Australian Politics and Policy - Senior, 2019a

Australian Politics and Policy
including detection of unexpected or undesirable side-effects. Similarly, there can
beevaluationsofoperationstofindwhichsurgicalproceduresaremosteffectiveor
whether pharmaceutical treatments can substitute for surgery, for example.
Asageneralrule,governmentsseekevidenceontheeffectivenessofhealth
care interventions. The gold standard, as in other areas of public administration, is
‘evidence-based policy’. But it is a tough standard in health care. Research is difficult
andexpensive,inpartbecausetherearenotstandardconditionsandtherearenot
standard procedures. And there are ethical considerations in experiments involving
people: is it ethical to conduct control experiments in which some patients are
given one form of operation while others are given another form?
Even when the effectiveness of a form of treatment is established, the question
of value-for-money arises. A new pharmaceutical may be very effective in prolonging
the life of cancer sufferers, but if the drug is very expensive, and if the
prolongation of life is only short, could scarce public money be better directed to
where more health benefits could be enjoyed?
Such considerations concern the basis of policy-makers’ job assignment in a
democracy. In the regulations they design or implement, or in the advice they give
governments, can they differentiate between the needs of different people? Can they
make hard and cold evaluations that would lead to a certain person being denied
a life-extending pharmaceutical so that a limited budget can be spent on suicide
prevention for adolescents for example?
In one frame, such considerations involve the policy maker having to say one
life is worth more than another. In another frame, however, it is simply a question
of the best allocation of scarce resources. A road authority with a limited budget
and a brief to make roads safer would be remiss if that money were not spent on
areas where the best outcomes could be achieved. Similarly, in evaluating health
interventions, policy makers strive to find value-for-money in terms of outcomes.
Such is the essence of cost–benefit analysis, a basic technique in the policy maker’s
toolbox.
What therapies give the best outcomes and what do they cost? One measure is
to consider how many extra years of life, on average, result from a therapy with a
given cost. A more refined analysis is to apply some weighting based on the quality
of those life-years. One such metric is the health-adjusted life expectancy (HALE)
– the average time an individual can live without disease or injury. 15 Anotheristhe
quality-adjusted life year (QALY), where a weight between 0 (death) and 1 (ideal
health) is assigned, and yet another is the disability-adjusted life year (DALY).
While such metrics implicitly put a value on life, the Australian Institute of
Health and Welfare (AIHW) qualifies the use of such metrics with the statement:
‘However,theuseofhealthstatepreferencesandDALYorQALYmeasuresto
quantify loss of health or health gain carries no implication that society will
15 AIHW 2017a.
614