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Biomedical subjects

P Musgrove

Publications and source records attributed to P Musgrove.

At least 19 recordsLinked to original sources
PubMed2000

Cost-effectiveness as a criterion for public spending on health: a reply to William Jack's 'second opinion'.

Cost-effectiveness analysis (CEA) deals with the principal health effect that enters any valuation of benefits, without the difficulty of moneterizing health gains or treating differences among individuals in how they value health improvements. Much of Jack's criticism of CEA is based on misunderstanding of how it should be used. It is often an important criterion for determining how to spend public money on health care, but never the only one. Reasoning from the way individuals would choose to spend their own money among different desirable effects, where CEA is not applicable or people do not want the most cost-effective interventions, does not correspond to the problems faced in allocating resources across individuals for the same purpose.

Cost-Benefit Analysis↗
PubMed2000

A critical review of 'a critical review': the methodology of the 1993 World Development Report, 'Investing in Health'.

Since its publication in 1993, the World Bank's World Development Report, Investing in Health, has been subjected to much criticism, particularly over the way it proposes to measure the health losses summarized in the concept of the 'burden of disease', and to establish priorities for health interventions according to the reduction in mortality and disability they could produce and what they would cost. Some of these criticisms are justified, and are recognized by the WDR; others arise from misunderstanding or misapplication of the concepts. Sifting these criticisms to arrive at a better understanding requires looking at what kind of analysis is involved, how the subjective elements of the exercise were determined, and how they can be used to choose which interventions deserve priority when a country cannot meet all its citizens' health needs.

Adolescent↗
PubMed1999

Public spending on health care: how are different criteria related?

At least nine different criteria are relevant for decisions about public spending for health care. These include economic efficiency criteria (public goods, externalities, catastrophic cost, and cost-effectiveness), ethical reasons (poverty, horizontal and vertical equity, and the rule of rescue), and political considerations (especially demands by the populace). Sometimes one criterion should be examined before another one is considered; that is, they are hierarchically related. Sometimes two criteria will not be compatible but will conflict, forcing difficult choices--particularly between efficiency and equity. Properly thought-out choices of which health care interventions to finance with public funds therefore depend not only on looking at all these criteria, but also on treating them in the appropriate sequence and taking account of their possible inconsistencies. Public funds should finance public and semi-public goods that are cost-effective and for which demand is inadequate; cost-effective interventions that preferentially benefit the poor; and catastrophically costly care, when contributory insurance will not work or there are good reasons to finance insurance publicly.

Cost-Benefit Analysis↗
PubMed1999

Cost-effective malaria control in Brazil. Cost-effectiveness of a Malaria Control Program in the Amazon Basin of Brazil, 1988-1996.

Malaria transmission was controlled elsewhere in Brazil by 1980, but in the Amazon Basin cases increased steadily until 1989, to almost half a million a year and the coefficient of mortality quadrupled in 1977-1988. The government's malaria control program almost collapsed financially in 1987-1989 and underwent a turbulent reorganization in 1991-1993. A World Bank project supported the program from late 1989 to mid-1996, and in 1992-1993, with help from the Pan American Health Organization, facilitated a change toward earlier and more aggressive case treatment and more concentrated vector control. The epidemic stopped expanding in 1990-1991 and reversed in 1992-1996. The total cost of the program from 1989 through mid-1996 was US$616 million: US$526 million for prevention and US$90 million for treatment. Compared to what would have happened in the absence of the program, nearly two million cases of malaria and 231,000 deaths were prevented; the lives saved were due almost equally to preventing infection and to case treatment. Converting the savings in lives and in morbidity into Disability-Adjusted Life Years yields almost nine million DALYs, 5.1 million from treatment and 3.9 million from prevention. Nearly all the gain came from controlling deaths and therefore from controlling falciparum. The overall cost-effectiveness was US$2672 per life saved or US$69 per DALY, which is low compared to most previous estimates and compares favorably to many other disease control interventions. Contrary to much previous experience, case treatment appears more cost-effective than vector control, particularly where falciparum is prevalent and unfocussed insecticide spraying is relatively ineffective. Halting the epidemic by better targeted vector control and emphasizing treatment paid off in much reduced mortality from malaria and in significantly lower costs per life saved.

Brazil↗
PubMed1994

National health expenditures: a global analysis.

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. These econometric exercises were also used to relate expenditure to measures of health status. 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.

Financing, Government↗
PubMed1994

Design, content and financing of an essential national package of health services.

A minimum package of public health and clinical interventions, which are highly cost-effective and deal with major sources of disease burden, could be provided in low-income countries for about US$ 12 per person per year, and in middle-income countries for about $22. Properly delivered, this package could eliminate 21% to 38% of the burden of premature mortality and disability in children under 15 years and 10-18% of the burden in adults. The cost would exceed what governments now spend on health in the poorest countries but would be easily affordable in middle-income countries. Governments should ensure that, at the least, poor populations have access to these services. Additional public expenditure should then go either to extending coverage to the non-poor or to expansion beyond the minimum collection of services to an essential national package of health care, including somewhat less cost-effective interventions against a larger number of diseases and conditions.

Adult↗
PubMed1993

Feeding Latin America's children.

More than US $1.6 billion is spent annually on 104 programs in 19 Latin American and Caribbean countries to subsidize or provide food for people supposedly at risk of malnutrition. This amount constitutes only 0.2% of these countries gross national product. If there is no double-counting, these programs reach more than 80 million people, or 21% of the population, at a cost of $20/beneficiary or $4 per capita. Yet some 10 million children are malnourished, which suggests that the expenditures are poorly directed or ineffective. There is little hard evidence that these programs are preventing much malnutrition; even curative results are seldom measured. THe effort is too small in some countries with great needs, while other countries have nearly eliminated malnutrition. Where coverage is high, programs--although generally targeted and with sensible criteria--do not always reach the neediest. They may also fail to provide enough food or to combine food with the health care and nutritional education necessary to attack all 3 root causes of malnutrition: poverty, disease, and ignorance. The evidence, limited mostly to program inputs rather than results, suggests that greater progress against undernourishment is possible even with current spending levels.

Adolescent↗
PubMed1993

[Relations between health and development].

The relationship between the health of a population and the state of development of a society is complex and varies over time. Throughout history, improved health has been one of the main benefits of development. This benefit results partly from an increase in income and partly from scientific progress in the fight against disease and disability. This second factor is increasingly important compared to simple economic growth. Reciprocally, health could be expected to have a favorable effect on development, although this effect is more difficult to detect. Nevertheless, health can be considered part of a society's capital stock, as long as the essential differences between this type of capital and physical capital are recognized. These differences, in turn, provide an insight into the health services market and, in particular, into the tendency to spend more and more resources on health. It is necessary to respect the intrinsic value of human capital, rather than focusing strictly on the economic productivity that may be derived from it, in order to prevent discrimination against children, the elderly, the poor, or the disabled.

Costs and Cost Analysis↗
PubMed1992

Cost-benefit analysis of a regional system for vaccination against pneumonia, meningitis type B, and typhoid fever.

In early 1989 PAHO began examining a proposal for a regional program that would develop and disseminate vaccines of particular interest to its Member Countries. As part of that examination, a cost-benefit analysis was performed. That general analysis, presented here, sought to point up key factors that would strongly influence whether or not the program's benefits outweighed its costs. The program's two fundamental components, vaccine development and vaccine administration, were evaluated separately. Using a discount rate (r) of 10%, 10-year vaccine development costs were estimated at US$80.3 million in constant dollars. It was felt that enough people (at least 19.5 million a year) would be vaccinated so that the program would benefit from economics of scale. The total discounted number of vaccinations administered over a 20-year period was expected to be in the range of 400 to 506 million. Using these figures, estimates were made of the maximum that could be spent on vaccine administration without exceeding anticipated benefits. Considering only treatment costs saved through vaccination, assuming all sick people were treated, the ceiling cost for vaccinating one person against one target disease would be in the range of US$0.52-0.58. Even if not all the sick were treated, however, the Regional Vaccine System (SIREVA) would still appear justified if the benefits per disease case prevented were found to average between US$1,000 and US$2,000. Even so, it should be noted that these estimates are subject to a good deal of additional variation because of uncertainties regarding the worth of many elements evaluated--including the costs of lost work time, disability, and mortality--and because some of the elements involved--such as pain, suffering, and death--fall outside the purely economic realm.

Cost Savings↗
PubMed1990

Do nutrition programs make a difference? The case of Brazil.

Four Brazilian food and nutrition programs operating during some part of 1974-86 are evaluated for their effectiveness in curing or preventing infant and child malnutrition, including low birth weight when pregnant women were beneficiaries. Two programs distributed free food to identified clients: traditional commercial foods in one case and specially formulated supplements in the other. The other two programs subsidized four or more basic foodstuffs: one experiment quantitatively restricted a subsidy to identified families, and the other was unrestricted and open to all families patronizing certain shops. The programs were more effective at curing than at preventing malnutrition, and more effective at increasing weight than height. Many beneficiaries, even when initially underweight, showed no change, and some deteriorated despite the food transfer. Results were better after than during the first year of life, when deterioration is most likely. Donation programs including medical and educational components proved more effective than pure subsidies, showing that while poverty may be the chief cause of malnutrition, the problem should be seen as poor health rather than simply low food consumption. Evaluation also shows that programs were inefficient in transferring benefits, and that clients were deterred from participating by the costs of obtaining the food and its poor quality and small volume. Longer participation improved results, but more frequent participation in a given interval did not necessarily do so.

Body Height↗
PubMed1987

The economic crisis and its impact on health and health care in Latin America and the Caribbean.

The economic crisis that struck most Latin American and Caribbean countries beginning in 1982 has caused sharp reductions in domestic investment and in imports; domestic consumption has been less affected, while public sector spending has responded in different degrees in different countries. In general, public spending on health decreased, sometimes quite dramatically, but some countries were able to maintain the real value of noninvestment spending for health by central governments. It is much harder to tell what may have happened to output of health services, and still harder to know how health status has been affected. Scattered evidence suggests two conclusions. First, worsened economic conditions can seriously damage health status, with effects on infant mortality and on the patterns of disease and death, especially for children. Second, these repercussions do not have to occur, and public programs designed specifically to maintain basic health services and to assure adequate nutrition are effective in offsetting the worst consequences of economic hardship.

Child↗
PubMed1986

What should consumers in poor countries pay for publicly-provided health services?

Under the assumption that the price charged for public medical care is not to determine supply (because general revenue is available), the optimum price is determined taking account not of the cost of production but only of the government's welfare function. If this includes both the revenue obtained and the total number of consultations, the optimum price is set where consumers' demand becomes inelastic--how inelastic depends on the relative values of revenue and consultations. Introducing a concern for consumers' own utilities and their incomes leads to a lower price, depending on the inequality of income. Distinguishing necessary and frivolous consultations can either raise or lower the price; the optimum depends on the share of demand that is frivolous. Price discrimination may be justified and, if practised, should lead to lower fees where the other costs (travel, etc.) of obtaining attention are higher.

Costs and Cost Analysis↗