The American Speech-Language-Hearing Association (ASHA) strives to ensure that all individuals have access to and are positioned to appropriately achieve effective communication.[1] Should it also matter that resource allocation decisions are made in an appropriate manner? In other words, this mission cannot be achieved without carefully considering the scarcity of resources, opposing information, and costs of forgone opportunities. An important issue, then, would be whether the processes involved are feasible, valuable, and/or efficient. Economics has traditionally been a predominantly consequentialist discipline, and the typical treatment of the characteristics within economics has been to interpret them as having solely ancillary value—they are valuable only to the extent that they enhance outcomes. Yet only recently has ASHA recognized those fundamental economic principles as both inherently valuable and profoundly necessary for pursuing and achieving this mission. ASHA's Strategic Objectives 1, 4, 5, and 6[1] emphasize the value, choice, and novelty of services, treatments, and delivery mechanisms. In addition to services that inform and enhance communication, ASHA has also embedded the tenants of health economics within their objectives, thereby implicitly acknowledging that the health economics of speech and language deserves consideration, discussion, and study.

Economics involves the study of the allocation of scarce resources.[2] Given that individuals have infinite desires and needs, but only limited resources with which to satisfy them, economics helps us understand how to best distribute those resources to achieve optimal outcomes. While discussion of health economics did not begin until roughly the mid-twentieth century,[3] it is embedded within the ideals of efficiency and rationality. As a discipline, health economics experienced significant maturity in the 1980s and 1990s and has since maintained consistent growth.[4] Recently, the field of speech-language pathology has begun to consider how it relates to communication disorders. There are costs associated with both having a communication disorder (quality of life, relationships, income, etc.) and costs associated with treating a communication disorder (time, money, etc.).[5] [6] [7] While those costs incurred by the individual with the communication disorder are generally considered first, family members, caregivers, and/or loved ones; health providers; third-party pay sources; and society as a whole also bear a portion of the cost burden.[8]

The type, amount, and nature of these associated costs varies by the individual and their condition.[7] For example, a child with a developmental disorder faces a difference set of costs from an adult who has experienced a cerebrovascular accident. Additionally, costs are not equitable across all individuals or populations.[9] [10] Heterogeneity of severity, onset, and coexisting conditions can influence both the cost of the disorder and the availability of and access to treatment.[11] [12] Consequently, the value of treatment might also vary similarly to costs as treatment might be differentially valued by those with different types of functional outcomes. Therefore, utilization of economic systems of value maximization, cost minimization, and efficient allocation can inform the use of services, treatments, and methods. While many Americans currently view the healthcare industry negatively due to rising costs and limited access, sciences, like economics, which are based in optimality and efficiency could allow greater transparency and more equitable distribution of access.[13]

This issue highlights the use and tools of health economics in speech-language pathology treatment, research, and study. The collection of works in this issue will provide clinicians and researchers in the field with several practical tutorials, applications of health economics, and compelling research questions with novel findings. These six papers provide an exposition upon which future inquiries can be built to advance our understanding of this topic. As you thoughtfully consider this issue, we encourage scholars, clinicians, and researchers to converse, question, and consider this oftentimes overlooked topic that is intimately tied to the work we conduct.

The first paper in this issue by Baylor et al[14] utilizes a national dataset to evaluate the inclusion of communication disorders in national surveys and to estimate the prevalence of aging adults living with communication difficulties, profile how these adults interact with healthcare systems, and identify their potential barriers to healthcare utilization. The authors highlight considerations for healthcare providers to improve the experiences for elderly patients and help to reduce costs to patients and clinicians. Additionally, findings suggest that companions and family members play an important role in the determination of functional outcomes and service delivery.

Ellis and Jacobs[15] review current literature applying health economics study to aphasia, then identify avenues for future research in this area. In their paper, Ellis and Jacobs identify the costs associated with aphasia and how this burden is distributed. They urge consideration of outcomes beyond functional improvements in the treatment of those with aphasia such as cost, cost-effectiveness, affordability, and value of treatments. They assert that failure to consider these factors hinders the adoption of novel treatments and clinical approaches.

With the first two papers as the background, Hoch and colleagues[16] provide a thorough overview of various types and classifications of costs. Each type of cost is introduced to the reader and explained using examples. Finally, the authors illustrate how these costs may be population-weighted and utilized for policy and decision evaluation. Throughout this essay, the authors contend that health economics is essential for the sustainability of quality care with finite resources.

Meulenbroek and Cherney[17] evaluate a computer-based approach for targeting social communication for individuals with traumatic brain injury (TBI). When used to supplement conventional treatment, the approach described results in overall costs savings. The authors detailed aspects of this approach that users preferred and opportunities for improvement. They discuss how the leveraging of technology can result in new client-led tools that enhance progress during rehabilitation. The authors conclude by outlining additional areas where technology could be leveraged by speech-language pathologists (SLPs) and exploited in other TBI treatments.

In the fifth paper, Briley and Jacobs[18] discuss the potential impacts of stuttering on individuals' well-being and their subsequent labor market outcomes. Coping behaviors are identified, specific to stuttering, that could potentially influence career-related outcomes. The authors provide evidence, using a nationally representative sample, of wage differentials between people who do and do not stutter. Additionally, this sample provides evidence of improved labor market outcomes among individuals who stutter who have seen an SLP compared to those individuals who stutter who had not. However, authors note that a well-designed study is needed to investigate the relationships between stuttering, different treatment approaches, and individual labor market outcomes.

In the final paper, Hoch et al[19] provide readers with a tutorial on cost-effective analysis. Using hypothetical data, the authors demonstrate the necessary steps taken in such a study. This paper highlights the need to consider value and effectiveness when making decisions for both policy and clinical treatment approaches.

The collection of papers contained herein represents the work of scholars committed to innovation in their respective fields. They endeavor to consider the importance of foundational elements beyond clinical effectiveness. They recognize the scarcity of all resources and that, only with consideration of how these constraints influence how we work and operate, can we, as clinicians, advance our discipline within the healthcare realm. By identifying and understanding the constraints within which we work and operate, we, as clinicians, will be best positioned to serve our clients. As our profession continues to innovate, improve, and refine treatments and service deliveries, we can only achieve optimal effectiveness and quality by acknowledging scarcities and efficiently allocating according to the principles of health economics. We hope that this issue enhances your understanding of these principles and how they are embodied in our field. Only through understanding and continued discussions, can we serve as a vehicle to effect change.

Article published online:
20 July 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA