Social science & medicine
-
Social science & medicine · Aug 1995
The relationship between cost-effectiveness analysis and cost-benefit analysis.
This paper examines the relationship between cost-effectiveness analysis and cost-benefit analysis. Provided that a cost-effectiveness analysis includes all the relevant societal costs, it is shown that a cost-effectiveness analysis can be interpreted as a cost-benefit analysis where the willingness to pay per effectiveness unit is assumed to be constant and the same for everyone. ⋯ It is argued that cost-effectiveness analysis is best viewed as a subset of cost-benefit analysis, where the aim of the analysis is to estimate the cost function of producing health effects. It is also concluded that to interpret and use cost-effectiveness analysis as a tool to maximize the health effects for one specified real-world budget, will be inconsistent with a societal perspective and is likely to lead to major problems of suboptimization.
-
This paper examines the equity characteristics of health care financing and delivery in Australia and compares its performance with recent findings on systems in Europe and the United States. Vertical equity of finance is evaluated with income and payment concentration indices derived from published survey data on taxes and expenditure by income decile. Horizontal equity of health care delivery is assessed with standardized expenditure concentration coefficients for three measures of health status and four types of health services, derived from household survey data on health care utilization, health status, income and demographics. ⋯ This analysis provides a benchmark for monitoring the equity of the Australian system and provides information on the equity of a mixed private and public financing system that covers the entire population. This is relevant to the U. S. which is moving in this direction by extending private cover to the uninsured and to European countries that are increasing private sector involvement in health care financing.
-
The delivery of humanitarian aid in wartime is difficult. However, it is essential that aid is provided in the most effective manner possible, targeted on those most in need whilst minimizing waste. Furthermore the delivery of aid should be sensitive to the future needs of the communities in conflict. ⋯ The data generated was valuable in planning interventions to minimise the possibility of major outbreaks of infection, reduce the impact of infectious disease and in guiding the humanitarian aid effort. The experience described suggests that public health surveillance of the civilian population in wartime is possible and useful. Besides the need for planning, the public health doctor in wartime has a role as an advocate for those suffering; this function can be carried out much more effectively if it is based on objective data collection rather than hearsay.
-
Social science & medicine · Mar 1995
Comparative StudyRelationship of caregiver reactions and depression to cancer patients' symptoms, functional states and depression--a longitudinal view.
This research examined, in a sample of N = 150 cancer patients and caregivers, the relationships among patient's physical functioning, depression and symptomatology, impact on caregivers' schedule and health, and caregiver depression, as well as the changes in these variables over time. A measure of caregivers' optimism was also included in the analyses. The disposition of caregiver optimism was a strong predictor of caregiver reactions to the burdens of caring, and seemed to play the role of a personality characteristic which was for the most part independent of patient variables. ⋯ Caregivers' reactions were clearly distinct, and were influenced differently by different patient variables. However, all three types of caregivers' reactions were influenced by caregivers' optimism. Oncologists, nurses and other health care professionals involved in the care of patients with cancer should consider this potentially important personal characteristic in the assessment of need for and the development of interventions designed to assist patients with cancer and their family caregivers.
-
The results from two surveys in England of relatives and others who knew people in samples drawn from death certificates are reported. The main focus is on a sample of 3696 people dying in 1990 in 20 health authorities, with supporting analysis from an earlier national sample of 639 people dying in 1987. The argument that good care and, in particular, hospice care is effective in reducing the desire for euthanasia has been proposed as an argument against the legalization of voluntary euthanasia. ⋯ It is suggested that this may be due to hospice care being geared to helping patients express their fears and exercise choice. The wish for euthanasia may then be an assertion of personal control, rather than an act of surrender. Alternatively, people (and their relatives) who accept hospice care may be predisposed to consider the benefits of an earlier death.(ABSTRACT TRUNCATED AT 250 WORDS)