Health care is responsible for a range of negative environmental impacts, including greenhouse gas emissions, air pollution, plastics waste, and pharmaceutical pollution of ecosystems through excretion and inappropriate disposal. Evidence on the scale of these impacts has been growing in high-income countries. To date, there has been only limited discussion of how environmental impacts might be incorporated into economic evaluations of health care programs, including health technology assessment. This paper considers why and how this aim might be achieved, using perspectives from both mainstream and ecological economics. There are strong arguments for using economic evaluation to internalise the negative environmental externalities currently being generated by health care, as well as precautionary arguments for health systems to better understand their exposure to their environmental impacts. The paper tests the feasibility of incorporating the costs of greenhouse gas emissions within costing for economic evaluation, and concludes that the use of shadow prices to achieve this aim is feasible. It suggests that this cost-based approach is preferable to more convoluted attempts to incorporate environmental impacts in the outcome component of health economic evaluations. The interaction between overuse, antimicrobial resistance and environmental harms of health care is identified as an area that would benefit from investigation using innovative economic methods.

Item Type:	Refereed Article
Keywords:	health care, environmental impacts, externalities, economic evaluation, health economics, ecological economics
Research Division:	Health Sciences
Research Group:	Health services and systems
Research Field:	Health care administration
Objective Division:	Health
Objective Group:	Public health (excl. specific population health)
Objective Field:	Health status (incl. wellbeing)
UTAS Author:	Hensher, M (Mr Martin Hensher)
ID Code:	139680
Year Published:	2020
Web of Science® Times Cited:	7
Deposited By:	Medicine
Deposited On:	2020-06-25
Last Modified:	2021-09-16
Downloads:	0