Sound health care economics: Provide the treatment needed (not less, not more)

Abstract

Founding figures in Western medicine both puzzled over and anticipated a day when demand for expensive treatments would outstrip financial wherewithal. In the United States, that day has arrived and, with it, the need for sound health care economic policy that selectively covers treatments of demonstrable effectiveness and efficiency. Standard cost-effectiveness methods exist to determine the value of alternative treatments, but they have rarely been applied to behavioral interventions in the United States. Cost-effectiveness analyses are one part of the solution to learning which treatment packages warrant coverage because they produce the most health for the most people. Another part of the solution involves applying novel multiphase optimize strategy methods to reengineer behavioral interventions so that they yield the maximum health benefit attainable for the least resource expenditure. Among the research designs in the multiphase optimize strategy toolkit are methods to derive algorithms that address naturally occurring population heterogeneity in the response to treatments. Such algorithms suggest a population-level protocol to adapt and prioritize treatment options once a patient has failed to respond to an evidence-based practice that was offered as first-line treatment. Developing sound health care economic policy for the population requires systematically figuring out who needs what care and how to provide them what they need-not less and not more. (PsycINFO Database Record (c) 2019 APA, all rights reserved).