Advertisement

Health Care Analysis

, Volume 13, Issue 1, pp 33–51 | Cite as

Clarifying Efficiency-Equity Tradeoffs Through Explicit Criteria, With a Focus on Developing Countries

  • Chris JamesEmail author
  • Guy Carrin
  • William Savedoff
  • Piya Hanvoravongchai
Article

Abstract

Expenditures on health in many developing countries are being disproportionately spent on health services that have a low overall health impact, and that disproportionately benefit the rich. Without explicit consideration of priority setting, this situation is likely to remain unchanged: resource allocation is too often dictated by historical patterns, and maintains vested interests. This paper explores how prioritization between different health interventions can be rationalised by the use of clearly defined criteria. A number of key efficiency and equity criteria are examined, in particular analysing how potential tradeoffs could be incorporated into the decision making process.

Keywords

priority setting criteria efficiency equity weighting developing countries 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Bobadilla, J.-L., Cowley, P., Musgrove, P., and Saxenian, H. (1994) Design, Content and Financing of an Essential National Package of Health Services. Bulletin of the World Health Organization 72(4), 653–662.Google Scholar
  2. Calltorp, J. (1999) Priority-setting in Health policy in Sweden and a Comparison with Norway. Health Policy 50, 1–22.Google Scholar
  3. Coffield, A., Maciosek, M., McGinnis, J., Harris, J., Caldwell, M., Teutsch, S., Atkins, D., Richland, J., and Haddix, A. (2001) Priorities Among Recommended Clinical Preventive Services. American Journal of Preventive Medicine 21(1), 1–9.Google Scholar
  4. Commission on Macroeconomics and Health (2002) Improving Health Outcomes of the Poor. Report of Working Group 5 of the Commission on Macroeconomics and Health. (Geneva:WHO).Google Scholar
  5. Daniels, N. (1985) Just Health Care. Cambridge: Cambridge University Press.Google Scholar
  6. Drummond, M.F., and McGuire, A. (ed.) (2001) Economic Evaluation in Health Care: Merging Theory with Practice. Oxford: Oxford University Press.Google Scholar
  7. Drummond, M.F., O’Brien, B., Stoddart, G.L., and Torrance, G.W. (1997) Methods for the Economic Evaluation of Health Care Programmes (2nd ed.). Oxford: Oxford University Press.Google Scholar
  8. Drummond, M.F., and Torrance, G.W. (1993) Cost-effectiveness League Tables: More Harm Than Good? Social Science and Medicine 38(12), 1591–1688.Google Scholar
  9. Garber, A.M. (2000) Advances in CE Analysis, In A.J. Culyer, and J.P. Newhouse (Eds.), Handbook of Health Economics, Vol. 1A, Amsterdam: Elsevier Science, 181–221.Google Scholar
  10. Ham, C. (1997) Priority Setting in Health Care: Learning from International Experience. Health Policy 42, 49–66.Google Scholar
  11. Hauck, K., Smith, P., and Goddard, M. (2003) The Economics of Priority Setting for Health Care–-A Literature Review. HNP Discussion Paper.Google Scholar
  12. Hoedemaekers, R., and Dekkers, W. (2003) Key Concepts in Health Care Priority Setting. Health Care Analysis 11, 309–323.Google Scholar
  13. Hoedemaekers, R., and Dekkers, W. (2003) Justice and Solidarity in Priority Setting in Health Care. Health Care Analysis 11, 325–343.Google Scholar
  14. Holm, S. (1998) Goodbye to the Simple Solutions: The Second Phase of Priority Setting in Health Care. British Medical Journal 317, 1000–1007.Google Scholar
  15. Horton, R. (1999) NICE: A Step Forward in the Quality of NHS Care. Lancet 353, 1028– 1029.Google Scholar
  16. Hrbac, B., Ljubic, B., and Bagaric, I. (2000) Basic Package of Entitlements and Solidarity in the Federation of Bosnia and Herzegovina. Croatian Medical Journal 41(3), 287–293.Google Scholar
  17. Hutubessy, R., Baltussen, R., Tan-Torres, Edejer, T., and Evans, D.B. (2002) Generalised Cost-Effectiveness Analysis: An Aid to Decision Making in Health. Applied Health Economics and Health Policy 1(2), 1–7.Google Scholar
  18. Hutubessy, R., Chisholm, D., Tan-Torres, Edejer, T., and WHO-CHOICE (2003) Generalised Cost-Effectiveness Analysis for National-Level Priority-Setting in the Health Sector. Cost Effectiveness and Resource Allocation 1, 8.Google Scholar
  19. Kenkel, D. (1997) On Valuing Morbidity, Cost-Effectiveness Analysis, and Being Rude. Journal of Health Economics 16, 749–757.Google Scholar
  20. Liu, X (2003) Policy Tools for Allocative Efficiency of Health Services. Geneva: WHO.Google Scholar
  21. Martin, D., and Singer, P. (2003) A Strategy to Improve Priority Setting in Health Care Institutions. Health Care Analysis 11, 59–68.Google Scholar
  22. Maynard, A. (1999) Rationing Health Care: An Exploration. Health Policy 49, 5–11.Google Scholar
  23. McIntyre, D., and Gilson, L. (2000) Redressing Dis-advantage: Promoting Vertical Equity Within South Africa. Health Care Analysis 8, 235–258.Google Scholar
  24. Milton, C., and Donaldson, C. (2003) Resource Allocation in Health Care: Health Economics and Beyond. Health Care Analysis 11, 245–257.Google Scholar
  25. Mossialos, E., and King, D. (1999) Citizens and Rationing: Analysis of a European survey. Health Policy 49, 75–135.Google Scholar
  26. Murray, C.J.L. (1994) Quantifying the Burden of Disease: The Technical Basis for Disability-Adjusted Life Years. Bulletin of the World Health Organization 72(3), 429–445.Google Scholar
  27. Murray, C.J.L., Evans, D.B., Acharya, A., and Baltussen, R. (2000) Development of WHO Guidelines on Generalized Cost-Effectiveness Analysis. Health Economics 9, 235–251.Google Scholar
  28. Musgrove, P. (1999) Public Spending on Health Care: How are Different Criteria Related? Health Policy 47, 207–223.Google Scholar
  29. Nord, E., Pinto, J.L., Richardson, J., Mensal, P., and Ube, P. (1999) Incorporating Societal Concerns for Fairness in Numerical Valuations of Health Programmes. Health Economics 8, 25– 39.Google Scholar
  30. Politi, C., Carrin, G., Evans, D., Kuzoe, F., and Cattand, P. (1995) Cost-effectiveness Analysis of Alternative Treatments of African Gambiense Trypanosomiasis in Uganda. Health Economics 4, 273–287.Google Scholar
  31. Robinson, R. (1999) Limits to Rationality: Economics, Economists and Priority Setting. Health Policy 49, 13–26.Google Scholar
  32. Rutten, F., and van Busschbach, J. (2001) How to Define a Basic Package of Health Services for a Tax Funded or Social Insurance Based Health Care System. Health Economics in Prevention and Care (the European Journal of Health Economics) 2, 45–46.Google Scholar
  33. Tarimo, E. (1997) Essential Health Service Packages: Uses, Abuses and Future Directions. Division of Analysis, Research and Assessment, World Health Organization.Google Scholar
  34. Tengs, T. (1997) Dying Too Soon: How Cost-Effectiveness Analysis can Save Lives. Dallas: National Center for Policy Analysis. NCPA Policy Report nr 204.Google Scholar
  35. Van de Gritten, T.E.D., and Kasdorp, J.P. (1999) Choices in Dutch Health Care: Mixing Strategies and Responsibilities. Health Policy 50, 105–122.Google Scholar
  36. Wagstaff and van Doorslaer (2000) Equity in Health Care Finance and Delivery, Chapter 34 In Culyer and Newhouse, (Eds.), Handbook of Health Economics, Vol. 1B, Amsterdam: Elsevier Science, 1803–1862.Google Scholar
  37. Williams, A. (1997) Intergenerational Equity: An Exploration of the “Fair Innings” Argument. Health Economics 6, 117–132.Google Scholar
  38. Williams, A., and Cookson, R. (2000) Equity in Health, Chapter 35 In Culyer and Newhouse (Eds.), Handbook of Health Economics, Vol. 1B, Amsterdam: Elsevier Science, 1863–1910.Google Scholar
  39. World Bank (1993) World Development Report 1993. Investing in health.Google Scholar
  40. World Health Organization (2002) The World Health Report 2002. Reducing Risks: Promoting Health Life. Geneva: WHO.Google Scholar

Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  • Chris James
    • 1
    • 5
    Email author
  • Guy Carrin
    • 2
  • William Savedoff
    • 3
  • Piya Hanvoravongchai
    • 4
  1. 1.Health Economist, Department of Health System Financing, Expenditure and Resource AllocationWorld Health OrganizationSwitzerland
  2. 2.Senior Health Economist, Department of Health System Financing, Expenditure and Resource AllocationWorld Health OrganizationSwitzerland
  3. 3.Senior PartnerSocial InsightPortland
  4. 4.Researcher, International Health Policy ProgramMinistry of Public HealthThailand
  5. 5.Health Economist, Department of Health System Financing, Expenditure and Resource AllocationWorld Health OrganizationGenevaSwitzerland

Personalised recommendations