Foreword

Summary

Thirty years ago, those interested in the economics of health and health care were confined to the groves of academia. Snubbed by general economists, health economists were regarded as little more than upstarts with nothing relevant or interesting to say. And they were regarded by clinicians as unnecessary and irrelevant. How the world has changed.

Every country in the world is facing demands for increased expenditure at a time when resources are finite. Every country is seeking to restrain health care expenditure as the prices of new technologies – many with significant advantages – are increasing year on year. Clinicians can no longer ignore the economic cost of providing for all the health care needs of their patients. As the late (and very great) Sir George Godber – Chief Medical Officer of England from 1960 to 1973 – once famously said, “When a doctor sees a patient in his consulting room he must also remember those in the waiting room.”

In this book Cam Donaldson provides an insight into the economics of health care that is accessible to non-experts including clinicians. He starts with a critical examination of some of the diverse approaches that developed countries have taken to financing health care, public versus private provision and the impact of charges. He pays considerable attention to ‘programme budgeting and marginal analysis’ as well as to formal methods of economic evaluation including the quality adjusted life year measure. All this with hardly a single mathematical formula.

This book will appeal to those lacking any formal training in health economics. I commend it, particularly, to those like me who can hardly understand their bank statements let alone their income tax forms. And for tomorrow’s health professionals, it is a must. They are going to struggle, throughout their professional lives, if they cannot get to grips with the realities of the modern world.

Sir Michael Rawlins

London, June 2010