Abstracts Economics

Health system sustainability : new perspectives from macroeconomics and ecological economics

by MC Hensher

Background: Traditionally, discussions of the ‚ÄövÑv¿sustainability‚ÄövÑvp of health care systems have largely been economic in nature, centring on whether societies can ‚ÄövÑv¿afford‚ÄövÑvp to fund the ever-growing array of health technologies potentially available to them. Climate change and a range of other environmental problems are now recognised as posing increasingly grave threats to human health. Meanwhile, understanding of the scale of the environmental damage caused by health care systems has expanded rapidly in recent years, as have demands that health care systems address the challenge of ecological sustainability. Meanwhile, global economic growth has remained historically low over the last decade; many see the need for profound transformations of economic systems at national and global level if humanity is to avoid environmental catastrophe. This PhD thesis, entitled ‚ÄövÑv¿Health System Sustainability: new perspectives from macroeconomics and ecological economics‚ÄövÑvp, examines the interface between economic and environmental sustainability in health care. Aims: The aims of the research program reported in this thesis were as follows: i) to investigate the likely economic implications for health systems of the Anthropocene and the ecological crisis; ii) to apply concepts and frameworks from ecological economics to health and health care; and iii) to explore how the discipline of health economics and some of its key tools may need to adjust in response to the growing importance of environmental sustainability in health care systems and policy. Methods: To achieve these research aims, a variety of methods have been used in the research program reported in this thesis. The approaches used have included extensive literature reviews, presentation and statistical analysis of comparative international data, scenario analysis, modelling of the incorporation of negative environmental externalities into healthcare costs and cost-effectiveness analyses, and the development of a variety of theoretical and conceptual frameworks. Thesis outline: The thesis has been structured into three main sections. Section I explores the macroeconomics of health and health care in the Anthropocene era: ‚ÄövѬ¢ Chapter 2 reviews the post-Global Financial Crisis economics literature on economic growth and ‚ÄövÑv¿post-growth‚ÄövÑvp economics, and investigates the consequences for health care systems and health economics. ‚ÄövѬ¢ Chapter 3 reviews the ecological macroeconomics literature, and uses scenario analysis to examine the likely consequences for health systems of three post-growth economic scenarios (a ‚ÄövÑv¿steady state‚ÄövÑvp economy, voluntary degrowth ‚ÄövÑv¨ a planned reduction in the material scale of the economy, and involuntary degrowth ‚ÄövÑv¨ an unplanned reduction in the material scale and complexity of the economy). ‚ÄövѬ¢ Chapter 4 reviews and synthesises the literature on decoupling economic growth from ecological impacts, and considers the challenges facing healthcare systems in responding to a world of…