11/2/2022 0 Comments Marginal cost of a big macNo more so than in the US, where Federal and State governments have often been at loggerheads over the health and economic trade-offs of releasing (and imposing) lockdown, as well as in the now-numerous other locations, internationally, where local lockdowns have been imposed. The trade-offs emerging now are those around lockdown. But surely, health economics has more to offer as a way of thinking and, thus, in contributing to honest debate about emerging trade-offs once R is controlled and the curve flattened. Also, economists can contribute to the more ‘science-like’ modelling work of various international research groups and, likely, have been doing so. Particularly, at certain levels of disease, R must be controlled. This is also because, beyond a particular level of R (the reproduction rate for the virus) and background prevalence and incidence, the economy and health considerations go hand-in-hand. the ‘100,000-per-day’ in the UK) and little recognition given to a more-systematic approach to what might be needed by different groups, from which priorities for access, based on health gain for resources expended, could be established.Įven economists would recognise that there is a level of pandemic where trade-offs do not matter, or, at least, are so obvious that little analysis is required. From the very start, in many countries, shortages in testing and personal protective equipment were apparent, with meaningless large numbers thrown out in attempts to appease the public (e.g. Within health care, non-COVID-related care has been suspended to accommodate needs arising from the pandemic initially for sound clinical reasons relating to do-no-harm, but less so now. Health and social care have been traded off against each other, with investments in large (often unused) health care capacity at the expense of services and equipment for people in care homes. The economic stimuli of governments across the globe have traded-off the future against the present and sectors of the economy with each other. However, trade-offs have been palpable at all levels of decision making. Perhaps laying bare the trade-offs being made would not be seen as helpful to politicians who, naturally, do not like to recognise that they exist. Perhaps (health) economics is not ‘scientific’ enough. It could be argued that this has been one of the puzzling things of the coronavirus disease 2019 (COVID-19) pandemic, given that resource scarcity and trade-offs are the very lifeblood of economics. Trade-offs, trade-offs everywhere, but not a health economist in sight. Given the inevitability of such trade-offs, the framework exposes crucial questions to be addressed, such as: the critical value of R and/or background infection, above which health considerations predominate, and which may vary from jurisdiction to jurisdiction and the value of lives forgone resulting from the small increases in R and/or background infection levels that may have to be tolerated as the economy is gradually opened. The framework accommodates both perspectives in the health-vs-economy debate whereby, depending on where we are within the marginal analysis framework, either health issues are allowed to dominate or, below some threshold of R and/or background level of infection, health and economic considerations can be traded off against each other. We illustrate its potential through consideration of optimising the balance between reducing the reproductive rate ( R) of the virus and further opening of the economy. Here, we illustrate why it is important, from a wellbeing perspective, to recognise such trade-offs, and provide a framework, based on the economic concept of ‘marginal analysis’, for doing so. Despite denials of politicians and other advisors, trade-offs have already been apparent in many policy decisions addressing the coronavirus disease 2019 pandemic and its social and economic consequences.
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