Health economics methods for public health resource allocation: a qualitative interview study of decision makers from an English local authority

Abstract

Local authorities in England have responsibility for public health, however, in recent years, budgets have been drastically reduced placing decision makers under unprecedented financial pressure. Although health economics can offer support for decision making, there is limited evidence of it being used in practice. The aim of this study was to undertake in-depth qualitative research within one local authority to better understand the context for public health decision making; what, and how economics evidence is being used; and invite suggestions for how methods could be improved to better support local public health decision making. The study included both observational methods and in-depth interviews. Key meetings were observed and semi-structured interviews conducted with participants who had a decision-making role to explore views on economics, to understand the barriers to using evidence and to invite suggestions for improvements to methods. Despite all informants valuing the use of health economics, many barriers were cited: including a perception of a narrow focus on the health sector; lack of consideration of population impact; and problems with translating long timescales to short term impact. Methodological suggestions included the broadening of frameworks; increased use of natural experiments; and capturing wider non-health outcomes that resonate with the priorities of multiple stakeholders.

The art and science of priority-setting: assessing the value of Public Health England’s Prioritization Framework

“…Moreover, in line with previous evidence exploring challenges to public health decision-making, the impact of the political environment in local government was a major factor determining the likely uptake of the PF. 13 Ensuring committed leadership and engagement from senior politicians as well as officers was regarded as critical to success. At the same time, significant financial pressures for efficiency savings and fundamental questions about the future of the ring-fenced public health budget could hinder the adoption of the PF tool and make decision-makers wary of its purpose and impact.…”

“… 18–20 However, there is little published empirical research on the ways in which prioritization decisions are reached within the new public health system. 13 Understanding how public health priorities are determined in local government, and how priority-setting tools might support decision-making, remains unclear.…”

Methods for public health economic evaluation: A Delphi survey of decision makers in English and Welsh local government

“…To determine the acceptability and usefulness of alternative economic evaluation approaches and methods used, a list of initial methodological “items” were generated from two main sources: one‐to‐one interviews with public health officers working within a local government authority setting reported separately (Frew & Breheny, ) and known methodological issues identified from a purposive literature review on the barriers to using economic evaluation methods within public health (Kelly et al, ; Payne et al, ; Weatherly et al, ). The questionnaire was piloted and refined using internal (academic) health economics colleagues ( n = 7) and external public health colleagues ( n = 8) working within one local authority setting.…”

Program Evaluation of Population- and System-Level Policies: Evidence for Decision Making

“…However, broader impacts may be relevant for some policies, including those related to health (e.g., mortality) and health care processes (e.g., access to care) but also non-health related outcomes (e.g., labor market participation, financial protection). 13,[16][17][18][19] The unit of analysis for the outcomes of interest may be at the individual level or higher (e.g., firm, hospital).…”