On Friday February 24, Eddy Van Doorslaer, professor of health economics, said goodbye to the university after 32 years. Before his valedictory lecture, the symposium "Health Economics: what's next?" was organized. This was a reflection on trends in health economics and a tribute to Van Doorslaer's contribution to the field. He received a royal award for this contribution after his lecture.
"His work has a major impact on healthcare policy worldwide and contributes to reducing health inequality," said host Werner Brouwer of Erasmus School of Health Policy & Management (ESHPM). The faculty organized the symposium together with Erasmus School of Economics (ESE), where Van Doorslaer had also been a professor since 2006.
All speakers emphasized his huge contribution to health economics. For that contribution, he was appointed Knight of the Order of the Dutch Lion. From Erasmus University Rotterdam he received the Desiderius Award. The Erasmus Centre for Health Economics Rotterdam (EsCHER) also launched the 'Eddy Van Doorslaer Award'.
‘A world to win’
Van Doorslaer himself chose the speakers of the symposium 'Health Economics: what's next?'. During different phases of his career, he had worked with all of them. Yet he had specifically asked the speakers to reflect on future trends and challenges in health economics. Professor Maureen Rutten-van Mölken (ESHPM) discussed personalized medicine, which means medication is tailored to the DNA profile of a patient. This leads to far fewer side effects in some treatments, such as chemotherapy. It can also save unnecessary healthcare costs, for example by preventing overdosage.
According to Rutten, there is "a world to win" with personalized medication. Yet there are still challenges, according to the professor, for example because personalized medication makes it more difficult to demonstrate the (cost) effectiveness of treatments in large-scale studies. To fulfill the great expectations, she hopes that the DNA profile of the population will be mapped on a larger scale. At the same time this offers opportunities for prevention, Rutten concluded: "Personalized prevention looks promising, but also raises an ethical debate. If someone is genetically more at risk for certain diseases, that person should have the right not to want to know."
The good, the bad and the ugly
Behavioral economist Han Bleichrodt (Formerly ESE, now University of Alicante) reflected on the QALY. That stands for quality-adjusted life year and is a widely used calculation method that compares the cost of a treatment with the health gain. He called the QALY "the good, the bad and the ugly" because the calculation method, although simple in design and widely applicable, also has limitations in his view. For example, QALYs can be systematically miscalculated or even overestimated. Yet Bleichrodt was optimistic: "The QALY method continues to evolve and good modifications are being developed."
Worldwide, 1.4 billion people are in financial distress because of their healthcare costs. In a presentation titled "Financial Protection", Owen O'Donnell (ESE) highlighted the major impact Van Doorslaer has had in reducing inequity in healthcare. The measure he developed is widely used to assess the impact of healthcare spending in different countries, for example, when households are forced to do out-of-pocket spendings. "Of course there are shortcomings, but the strength of this measure lies in its simplicity", O'Donnell emphasized. In his outlook, he suggested some modifications to the methods developed by Van Doorslaer.
Valedictory lecture: “UHC, more than old wine in a new bottle?”
In his lecture Van Doorslaer reflected on the World Health Organization's Universal Health Coverage programme (watch here). That programme focuses on improving access to care worldwide, including the poorest. He stressed the importance of good measures for making political choices, for example when introducing a more progressive healthcare system (where the rich contribute more). He also illustrated how the methods he developed still influence the Universal Health Coverage programme to this day. Van Doorslaer concluded his farewell speech with a personal note to his colleagues: "I want to thank you all for our unique and rewarding collaborations. The future of health economics at EUR looks bright."
Spending every dollar well
"To reduce mortality, by now low-quality care is a bigger obstacle than access to healthcare," said Ellen van der Poel. She is a health economist and works in Senegal for the World Bank. Van der Poel talked about a research project where the financing of clinics is linked to the quality of care provided. Although in practice it is hard to implement this system, she says it is worth exploring. "Efficiency is crucial. You don't want to just throw money, but make sure that every dollar you invest in health care is well spent."
Genetics: from 2D to 3D research
Hans van Kippersluis (ESE), professor of applied economics, gave a historical overview of research on the origins of health inequality. He referred to some famous studies on the effect of education and income on health. For example, studies that map whether university graduates or lottery winners live longer on average. Many of these studies, according to Kippersluis, have limitations: there are many individual characteristics, including genetic factors, that make comparison problematic. "When we can also look at genetics, we can go from 2D to 3D research. At the same time, this will make it possible to identity if health inequalities are related to genetic differences."