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Incorporating environmental impacts into the economic evaluation of health care systems: Perspectives from ecological economics

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Abstract

Health care is responsible for a range of negative environmental impacts, including greenhouse gas emissions, air pollution, plastics waste, and pharmaceutical pollution of ecosystems through excretion and inappropriate disposal. Evidence on the scale of these impacts has been growing in high-income countries. To date, there has been only limited discussion of how environmental impacts might be incorporated into economic evaluations of health care programs, including health technology assessment. This paper considers why and how this aim might be achieved, using perspectives from both mainstream and ecological economics. There are strong arguments for using economic evaluation to internalise the negative environmental externalities currently being generated by health care, as well as precautionary arguments for health systems to better understand their exposure to their environmental impacts. The paper tests the feasibility of incorporating the costs of greenhouse gas emissions within costing for economic evaluation, and concludes that the use of shadow prices to achieve this aim is feasible. It suggests that this cost-based approach is preferable to more convoluted attempts to incorporate environmental impacts in the outcome component of health economic evaluations. The interaction between overuse, antimicrobial resistance and environmental harms of health care is identified as an area that would benefit from investigation using innovative economic methods. Until 28 th January 2020, you can read the full text of this article online for free via the Elsevier Share Link at: https://authors.elsevier.com/a/1aCIh3HVLKeNnE
Hensher M. (2020)
Incorporating environmental impacts into the economic evaluation of health care systems:
Perspectives from ecological economics. Resources, Conservation and Recycling 154:
104623.
https://doi.org/10.1016/j.resconrec.2019.104623
Abstract
Health care is responsible for a range of negative environmental impacts, including
greenhouse gas emissions, air pollution, plastics waste, and pharmaceutical pollution of
ecosystems through excretion and inappropriate disposal. Evidence on the scale of these
impacts has been growing in high-income countries. To date, there has been only limited
discussion of how environmental impacts might be incorporated into economic evaluations
of health care programs, including health technology assessment. This paper considers why
and how this aim might be achieved, using perspectives from both mainstream and ecological
economics. There are strong arguments for using economic evaluation to internalise the
negative environmental externalities currently being generated by health care, as well as
precautionary arguments for health systems to better understand their exposure to their
environmental impacts. The paper tests the feasibility of incorporating the costs of
greenhouse gas emissions within costing for economic evaluation, and concludes that the use
of shadow prices to achieve this aim is feasible. It suggests that this cost-based approach is
preferable to more convoluted attempts to incorporate environmental impacts in the
outcome component of health economic evaluations. The interaction between overuse,
antimicrobial resistance and environmental harms of health care is identified as an area that
would benefit from investigation using innovative economic methods.
Until 28th January 2020, you can read the full text of this article online for
free via the Elsevier Share Link at:
https://authors.elsevier.com/a/1aCIh3HVLKeNnE
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