Where my health is concerned, cost is no object." The reply of the penniless man to an expensive specialist reflects a moral question. Should the costs of health services be a significant consideration in deciding upon governmental health policies and programs? The answer in my opinion is yes. Costs ought to be used in deciding the level of health activities versus other social goods and services, and in planning which health programs to support. The truly moral problem is not to distinguish between good and evil but rather to select appropriately among alternative goods. After arguing that consideration of cost is a moral imperative, the usefulness of cost-benefit analysis in framing the right questions and in improving the chances of moving in directions of social improvement is urged, and some limitations are noted. Finally, examples of the use of cost-effectiveness analysis in studying problems of disease control and maternal and child health are given.
Ahtract-This paper presents information and concepts concerning the health of populations in less developed countries as background for discussions of more focused and detailed papers on these and related subjects.It begins with a review of health status and trends in developing countries since 1950. followed by a section identifying the major health problems and their causes.The third part includes analyses of associations between health resources. water and sanitation facilities. food availability. and economic and social indicators taken as independent variables and measures of health status-life expectancy, crude death rates. and infant mortality-as the dependent variables.The final section discusses health policies and their implementation and offers an analysis of the resource requirements and health effects of diffesent methods of organizing and combining health programs in a few developing countries. The objective is to illustrate a method of determining preferred activities at any given level of investment and the probable health effects of varying increases in the level of health expenditures. LIFE EXPEflANCV AND DEATH RATES IN LESS DEVELOPED COUNTRIES: STATUS AND TRENDS Merhodological twre 99 7 7 10 9 22 15 14 17 15
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