcul financier, un calcul privé, un calcul technocratique qui se substitue aux

débats et à la décision • Faire un calcul insoutenable : comment choisir entre 0 et l’infini

L’ambition : une aide à la décision • Eclairer et motiver la décision publique dans un cadre de défaillances des

marchés • Calibrer et définir les niveaux optimum d’interventions (normes, réglementations,

fiscalité, dédommagements) • Discriminer entre les différents investissements en intégrant les contraintes du

développement durable • Montrer (ex ante, ex post) l’utilité des dépenses publiques qui créent de la valeur

sociale • Assurer un minimum de cohérence dans les différents arbitrages • Optimiser l’utilisation de la ressource publique qui devient rare


Donner une valeur à ce qui n’a pas de prix :

élaboration d’un référentiel

Des valeurs scientifiquement fondées… • Caractériser le phénomène (pollution, effet de serre, congestion, effets de

coupure…)

• Définir les impacts (dommages par exemple)

• Donner une valeur économique (différents outils)

• Considérer les études (plus ou moins homogènes)

• Analyser les pratiques des autres administrations

• Engager une négociation dans un cercle restreint

• Passer de plusieurs valeurs à un référentiel reconnu et accepté (validation)


… en phase avec la hiérarchie des valeurs de la société ? • Un référentiel en relation avec ce que révèlent les comportements (individuel,

collectif)

• Un référentiel normé et contrôlé mais contestable et évolutif. (processus concertés, organisation d’un compromis le plus ouvert possible, commande et validation politique)

• Un référentiel fondé sur un processus de production légitime.

• Un référentiel indépendant des décisions du moment (neutralité du processus par rapport aux projets, continuité du processus de production)

• Un référentiel à faible coût d’usage : Des valeurs simples et opératoires (mode d’emploi)

• Un référentiel ouvert aux problématiques d’équité, d’équilibre du territoire, environnement durable

87




… appropriable par les acteurs publics et privés • Culture à diffuser : Mieux maîtriser et mieux comprendre le calcul économique

(formation, diffusion de la culture du calcul économique)

• Calcul intersectoriel (transport, énergie, mais aussi santé, défense, recherche,

etc.)

• Calcul à décliner sur les territoires : collectivités territoriales (Région)

• Calcul alimenter par la recherche : Se donner les moyens de l’enrichissement

du calcul économique (recherche : production de données (consentement à

payer), construction de modèles, veille)

• Calcul qui doit s’inscrire dans le processus de décision (règles claires à

établir secteur par secteur : élaboration guidelines…)

• Renforcer ou créer les dispositifs de contre-expertise (évaluation des

études, renforcement des évaluations ex post)




La production « séquentielle » de référentiels méthodologiques et de valeurs tutélaires

89

- Travaux de prospective « Transport 2010 » 1992

- Les coûts des nuisances : M. Boiteux (1994; 2001)

- La révision du taux d’actualisation : D. Lebègue (2005)

- Un référentiel carbone : A. Quinet (2008)

- La valeur de la biodiversité : B. Chevassus-au-Louis (2009)

- Introduction systématique du risque: C. Gollier (2011)

- Refonte des outils d’analyse socio-économiques des dépenses publiques (E. Quinet

en cours)

Travail mené au Commissariat Général du Plan puis au Centre Analyse Stratégique

Instruction Cadre relative aux méthodes d’évaluation

économique des grands projets d’infrastructures de

transport, 25 Mars 2004 mise à jour le 27 mai 2005,

Ministère des Transports de l’Equipement, du Tourisme et

de la Mer.


Revue Metropolis, N° 108/109, Mars 2002

La valeur statistique de la vie humaine

90

L’effort que la collectivité est prête à consentir

pour réduire un risque morbi-mortalité

Préoccupation dans le secteur des transports :

Insécurité routière : risque décès

Impact de la pollution/bruit sur la santé : dégradation de la qualité de vie

Le prix, le coût du mort

Le prix de la vie humaine

Valeur Statistique de la Vie

…

La valeur de la vie humaine


Table ronde



Luc Baumstark, conseiller scientifique, Commission QUINET, Centre

d’analyse stratégique – économiste, Université de Lyon

Gilles Johanet, procureur général, Cour des comptes

Mark Sculpher, professeur au centre d’économie de la santé, Université

de York (UK)

Peter Smith, professeur de politiques de la santé,


Jérôme Wittwer, professeur, Laboratoire d’Économie de Dauphine –

Laboratoire d’Économie et de Gestion des Organisations de Santé

Comment choisir ? La place de l’évaluation économique 92


Lise Rochaix

Modérateur membre du Collège,



Conclusion

Jean-Luc Harousseau,

président, Haute Autorité de Santé

Chacun des intervenants a déclaré ses liens d’intérêt

avec les industries de santé en rapport avec le thème de

la présentation (loi du 4 mars 2002)

Retrouvez ces déclarations sur le site Internet

de la HAS, espace Colloque HAS

www.has-sante.fr


96

La Haute Autorité de Santé vous remercie

d’avoir participé à ce colloque

www.has-sante.fr


97

Colloque HAS - L'évaluation économique en santé

Health & Medicine

Transcript of Colloque HAS - L'évaluation économique en santé