|This kid knows a thing or two about cost-effectiveness.|
In the U.S. medical system, where cost-effectiveness is explicitly not used, overuse of technology and resources is rife. As such, every unnecessary test and procedure increases costs for insurance companies. To recoup this loss, insurance companies raise premiums. As premiums rise, families decide they can no longer afford health insurance and the ranks of the uninsured grow. The cause and effect may be separated by months and miles, but the connection is very real.
Remind you of your local emergency room?
In determining cost-effectiveness, we usually look at an outcome related to years lived. It is fair to question this outcome, as people's contributions to the world are not necessarily tied to their longevity. However, we would not necessarily agree to base access to care on one's contributions to society in the first place (or even how to measure those contributions). Longevity is also a problematic measure as people in some parts of the world have much shorter life expectancies than those in other parts. Is it less cost-effective to help someone in Somalia rather than in France if she will not live as long after a given intervention? And does cost-effectiveness diminish as those who are treated and live longer require more costly care in the future? These are important questions and not easily answered. In global health, if the money is limited (and it always is), then we have to figure out who to give it to and cost-effectiveness offers us a method. We may not always agree on all of the variables in the equation, but my hope is that we agree that a calculation—even an imperfect one—is necessary.