Researcher spotlight: Dr Marcin Sowa

8 May 2020

Dr Marcin SowaDr Marcin Sowa is a Postdoctoral Research Fellow in the Centre for the Business and Economics of Health (CBEH).

His primary research interests are health policy and evidence-based decision models, and he has worked on the topics of private health insurance, hospital governance, comparative healthcare systems and health technology assessment, as well as the economics of oral health care and chronic disease.

We sat down with Dr Sowa to learn about his passion for health economics, learnings from COVID-19 and current research projects.

What is health economics?

Health economics is an applied field. As a health economist, I look at what is happening within the healthcare system and, through economic analysis, determine whether the system and its outcomes could be improved.

Health economists aim to answer fundamental economic questions:

How are we allocating our scarce resources such as hospital beds and doctors’ time? Are we generating the greatest possible benefit from what is available? How are the benefits distributed in the community? Who decides about priorities and incentives?

Essentially, we try to maximise the benefits from the resources available to us. If the resources are public or publicly funded, then any trade-offs that have to be made should ideally align with social preferences.

Why is health economics research so important, particularly in light of the COVID-19 pandemic?

I think what makes health economics important is the value we attach to health and the size and importance of the healthcare industry. We all want to live and enjoy healthy lives, and we’re all producers of our own health to some extent. But we’re also consumers of health and health care. There’s a massive healthcare system that supports our health, which accounts for around 10 per cent of the economy. It’s the largest industry we have.

The current COVID-19 crisis has demonstrated the strong mutual dependency of the health sector and the broader economy. The economy clearly cannot function without the good health of the population. On the other hand, economic activity generates resources that enable the health sector operation.

The epidemic has also highlighted the critical role of information to support decision-making. This goes beyond the traditionally understood evidence-based medicine and includes understanding the consequences of medical and public health decisions for productivity.

Can you provide a practical example of your health economics research?

Recently, I have been involved in a research project for West Moreton Hospital and Health Service with my CBEH colleagues Professor Steve Birch, Dr Jonas Fooken and our research officer Diana Khanna. We’ve been asked to prepare economic analyses to inform decisions at the Ipswich Community Dental Clinic (ICDC).

For years, ICDC has had an in-house sterilisation unit for their dental instruments. But the standards have recently changed, and the new requirement is that all sterilisation of dental instruments should be done to a surgical standard. So the clinic now faces the question – should we upgrade our in-house process or move it to an off-site facility that already meets the requirements?

ICDC requested an economic analysis to help with that decision. It’s not solely a question of the additional investment required; it’s also a question of costs associated with the new process, its risks, opportunity costs and opportunity benefits. For example, removing the sterilisation process facility would free up some space at the clinic. We have to ask, what would be the potential uses for that space, and what value would it generate?

We’ve tried to appraise such direct and indirect consequences and identify the main drivers of the decision to help the clinic make the right call.

The clinic also wanted to explore replacing some of their reusable instruments with disposable ones, but they’re conscious of the potential environmental impacts. So we’ve prepared a framework – combining economic and environmental impacts analysis – to guide their decision. This is interesting because you have to think about the impacts of manufacturing and disposal of many single-use instruments per one reusable instrument. On the other hand, you have to consider that reusable instruments are reprocessed after every use, which also impacts on the environment in terms of water and energy consumption.

Based on a literature review and our own analyses, we concluded that reusable instruments are preferred in most situations, but disposable ones can be a better option in some circumstances. Relying on reusable instruments also demands more from the provider organisation, because their advantage over single-use instruments depends on the efficiency of the sterilisation process.

What is the potential impact of this research?

We’re working on a case that is specific to ICDC, but West Moreton Hospital and Health Service are considering applying our model to other sites. There has been interest from other Hospital and Health Services as well. We’re excited that our research could have a broader, state-wide impact.

What is it like working at CBEH?

We’re still a young Centre, but there are so many opportunities to partner with people who have great interest in, and ideas for, improving health. I enjoy working with clinical groups, health researchers and provider organisations across Queensland. Many of them have practical questions or seek specific solutions. Naturally, we also have a network of national and international academic collaborators who tend to focus on the bigger picture.

It’s fantastic to be part of these efforts that can lead to better outcomes at all levels of the health system.

Can you tell us about some of your work outside of CBEH?

Since 2016, I have been serving as an appointed member of the Medical Services Advisory Committee, Evaluation Sub-Committee. This body advises the Minister for Health on the medical services that are being considered for funding by the Australian Government. For a new service or technology to become available on Medicare it has to be assessed as safe, effective and cost-effective. My role as a health economist is to focus on that last criterion. Based on clinicians’ evaluations of safety and effectiveness, we’re able to model how costly it is to generate additional benefit. This is important because the government can’t afford to fund everything and has to prioritise with all patients in mind. If a particular service is not good value for money, in many cases we’re better off investing the funds elsewhere.

What do you enjoy most about partnering with industry and government to solve problems?   

Contrary to a common belief, there’s a great appetite for good quality evidence and data to inform decisions of the industry and government. That’s my experience, anyway.

The world is complex and messy, and as a decision-maker, it’s not always easy to tell good ideas from the bad ones. I enjoy dealing with that messiness.

Approaching problems systematically, applying well thought-out frameworks and relying on the best available evidence are sure-fire ways to guide decisions.

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