Decision rules for allocation of finances to health systems strengthening

Morton, Alec; Thomas, Ranjeeta; Smith, Peter

doi:10.1016/j.jhealeco.2016.06.001

Cited by 25 publications

(20 citation statements)

References 25 publications

(24 reference statements)

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“…This means that the effects of such a measure could go beyond preventing and mitigating one particular type of outbreak. Such "policy spill-over effects" are rarely included [16].…”

Section: Introductionmentioning

confidence: 99%

Costs and benefits of interventions aimed at major infectious disease threats: lessons from the literature

2020

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Pandemics and major outbreaks have the potential to cause large health losses and major economic costs. To prioritize between preventive and responsive interventions, it is important to understand the costs and health losses interventions may prevent. We review the literature, investigating the type of studies performed, the costs and benefits included, and the methods employed against perceived major outbreak threats. We searched PubMed and SCOPUS for studies concerning the outbreaks of SARS in 2003, H5N1 in 2003, H1N1 in 2009, Cholera in Haiti in 2010, MERS-CoV in 2013, H7N9 in 2013, and Ebola in West-Africa in 2014. We screened titles and abstracts of papers, and subsequently examined remaining full-text papers. Data were extracted according to a pre-constructed protocol. We included 34 studies of which the majority evaluated interventions related to the H1N1 outbreak in a high-income setting. Most interventions concerned pharmaceuticals. Included costs and benefits, as well as the methods applied, varied substantially between studies. Most studies used a short time horizon and did not include future costs and benefits. We found substantial variation in the included elements and methods used. Policymakers need to be aware of this and the bias toward high-income countries and pharmaceutical interventions, which hampers generalizability. More standardization of included elements, methodology, and reporting would improve economic evaluations and their usefulness for policy.

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“…This means that the effects of such a measure could go beyond preventing and mitigating one particular type of outbreak. Such "policy spill-over effects" are rarely included [16].…”

Section: Introductionmentioning

confidence: 99%

Costs and benefits of interventions aimed at major infectious disease threats: lessons from the literature

2020

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“…A previous study has shown how it is possible to identify the optimal balance between investments in interventions and efficiency-improving HSS using mathematical programming methods (Morton et al, 2016). The innovation is to introduce an additional decision variable y into the standard CEA formulation that indicates the expenditure on HSS.…”

Section: Typology Of Health System Strengtheningmentioning

confidence: 99%

“…Through the parameter y, HSS type1 is implicitly addressing the ease with which technical efficiency of a platform can be improved. The simplest case is to assume that y uniformly improves the effectiveness of all interventions (Morton et al, 2016). The optimization problem is thenmaximizeyγ∑xivi0.25emsubject0.25emto0.25emy+∑xici≤B0.25em;all0≤xi≤1;yL≤y≤yU…”

Section: Typology Of Health System Strengtheningmentioning

confidence: 99%

How can we evaluate the cost-effectiveness of health system strengthening? A typology and illustrations

Hauck

Morton

Chalkidou

et al. 2019

Social Science & Medicine

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Health interventions often depend on a complex system of human and capital infrastructure that is shared with other interventions, in the form of service delivery platforms, such as healthcare facilities, hospitals, or community services. Most forms of health system strengthening seek to improve the efficiency or effectiveness of such delivery platforms. This paper presents a typology of ways in which health system strengthening can improve the economic efficiency of health services. Three types of health system strengthening are identified and modelled: (1) investment in the efficiency of an existing shared platform that generates positive benefits across a range of existing interventions; (2) relaxing a capacity constraint of an existing shared platform that inhibits the optimization of existing interventions; (3) providing an entirely new shared platform that supports a number of existing or new interventions. Theoretical models are illustrated with examples, and illustrate the importance of considering the portfolio of interventions using a platform, and not just piecemeal individual analysis of those interventions. They show how it is possible to extend principles of conventional cost-effectiveness analysis to identify an optimal balance between investing in health system strengthening and expenditure on specific interventions. The models developed in this paper provide a conceptual framework for evaluating the cost-effectiveness of investments in strengthening healthcare systems and, more broadly, shed light on the role that platforms play in promoting the cost-effectiveness of different interventions.

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“…Related literature in the area of economic evaluation deals with issues related to constraints with respect to implementation of health care technologies in practice ( Fenwick et al, 2008 , Hoomans and Severens, 2014 ). Note that although our starting point was that of incremental economic evaluations targeted at decision makers who might not have the discretion to relax health care input constraints, such constraints itself signal that the health system needs strengthening in terms of health care inputs ( Morton et al, 2016 ).…”

Section: Conclusion and Recommendationsmentioning

confidence: 99%

Health care input constraints and cost effectiveness analysis decision rules

Baal

Morton

Severens

2018

Social Science & Medicine

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Results of cost effectiveness analyses (CEA) studies are most useful for decision makers if they face only one constraint: the health care budget. However, in practice, decision makers wishing to use the results of CEA studies may face multiple resource constraints relating to, for instance, constraints in health care inputs such as a shortage of skilled labour. The presence of multiple resource constraints influences the decision rules of CEA and limits the usefulness of traditional CEA studies for decision makers. The goal of this paper is to illustrate how results of CEA can be interpreted and used in case a decision maker faces a health care input constraint.We set up a theoretical model describing the optimal allocation of the health care budget in the presence of a health care input constraint. Insights derived from that model were used to analyse a stylized example based on a decision about a surgical robot as well as a published cost effectiveness study on eye care services in Zambia.Our theoretical model shows that applying default decision rules in the presence of a health care input constraint leads to suboptimal decisions but that there are ways of preserving the traditional decision rules of CEA by reweighing different cost categories. The examples illustrate how such adjustments can be made, and makes clear that optimal decisions depend crucially on such adjustments.We conclude that it is possible to use the results of cost effectiveness studies in the presence of health care input constraints if results are properly adjusted.

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Decision rules for allocation of finances to health systems strengthening

Cited by 25 publications

References 25 publications

Costs and benefits of interventions aimed at major infectious disease threats: lessons from the literature

Costs and benefits of interventions aimed at major infectious disease threats: lessons from the literature

How can we evaluate the cost-effectiveness of health system strengthening? A typology and illustrations

Health care input constraints and cost effectiveness analysis decision rules

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