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

Hensher, M ORCID: 0000-0001-6444-6827 2020 , 'Incorporating environmental impacts into the economic evaluation of health care systems: Perspectives from ecological economics' , Resources, Conservation and Recycling, vol. 154 , pp. 1-12 , doi: 10.1016/j.resconrec.2019.104623.

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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.

Item Type: Article
Authors/Creators:Hensher, M
Keywords: health care, environmental impacts, externalities, economic evaluation, health economics, ecological economics
Journal or Publication Title: Resources, Conservation and Recycling
Publisher: Elsevier BV
ISSN: 0921-3449
DOI / ID Number: 10.1016/j.resconrec.2019.104623
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© 2019 Elsevier B.V. All rights reserved

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