Monday, 7 October 2013

Evidence-based... funding?

White HouseSince the US Government shutdown is on-going, with an impasse between the House and Senate revolving around 'Obamacare', it seems pertinent to discuss how health care services should be funded (or indeed cut). Several Western governments, including the US and the UK, routinely create vast expenses that exceed their incomes, leading to a budgetary crisis similar to the current one. The temptation for governments is to slash funding to the fiscally more 'greedy' programmes; in essence, to force reductions in expenditure in those areas, hoping they adapt to the new fiscal pressure.

It has been suggested, as an article written in the Nature journal back in April discusses, that a more sensible approach is t o allocate funds based upon evidence; that is, to fund what is proven to work, and cut what funding to failed initiatives. In fact it appears as though the US government is taking this route in order to fund all programmes within the sciences. From the April budget, it is made clear all branches need to follow six core practices:

  1. Goal-setting;
  2. Frequent measurement of performance and other indicators;
  3. On-going analysis;
  4. Use of evidence in decision-making;
  5. Data-driven reviews; and
  6. Information dissemination that is timely, accessible, and user-friendly.
One method, currently being trialled for teen pregnancy prevention in the US, is a tiered funding approach which is not dissimilar to the phases in clinical trials. At the lower stages there is initial funding to explore and assess ideas and developments, but that funding is limited. To progress through the tiers, and hence receive more funding, one would need to acquire more evidence to support the case for development.

Another method, more commonly used here in the UK, is through the use of social impact bonds (better known by the term 'Pay for Success'). This is particularly relevant under the increasing privatisation of medical services; outsider investors are required to meet set targets and prove they are saving the public money in order to receive compensation from the NHS. 

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