Priority setting and economic appraisal: Whose priorities—the community or the economist?

Green, Andrew; Barker, Carol

doi:10.1016/0277-9536(88)90412-1

Cited by 37 publications

(13 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Likewise, other studies found that drugs and medical supplies are the second major category of total cost [3,8,37]. Although we refrained from a more detailed analysis of drugs and medical supplies, other studies suggest that with better management of supplies and controls of prescription drugs, costs in basic health care could considerably be reduced [2,8,38,39].…”

Section: Direction Of Inputmentioning

confidence: 97%

Costing maternal health services in South Tanzania

2007

View full text Add to dashboard Cite

The following paper presents the methodology and results of a costing exercise of maternal health services in Tanzania. The main objective of this study was to determine the actual costs of antenatal and obstetric care in different health institutions in a district in Tanzania as a basis of more efficient resource allocation. A costing tool was developed that allows the calculation of costs of service units, such as deliveries and antenatal care, and separates these costs from the costs of other services. Time consumed by each activity was used as an allocation key. For that purpose, we recorded the personnel consumption with different time-study methodologies. This approach was tested and implemented in Mtwara Urban District, South Tanzania. The results were analyzed by a spreadsheet program. The paper presents average costs for different costing units of maternal care. Among other findings, we found that the cost of a normal vaginal delivery is US $12.30 in a dispensary and US $6.30 in the hospital--a result that needs explanation, as usually one would expect that hospitals are more cost-intensive than first-line facilities. However, dispensaries are grossly underutilized so that the costs per service unit are rather high. The cost for surgical delivery (only in hospitals) was found to be US $69.26 and the average cost per antenatal care consultation (only at dispensaries) was US $2.50. We conclude that improved planning of elective services is a prerequisite for more effective and efficient use of personnel resources. In addition, the definition of medically and economically sound standards, in particular staffing standards, is critical to make cost analysis an effective management tool to guide rational resource allocation.

show abstract

Section: Direction Of Inputmentioning

confidence: 97%

Costing maternal health services in South Tanzania

2007

View full text Add to dashboard Cite

show abstract

“…Cost-effectiveness compares cost per outcome of different interventions [9,10]. Net economic cost is used as a numerator and improved health as a denominator and the lower the ratio the more preferred the intervention.…”

Section: Introductionmentioning

confidence: 99%

Is cost-effectiveness analysis preferred to severity of disease as the main guiding principle in priority setting in resource poor settings? The case of Uganda

Kapiriri

Arnesen

Norheim

2004

Cost Eff Resour Alloc

View full text Add to dashboard Cite

IntroductionSeveral studies carried out to establish the relative preference of cost-effectiveness of interventions and severity of disease as criteria for priority setting in health have shown a strong preference for severity of disease. These preferences may differ in contexts of resource scarcity, as in developing countries, yet information is limited on such preferences in this context.ObjectiveThis study was carried out to identify the key players in priority setting in health and explore their relative preference regarding cost-effectiveness of interventions and severity of disease as criteria for setting priorities in Uganda.Design610 self-administered questionnaires were sent to respondents at national, district, health sub-district and facility levels. Respondents included mainly health workers. We used three different simulations, assuming same patient characteristics and same treatment outcome but with varying either severity of disease or cost-effectiveness of treatment, to explore respondents' preferences regarding cost-effectiveness and severity.ResultsActual main actors were identified to be health workers, development partners or donors and politicians. This was different from what respondents perceived as ideal. Above 90% of the respondents recognised the importance of both severity of disease and cost-effectiveness of intervention. In the three scenarios where they were made to choose between the two, a majority of the survey respondents assigned highest weight to treating the most severely ill patient with a less cost-effective intervention compared to the one with a more cost-effective intervention for a less severely ill patient. However, international development partners in in-depth interviews preferred the consideration of cost-effectiveness of intervention.ConclusionsIn a survey among health workers and other actors in priority setting in Uganda, we found that donors are considered to have more say than the survey respondents found ideal. Survey respondents considered both severity of disease and cost-effectiveness important criteria for setting priorities, with severity of disease as the leading principle. This pattern of preferences is similar to findings in context with relatively more resources. In-depth interviews with international development partners, showed that this group put relatively more emphasis on cost-effectiveness of interventions compared to severity of disease. These discrepancies in attitudes between national health workers and representatives from the donors require more investigation. The different attitudes should be openly debated to ensure legitimate decisions.

show abstract

“…Green and Barker (1990) have argued that standard techniques of economic appraisal are inappropriate for setting health care priorities: "The major difficulty [CEAJ faces stems from the need to have a single outcome measure, which is common to those in terventions being compared. For it to measure the effectiveness of a service the oulcome should be in terms of health objectives; if not, the analysis is reduced to measuring efficiency in service provision alone" (p. 925).…”

Section: Evaluation Methodsmentioning

confidence: 99%

“…Green and Barker (1990) state: "Whilst it is dear that, as individuals, we view the future as of less importance than the present (partly as a result of uncertainty), there is an equaUy valid argument that a social view, as ex ercised in a public sector appraisal, should defend the interests of future populations, and should deliberately take a long term view" (p. 925).…”

Section: Evaluation Methodsmentioning

confidence: 99%

“…It is for these reasons that Green and Barker (1990) reject economic evalu ation as a suitable approach to the setting of priorities for health expendi tures. "(Economic evaluation) can be a powerful tool at the leve l of detennining the most efficient way of dealing with a specified health prob lem, but as such is essentially concerned with questions of 'how: not ques tions of 'what' -process not prioritisation" (p .…”

Section: Economic Evaluation Of Models Of Community Services I 225mentioning

confidence: 99%

See 1 more Smart Citation

Health Care: A Community Concern? Developments in the Organization of Canadian Health Services

Dickinson¹,

Crichton²,

Robertson³

et al. 1998

Canadian Public Policy / Analyse de Politiques

View full text Add to dashboard Cite

Cover Art: The artwork on the cover of this book is not open access and falls under traditional copyright provisions; it cannot be reproduced in any way without written permission of the artists and their agents. The cover can be displayed as a complete cover image for the purposes of publicizing this work, but the artwork cannot be extracted from the context of the cover of this specific work without breaching the artist's copyright.

show abstract

Priority setting and economic appraisal: Whose priorities—the community or the economist?

Cited by 37 publications

References 12 publications

Costing maternal health services in South Tanzania

Costing maternal health services in South Tanzania

Is cost-effectiveness analysis preferred to severity of disease as the main guiding principle in priority setting in resource poor settings? The case of Uganda

Health Care: A Community Concern? Developments in the Organization of Canadian Health Services

Contact Info

Product

Resources

About