Articles: health.
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Bull. World Health Organ. · Jan 1994
Cost-effectiveness analysis and policy choices: investing in health systems.
The role of health systems infrastructure in studies of cost-effectiveness analysis and health resource allocation is discussed, and previous health sector cost-effectiveness analyses are cited. Two substantial difficulties concerning the nature of health system costs and the policy choices are presented. First, the issue of health system infrastructure can be addressed by use of computer models such as the Health Resource Allocation Model (HRAM) developed at Harvard, which integrates cost-effectiveness and burden of disease data. ⋯ Widespread use of cost-effectiveness databases for resource allocations in the health sector will require the cost-effectiveness analyses shift from reporting costs to reporting production functions. Second, three distinct policy questions can be treated using these tools, each necessitating its own inputs and constraints: allocations when given a fixed budget and health infrastructure, or when given resources for marginal expansion, or when given a politically constrained situation of expanding resources. Confusion concerning which question is being addressed must be avoided through development of a consistent and rigorous approach to using cost-effectiveness data for informing resource allocations.
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As part of the background research to the World development report 1993: investing in health, an effort was made to estimate public, private and total expenditures on health for all countries of the world. Estimates could be found for public spending for most countries, but for private expenditure in many fewer countries. Regressions were used to predict the missing values of regional and global estimates. ⋯ In 1990 the world spent an estimated US$ 1.7 trillion (1.7 x 10(12) on health, or $1.9 trillion (1.9 x 10(12)) in dollars adjusted for higher purchasing power in poorer countries. This amount was about 60% public and 40% private in origin. However, as incomes rise, public health expenditure tends to displace private spending and to account for the increasing share of incomes devoted to health.
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In Yemen, where both population increase and maternal mortality are exceptionally high, a strategy for safe motherhood has been adopted. The authors outline the obstacles to progress and suggest ways in which the aims of the strategy might be realized, with particular reference to complete reorganization of the services of family planning and maternal and child health care.
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The birthweight and mortality in hospital was recorded of 567 low birth weight (LBW, < or = 2000 g) infants born/admitted during a 7 years period in Agogo Hospital situated in the rainforest area of Ghana. One hundred and fifty-two (26.8%) of these children died in hospital; 87 (57%) of them in the first 48 hours. The average length of stay in hospital of the surviving children was 11.6 days. ⋯ In our setting, no sophisticated equipment and expensive intensive care provisions were available. This descriptive study was carried out to establish the survival rate in the neonatal period during the primary stay in hospital with low-cost conservative care. Dedicated staff members, who underwent only a simple training programme, and mothers participating in the care for their children contributed to the relatively favourable outcome.
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World Health Stat Q · Jan 1994
Population change, health planning and human resource development in the health sector.
As a result of the demographic and epidemiological transitions now occurring rapidly in many developed countries, a dramatic shift in the age structures of populations and the burden of disease towards the middle-aged and elderly is expected to take place over the next several decades. In the 1990s, however, there remains great diversity across countries in fertility levels and mortality patterns. The World Bank's 1993 World Development Report assessed the global burden of disease in order to define the minimum packages of public health measures and clinical interventions that would improve health conditions in low-income countries in a cost-effective and affordable way. ⋯ Such a population-based health strategy will require the development of a wide range of scientific, analytical and technical capacities, currently rare in most ministries of health. This will require the involvement of epidemiologists, demographers, sociologists, analysts, operations research specialists and environmental health scientists. Building up these capabilities in health ministries, universities or the private sector will be an essential ingredient of health system reform.