/ Dr. Fiona Kiernan

Biography
Fiona Kiernan is a Consultant in Anaesthesia and Intensive Care Medicine in Beaumont Hospital, Dublin and a fellow of the College of Anaesthetists of Ireland. She graduated from University College Dublin (UCD) in 2005, and completed anaesthesia training in Ireland, with a clinical fellowship in University College Hospital, London. She has held a place on the State Board of the Health Insurance Authority since 2016.

Along with her medical degree, she also holds a Masters in Health Economics, Policy and Management from the London School of Economics and Political Science, and is studying for a doctorate in economics with the Department of Economics in University College Dublin. She lectures on topics relating to resource allocation and health economics, and has presented internationally on healthcare utilisation, access to healthcare, behavioural economics in healthcare delivery, and the effects of uncertainty on health outcomes. Her main areas of research are outcome measurement, the social determinants of health, and the application of microeconometric theory in healthcare.

Abstract
Along with other high income countries, Ireland faces increasing pressure to provide high quality healthcare for citizens in the presence of high levels of debt, an ageing population, an increase in chronic diseases, and a growing demand for costly technology. A drive towards ensuring that health care systems are accountable to their citizens has resulted in a focus on economic evaluations in healthcare.

Clinicians are likely to have to demonstrate that the care we provide is cost-effective, and we will also have to compete for scarce resources available for public policies. Luckily, economic evaluations are now a routine, and often mandatory, part of clinical trials. It is important that anaesthetists involved in research routinely measure health variables that can be used to measure utility. But this measurement of utility and preference is not just the domain of researchers, and all clinicians should routinely consider the broader economic implications of healthcare decisions.

All to often it is assumed that these economic implications only revolve around cost-effectiveness analysis and health technology assessment.

However, focusing only on cost-effectiveness may fail to capture the full impact of the care we deliver. We cannot neglect how the care we provide may also have a potential socio-economic benefit through returns to employment, reduced need for informal caregiving, as well as socio-ethical contributions in terms of health equity.