We all assess value every day: repair or replace, a gym membership or running outdoors, a coffee on the go or at home. But how does a healthcare system assess the value of innovation, whether in the form of new diagnostics, devices, medicines or other technology?
Countries have designed complex and varied valuation and procurement processes, like health technology assessments (HTAs), to try to make these decisions structured, predictable and evidence-based. But, in spite of, or perhaps by virtue of, technical guardrails, HTA assessments do not accommodate the ‘difficult decisions’.
This may be because we no longer operate in an environment where health innovation is seen as purely positive:
- Policymakers speak of new medicines, technologies and innovations as drivers of cost to health systems – increasingly using provocative nouns like ‘threat’ or ‘strain’ to illustrate their sentiment
- The public in high-income countries now expect their healthcare to get worse in the future
- Our survey of European doctors found that one in three does not believe the prices of today’s innovative medicines are justified by industry’s stated need to (re)invest in developing the medicines of tomorrow.
Given this pessimism and parsimony, is it time to rethink how we make the case for health innovation?
Readers might respond to this question by referring to the work of HTA agencies like NICE in the UK or HAS in France. Surely, they are the arbiters of what is valuable innovation and what isn’t? Yet these frameworks do not exist in isolation and have been created by policymakers. As such, they can be reimagined to reflect what we value today and in the future.
We would expect HTA agencies to be the mechanism through which scepticism towards health innovation is enacted, with an ever-smaller funding envelope for new medicines. Indeed, if you listen to industry figures, that is the world that has been unfolding over the last few decades; European countries are now at the point where medicines spending, clawbacks and overall pricing no longer justify investment in the region.
How can we change this? To create the political will for investment, there needs to be a mindset shift connecting innovative medicines to a positive future we want – or a negative future we want to avoid. This is not a challenge unique to healthcare. The sectors most successful at securing long-term investment excel at connecting innovation to outcomes people care about: security, prosperity and a better future.
Defence provides an interesting contrast with healthcare. As with all public spending, the level of investment is a political choice, and European defence spending has risen substantially over the last five years.
Why has defence spending increased? While defence spending is linked to jobs and industry, policymakers know there are better ways to stimulate economic growth. Instead, we can only explain the increase in European defence spending in terms of preparedness, resilience and strategic security. The conversation has shifted from: ‘How much does this cost?’ to ‘What is the cost of not investing?’
With ongoing conflicts in Europe and around the world making security risks feel more immediate, it’s easy to see why the case is compelling. Military preparedness creates value through the risks it mitigates rather than the economic or societal benefit it generates. In fact, the hope is that we never have to ‘use’ the equipment that accounts for a significant proportion of defence spending.
In healthcare, we address challenges we know are going to happen and want to use innovation: people will become ill and we want to give them the best care and treatment. There is a cost today to buying innovative devices, diagnostics and medicines, but today’s breakthrough therapies become tomorrow’s standard of care. Whether through generic medicines or increased competition following patent expiry, healthcare innovation continues to deliver value long after the initial investment has been made.
This is a positive, but it also means the fear of ‘loss’ or ‘cost’ is less obvious. Even if investment in new innovations slows, we will still benefit from existing technologies and medicines. However, health systems that don’t fund today’s innovation will be left relying on yesterday’s science. The real cost of underinvestment is not the loss of what we already have, but the future advances, improved outcomes and longer, healthier lives that never materialise.
The key learning is that the most effective organisations will be those that regularly challenge their own assumptions, understand how societal priorities are changing, and frame innovation in terms of the future people want and the future they want to avoid.
References are available on request.
