UCSF students grapple with the health economics of pharmacy

This April, a group of UCSF second-year doctor of pharmacy (PharmD) students won the ISPOR 2021 Pharmacoeconomic Debate competition. The debate, which tackled the impacts of different insurance plans on the quality of U.S. health care, was an opportunity for students to explore the often-overlooked but critical field of health economics.

“To advocate for patients, it’s important as a practicing pharmacist to get a better picture of how the health care system works,” said Leslie Wilson, PhD, faculty member in the UCSF School of Pharmacy’s Department of Clinical Pharmacy and faculty preceptor of UCSF’s ISPOR chapter. “The pandemic, especially, has really illuminated how economics plays into everything from health care access to the development of vaccines and what the equity of it all is.”

ISPOR (the International Society for Pharmacoeconomics and Outcomes Research) is a professional organization dedicated to pharmacoeconomics, which compares the costs and values among pharmaceutical products; and health outcomes research, which focuses on the impact of health care interventions on patient well-being. Together, research from both fields makes health care more efficient, accessible, and equitable.

For this year’s debate, ISPOR asked competing teams to consider whether financial resources would be better spent on ESI (Employer-Sponsored Insurance, or employer-purchased) or individual (self-purchased) insurance plans, when it comes to patient outcomes.

Given that the ISPOR competition is still relatively new, the UCSF School of Pharmacy and California Northstate University College of Pharmacy were the only schools that participated. Four UCSF teams competed in the initial written portion of the debate, while the CNU teams competed in a similar preliminary round of their own.

The team from UCSF that ultimately won, consisting of Afshar Hassani, Kelly Lam, Sabrina Lin, and Venus Tong, all Class of 2022, divided up the research on the pros and cons of each side. They then submitted a comprehensive report with their findings.

“We considered multiple perspectives [while writing the report],” said Lin. “We needed to consider the patient perspective, the insurance company’s perspective, and the impact that [these different types of insurance] would make on the U.S. health care system and economy as a whole.”

The team encountered several challenges during their research, including finding reputable, evidence-based studies and up-to-date, easily accessible data on insurance claims.

It was also difficult to directly address patient satisfaction, according to Hassani. “We had to put ourselves in the patient’s shoes when we were answering these questions, because there weren’t a whole lot of studies for us to go off of,” he said.

Once each UCSF team had submitted its report, the top two participated in a faculty-judged oral debate against each other. After winning this semifinal round, the top UCSF team then faced the top CNU team in a final oral debate, which the UCSF team ultimately won.

The competition showed the students how health economics can improve patient outcomes by informing, for example, how to lower the cost of health care without sacrificing quality. The students also confronted the uncomfortable reality that while the health care system’s mission is to optimize patient health, it must also balance policy, availability, and profit, making it difficult to effectively advocate for patients.

“It’s really important for us to start breaking down how we fight for our patients on this,” said Lin. “Many people fall through the gaps in our health care system, and we need to do something about it.”

Similarly, Lam noted that navigating the maze of the health care system is no small feat for either patients or providers. “Without access to care, there is no care,” she said. “So learning about this and understanding it gives us the ability to advocate for policies that improve that access.”

The UCSF School of Pharmacy has already started to integrate more health policy and economics into its curriculum. PharmD students receive lectures on health systems and policy during their first quarter. The Medicare Part D Outreach, in which students enroll new patients into the government program, offers a hands-on way to interact with the public and learn more about insurance. Students may also participate in a health economics-focused group for their Discovery Project, allowing for deeper exploration of the topic.

The winning team came up with a few additional ideas to address health economics and policy in the curriculum, given that the program’s inquiry discussions are often narrowly focused on the clinical risks and benefits of certain drugs, according to Lam.

Students could gain more exposure to these topics by reframing at least one of the many inquiry debates they normally participate in, or by providing policy-focused classroom exercises, such as one in which students determine who to save in a disaster given limited health resources. The school might even consider offering more electives about health policy and economics in general.

With these new understandings in mind, the team is proud of their accomplishment, but they know that more work remains. The field of health economics is constantly changing, and trying to fully understand it is a process that will stretch far into every pharmacist’s career.

“There are so many moving pieces [in the U.S. healthcare system] that as pharmacists, there’s no way that we can be experts in everything,” said Tong. “We need to have that passion to learn about the system as it changes over time in order to benefit our patients. We just have to keep learning more and more as we go forward in our careers.”