We know that there are forgotten conclusions from health economics such as the inevitability of healthcare market failure. We are not taking this into account in the current system for making reimbursement decisions about medicines at the level of healthcare systems. But what if how we currently think about medicine reimbursement is more wrong than that.
Currently many healthcare systems make decisions about the reimbursement of a drug at the level of an individual, specifically comparing costs at an individual level with benefits at an individual level. However, the decision is for costs at a system or population level and healthcare systems have repeatedly show themselves incapable of considering benefits wider than an individual.
We are missing benefits to families, carers, education, welfare, and employment, to name a few. Most of these are difficult, if not impossible, to accurately measure in the context of the decisions being made. But does that make it right to ignore them? Should we be considering drug reimbursement decision-making in a completely different way? Most reimbursement processes implicitly ignore (and some explicitly) the positive and negative externalities of a decision made considering evidence at the level of an individual when this decision is to be implemented for a population.