Reflections on the development of health economics in low- and middle-income countries

Abstract

Health economics is a relatively new discipline, though its antecedents can be traced back to William Petty FRS (1623–1687). In high-income countries, the academic discipline and scientific literature have grown rapidly since the 1960s. In low- and middle-income countries, the growth of health economics has been strongly influenced by trends in health policy, especially among the international and bilateral agencies involved in supporting health sector development. Valuable and influential research has been done in areas such as cost–benefit and cost-effectiveness analysis, financing of healthcare, healthcare provision, and health systems analysis, but there has been insufficient questioning of the relevance of theories and policy recommendations in the rich world literature to the circumstances of poorer countries. Characteristics such as a country's economic structure, strength of political and social institutions, management capacity, and dependence on external agencies, mean that theories and models cannot necessarily be transferred between settings. Recent innovations in the health economics literature on low- and middle-income countries indicate how health economics can be shaped to provide more relevant advice for policy. For this to be taken further, it is critical that such countries develop stronger capacity for health economics within their universities and research institutes, with greater local commitment of funding.

Challenges of Rasthryia Swasthya Bima Yojana (RSBY) in West Bengal, India: An exploratory study

“…Despite voluminous critiques of markets in health care, many economists continue to argue that health is a commodity like any other and choice and market mechanisms are the most efficient means to deliver health services, outside the public domain . Their historic claim is that public provision of health services is ridden with issues of quality, efficiency, and “corruption”; economists from the neo liberal tradition claim the public sector is universally characterized by weak property rights, hence, without sufficient incentive to allocate resources “efficiently” in the health sector or elsewhere . The issue of efficiency in the health sector and its costs and benefits have been at the front line of the World Bank's “Investing in Health” 1993, in developing countries.…”

“…13,14 Their historic claim is that public provision of health services is ridden with issues of quality, efficiency, and "corruption"; economists from the neo liberal tradition claim the public sector is universally characterized by weak property rights, hence, without sufficient incentive to allocate resources "efficiently" in the health sector or elsewhere. [14][15][16][17][18][19] The issue of efficiency in the health sector and its costs and benefits have been at the front line of the World Bank's "Investing in Health" 1993, 13 in developing countries. The publication arrived when economies of many LMICS were characterized by Balance of Payment deficits which forced them into structural adjustment programmes (SAPs) advocated by the IMF.…”

The influence of cost-per-DALY information in health prioritisation and desirable features for a registry: a survey of health policy experts in Vietnam, India and Bangladesh

“…To this end, economic evaluation has been implemented in many areas, including coverage decisions, technology pricing and the development of clinical practice guidelines [2, 3]. Although economic evaluation is much more prevalent in high-income countries (HICs) [4], it may in principle make a bigger impact in low- and middle-income countries (LMICs) given the pressing needs in those settings [5, 6]. However, there are barriers to evidence-based policy in these countries that include limited stakeholder awareness, resources and data availability [7, 8], as well as the lack of capacity to conduct country-specific economic evaluations [9].…”

Reflexões sobre o papel das unidades de economia da saúde no âmbito de sistemas nacionais de saúde

“…Regarding the development of health economics in low and medium income countries, Mills (2014) states that, unlike high-income countries, in which health economics was stimulated by the rising academic interest in the economic aspects of public policies and by the increased national demand for health economists, which stimulated the offer of new educational programs and the increased research funding, in low and medium-income countries, in turn, the users of economic analyses at a global level, such as WHO and multilateral and bilateral supporting agencies, constituted the base for its expansion. According to the author, that gave the development of health economics a close bond with the political trends of these agencies.…”