Pitfalls of Healthcare Economics as Considered by Healthcare Professionals―Things They Should Know Before Discussing Healthcare Rationing in a Medical Setting

Medical care in Japan, which has achieved one of the world's longest life expectancies, is highly regarded globally, but national medical expenses continue to increase yearly. In the past, physicians focused mainly on doing what is best for the patient without considering any budget impact. However, physicians are now required to take into consideration health economic evaluations as well. As a result, physicians now consider medications not only from the standpoint of individual patients (micro perspective), but also from that of the public/society (macro perspective). This has led to a situation in which these two perspectives on the allocation of medical resources are easily confused. The purpose of this paper is to describe the situation outlined above, taking into account the current state of medical practice as well as key concepts in research ethics and medical economics. First, in terms of medical practice, as seen in the “Minds Manual for Clinical Practice Guideline Development 2020,” the introduction of health economic evaluation has forced healthcare professionals to think from a macro perspective when considering patient treatment. Second, in terms of the distinction between research and treatment, an important topic in research ethics, medical researchers need to think from a macro perspective when planning and conducting research, because they are required to consider the social benefits of the research. Consequently, the social benefit sought in research and the clinical benefit to individual patients/subjects, as well as the macro and micro perspectives relating to the allocation of medical resources, are intertwined in the eyes of researchers, placing them in a situation where conceptual confusion can readily occur. Finally, in terms of medical economics, the efficiency of production (micro level perspective) and efficiency of allocation (macro level perspective) are easily confused in medical practice when considering the cost-effectiveness of treatment. In view of the above, this paper discusses the importance of recognizing, as a preliminary step to further discussions on the issue of allocation of limited healthcare resources, that the decision-making body at the macro level must be the government rather than individual medical personnel, and that the decision-making body at the micro level must be individual medical personnel (and individual patients) rather than the government.