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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This report describes the breastfeeding and weaning practices of rural women in two Mexican towns and the cultural beliefs upon which these practices are based. Interviews and focus group discussions were used to collect information. Women thought breastfeeding preferable to bottle-feeding. ⋯ Women's decisions regarding infant feeding were influenced most by custom and advice from doctors and family members. In some instances medical advice conflicted with traditional practices. These findings suggest important avenues for intervention in hospital practices, education for health care workers, and in the development of health promotion services.
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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.