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The Place of Work in Healthcare Decision-making
Leela BarhamIndependent Health EconomistStephen BevanThe Work Foundation & Lancaster UniversityFounding President, Fit for Work Europe Coalition
A Fit for Work Coalition Provocation paper October 2011
Contents
The Place of Work in Healthcare Decision-making .................................11. Background ........................................................................................32. Health care decision making: The Context .........................................53. HTA and health care decision making in Europe ................................63.1 Defining HTA .................................................................................63.2 HTA in decision making .................................................................63.3 The Societal perspective and HTA .................................................73.4 Principles for ‘good’ HTA and the societal perspective .................83.5 Current adoption of the societal perspective ..............................124. Why isn’t work routinely considered in HTA? ...................................144.1 Is there a consensus that work should be considered in HTA? ....144.2 Is there confidence in the methods to include work within HTA? 164.3 Is there capability and capacity to include work within HTA? .....174.4 Are there practical challenges in moving to routinelyincorporating work within HTA? .........................................................184.5 What will be the impacts of routinely incorporating work withinHTA? ..................................................................................................185. Discussion ........................................................................................19
1.Background
The economic crisis that has gripped the European Union has focused the attention of both the European Commission and National Governments on a recovery whichprioritises jobs and inclusion. The EU Growth Strategy – Europe 2020 highlights thesepriorities:
‘We need a strategy to help us come out stronger from the crisis and turn the EU into asmart, sustainable and inclusive economy delivering high levels of employment, productivity and social cohesion
’.
Indeed, two of the five targets set out as part of the strategy emphasise the need to growthe employment rate of 20-64 year olds to 75 per cent by 2020 and to have 20 millionfewer people in or at risk of poverty and social exclusion, also by 2020. However,several demographic factors will determine how successfully these goals can beachieved. The ageing of the EU population, the need to work longer in order to afford apension, and the growing burden of chronic ill-health in the working age populationrepresent challenges both to higher employment rates and higher social inclusion.For almost five years, the ‘Fit for Work’ initiative has focused predominantly on the issueof workforce health and wellbeing and in this paper we will examine in more detail someof the important steps which may be needed to ensure that EU citizens of working ageare supported in playing a full part in the labour market even if they have a long-term or chronic health condition or disability.The challenge is considerable. For example, the European Union has a working agepopulation in excess of 170 million people. Yet almost one in six (16 per cent) has along-standing health problem or disability which affects their ability to participate fully inthe labour market
. This represents a significant under-utilisation of the productivecapacity of Member States and increases the risk that, during a period of highunemployment, a high proportion of these citizens will be excluded from the labour
1
EU Growth Strategy – Europe 2020;http://ec.europa.eu/europe2020/index_en.htm (accessed 8 October 2011).
2
Dupre D and Karjalainen, A (2003), Employment of Disabled People in Europe,Luxembourg:Eurostat. ; Brenner MH (2002), Employment and Public Health, Brussels:European Commission.
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