Abstract:
:In low- and middle-income countries (LMICs), making the best use of scarce resources is essential to achieving universal health coverage. The design of health benefits packages creates the opportunity to select interventions on the basis of explicit objectives. Distributional cost-effectiveness analysis (DCEA) provides a framework to evaluate interventions based on two objectives: increasing population health and reducing health inequality. We conduct aggregate DCEA of potential health benefits package interventions to demonstrate the feasibility of this approach in LMICs, using the case of the Malawian health benefits package. We use publicly available survey and census data common to LMICs and describe what challenges we encountered and how we addressed them. We estimate that diseases targeted by the health benefits package are most prevalent in the poorest population quintile and least prevalent in the richest quintile. The survey data we use indicate socioeconomic patterns in intervention uptake that diminish the population health gain and inequality reduction from the package. We find that a similar set of interventions would be prioritized when impact on health inequality is incorporated alongside impact on overall population health. However, conclusions about the impact of individual interventions on health inequalities are sensitive to assumptions regarding the health opportunity cost, the utilization of interventions, the distribution of diseases across population groups and the level of aversion to inequality. Our results suggest that efforts to improve access to the Essential Health Package could be targeted to specific interventions to improve the health of the poorest fastest but that identifying these interventions is uncertain. This exploratory work has shown the potential for applying the DCEA framework to inform health benefits package design within the LMIC setting and to provide insight into the equity impact of a health benefits package.
journal_name
Health Policy Planjournal_title
Health policy and planningauthors
Arnold M,Nkhoma D,Griffin Sdoi
10.1093/heapol/czaa015subject
Has Abstractpub_date
2020-07-01 00:00:00pages
646-656issue
6eissn
0268-1080issn
1460-2237pii
5828373journal_volume
35pub_type
杂志文章abstract::The decision-making process to introduce new vaccines into national immunization programmes is often complex, involving many stakeholders who provide technical information, mobilize finance, implement programmes and garner political support. Stakeholders may have different levels of interest, knowledge and motivations...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czs037
更新日期:2012-05-01 00:00:00
abstract::Previous studies have consistently found an inverse relationship between household-level poverty and health status. However, what is not well understood is whether and how the average economic status at the community level plays a role in the poverty-health relationship. The purpose of this study is to investigate the...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czj008
更新日期:2006-03-01 00:00:00
abstract::The persistently low quality and inadequacy of health services provided in public facilities has made the private sector an unavoidable choice for consumers of health care in Nigeria. Ineffective state regulation, however, has meant little control over the clinical activities of private sector providers while the pric...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/14.2.174
更新日期:1999-06-01 00:00:00
abstract:BACKGROUND:Health-care financing should be equitable. In many developing countries such as Kenya, changes to health-care financing systems are being implemented as a means of providing equitable access to health care with the aim of attaining universal coverage. Vertical equity means that people of dissimilar ability t...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czt073
更新日期:2014-10-01 00:00:00
abstract::Like many other developing countries, Burkina Faso has been exploring how community resources can be tapped to co-finance health services. Although revenue generation is important for the viability of health services, effects on utilization and on equity of access to health care must also be considered. The authors pr...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/9.2.185
更新日期:1994-06-01 00:00:00
abstract::Poor mental health is a pressing global health problem, with high prevalence among poor populations from low-income countries. Existing studies of conditional cash transfer (CCT) effects on mental health have found positive effects. However, there is a gap in the literature on population-wide effects of cash transfers...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czaa079
更新日期:2020-11-20 00:00:00
abstract::The redistributive effects of a social insurance programme are determined by how the programme is paid for-who pays and how much do they pay?-and how the benefits are distributed. As a result, the redistributive effects of a social health insurance programme should be evaluated on the basis of its net benefit-the diff...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czl037
更新日期:2007-01-01 00:00:00
abstract::In Ghana, Tanzania and South Africa, health care financing is progressive overall. However, out-of-pocket payments and health insurance for the informal sector are regressive. The distribution of health care benefits is generally pro-rich. This paper explores the factors influencing these distributions in the three co...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czs024
更新日期:2012-03-01 00:00:00
abstract::Cambodia's healthcare system has seen significant improvements in the last two decades. Despite this, access to quality care remains problematic, particularly for poor rural Cambodians. The government has committed to universal health coverage (UHC) and is reforming the health financing system to align with this goal....
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czz011
更新日期:2019-10-01 00:00:00
abstract::Financial protection should be the principal objective of any health system. Commonly used indicators for financial protection are out-of-pocket (OOP) payments as a share of total health expenditure and the amount of households driven into poverty by catastrophic health expenditures (CHEs). In the last decade, OOP hea...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czt002
更新日期:2014-03-01 00:00:00
abstract::Reproduction is a dual commitment, but so often in much of the world, it is seen as wholly the woman's responsibility. She bears the burden not only of pregnancy and childbirth but also the threats from excessive child bearing, some responsibility for contraception, infertility investigation and often undiagnosed sexu...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/11.1.84
更新日期:1996-03-01 00:00:00
abstract::It is widely accepted that substantial reductions in maternal mortality and severe morbidity are impossible to achieve without an effective referral system for complicated cases. Early detection and referral to higher levels of care might also substantially reduce neonatal deaths due to the complications of childbirth...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/16.4.353
更新日期:2001-12-01 00:00:00
abstract::The end of the Cold War brought with it opportunities to resolve a number of conflicts around the world, including those in Angola, Cambodia, El Salvador and Mozambique. International political efforts to negotiate peace in these countries were accompanied by significant aid programmes ostensibly designed to redress t...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/14.3.229
更新日期:1999-09-01 00:00:00
abstract:BACKGROUND:Socio-economic inequalities in maternal and child health are ubiquitous, but limited information is available on how much the quality of care varies according to wealth or ethnicity in low- and middle-income countries. Also, little information exists on quality differences between public and private provider...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czp065
更新日期:2010-07-01 00:00:00
abstract::Generic prescribing and generic substitution are mechanisms for reducing the cost of drugs. The purpose of this study was to assess the extent to which generic prescribing by private medical practitioners and generic substitution by private pharmacists is practised in South Africa and to estimate the potential savings...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/11.2.198
更新日期:1996-06-01 00:00:00
abstract::Many countries have expanded insurance programmes in an effort to achieve universal health coverage (UHC). We assess a complementary path toward financial risk protection: increased access to technologies that improve health and reduce the risk of large health expenditures. Malawi has provided free HIV treatment since...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czaa023
更新日期:2020-07-01 00:00:00
abstract::This article assesses whether social franchising of tuberculosis (TB) services in Myanmar has succeeded in providing quality treatment while ensuring equity in access and financial protection for poor patients. Newly diagnosed TB patients receiving treatment from private general practitioners (GPs) belonging to the fr...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czm007
更新日期:2007-05-01 00:00:00
abstract::The health profile of Bangladesh has improved remarkably, yet gaps in delivering quality health care remain. In response to the need for evidence to quantify resources for providing health services in Bangladesh, this study estimates unit costs of providing the essential services package (ESP) in the not-for-profit se...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czx105
更新日期:2017-12-01 00:00:00
abstract::This paper explores changes to budget allocations for health during the decentralization process in UGANDA: When the districts were given the authority to allot their own budgets, allocations for health were reduced considerably. The rationale for this by district leaders is investigated and analyzed. Their criteria f...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/16.2.187
更新日期:2001-06-01 00:00:00
abstract::This paper seeks to examine barriers faced by members of a community-based insurance (CBI) scheme, which is targeted at poor women and their families, in accessing scheme benefits. CBI schemes have been developed and promoted as mechanisms to offer protection to poor families from the risks of ill-health, death and lo...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czj010
更新日期:2006-03-01 00:00:00
abstract:INTRODUCTION:There is an immense need for scaling-up neuropsychiatric care in low-income countries. Contextualized cost-effectiveness analyses (CEAs) provide relevant information for local policies. The aim of this study is to perform a contextualized CEA of neuropsychiatric interventions in Ethiopia and to illustrate ...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czv093
更新日期:2016-05-01 00:00:00
abstract::Approximately 900 000 newborn children die every year in India, accounting for 28% of neonatal deaths globally. In 2011, India introduced a home-based newborn care (HBNC) package to be delivered by community health workers across rural areas. We estimate the disease and economic burden that could be averted by scaling...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czv113
更新日期:2016-06-01 00:00:00
abstract::Formalized task shifting structures have been used to rapidly scale up antiretroviral service delivery to underserved populations in several countries, and may be a promising mechanism for accomplishing universal health coverage. However, studies evaluating the quality of service delivery through task shifting have la...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czu072
更新日期:2014-09-01 00:00:00
abstract::Informal payments for health care are a well-known phenomenon in many health care systems around the world. While informal payments could be an important source of health care financing, they have an adverse impact on efficiency and access to care, and are a major impediment to ongoing health care reforms. This paper ...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czw147
更新日期:2017-05-01 00:00:00
abstract::Hypertension and diabetes are highly prevalent in China and pose significant health and economic burdens, but large gaps in care remain for people with such conditions. In this article, drawing on administrative insurance claim data from China's Urban Employee Basic Medical Insurance (UEBMI), we use an interrupted tim...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czaa087
更新日期:2020-10-01 00:00:00
abstract::Ensuring financial access to health services is a critical challenge for poor countries if they are to reach the health Millennium Development Goals (MDGs). This article examines the case of Rwanda, a country which has championed innovative health care financing policies. Between 2000 and 2007, Rwanda has improved fin...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czr070
更新日期:2011-11-01 00:00:00
abstract::As national resources for health decline, so dependence on international resources to finance the capital and recurrent costs is increasing. This dependence, combined with an increasing emphasis on policy-based, as opposed to project-based, lending and grant-making has been accompanied by greater involvement of intern...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/10.2.122
更新日期:1995-06-01 00:00:00
abstract::Since 2001 substantial resources have been allocated to the reproductive, maternal, newborn and child health sector (RMNCH) in Pakistan. Many new programmes have been started and coverage of some existing programmes has been extended to un-served and rural areas. Despite these efforts the Millennium Development Goals ...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czx021
更新日期:2017-07-01 00:00:00
abstract::The question of why some immunization programmes in sub-Saharan Africa are more successful than others is an intriguing one, but not one that is frequently raised or investigated. Borrowing techniques from both performance benchmarking and positive deviance inquiry, we explored this question in six countries. We first...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czn028
更新日期:2008-11-01 00:00:00
abstract:OBJECTIVE:Irrational use of medicines is a serious problem in China and has been the primary target of China's national essential medicines programme (NEMP). The aim of this study was to evaluate the effect of the NEMP on rational use of medicines in China. METHODS:A nationwide sample of 3 76 700 prescriptions written...
journal_title:Health policy and planning
pub_type: 杂志文章
doi:10.1093/heapol/czv008
更新日期:2016-02-01 00:00:00