Cost-effectiveness analysis as an aid to decision making has been increasingly publicized and discussed during the past two to three decades. However, the total body of cost-effectiveness analyses in health care is actually rather small, and high-quality studies are rather rare. Furthermore, the applications of economic analysis to health policy have been hampered by a number of problems, including those that are methodological and contextual. We consider a number of areas of public health policy but pay special attention to a growing area of inquiry and application: the overall coverage of health services. Cost-effectiveness analysis has played a relatively small role in general coverage decisions, but in recent years, it has been applied increasingly to decisions concerning pharmaceutical coverage. We speculate on concerning reasons for this particular focus in cost-effectiveness analysis. Future progress will depend heavily on discussion and consensus building.
Resource allocation and health financing
Having considered a wide range of options, the Expert Working Group put forward the following fundraising proposals based on the likelihood they can generate new funds for health research and development in a sustainable way: a new indirect tax (a consumer-based tax); voluntary business and consumer contributions; new donor funds for health research and development; and a new indirect tax. The High-Level Taskforce on Innovative International Financing for Health Systems estimates that additional funding for health might grow to some US$7.4 billion per annum by 2015 from traditional donors (under optimistic assumptions and if donors meet their commitments to aid) and that developing country contributions might be in the range of US$9.5–12.1 billion per annum. However, there would be a gap in available additional funds until then, as additional resources rise from US$2.8 billion in 2009 to US$7.4 billion in 2015. The following five proposals should provide funding allocation across most research and development stages and developers in a manner that is best designed to maximise public health returns in the developing world: funding via product development partnerships; direct grants to small and medium-sized enterprises and grants for developing country trials; milestone prizes; end-prizes (cash); and purchase or procurement agreements.
Since 1994, considerable progress has been made in transforming the South African health care system, implementing programmes that improve the health of the population, and improving access to health care services. However, amid escalating health care costs disparities continue to exist between the public and private health sectors. The implementation of a national or social health insurance remains elusive despite three government-appointed committees on the matter.
This sheet provides information on public sector health care spending in South Africa. I found that public sector health spending as a share of total government spending has remained relatively constant. However, it has been following a downward trend in that it did not keep pace with inflation or population growth through much of the 1990s, but there have been recent increases. Public sector health personnel employment also declined in the 1990s; there is an urgent need for additional clinical staff. The largest single share of funds is spent on primary care and district hospitals. It argues that meeting one of South Africa's major health challenges, namely HIV and AIDS treatment, will require resources that exceed those currently available.
The 2018 global health financing report presents health spending data for all WHO Member States between 2000 and 2016. It shows a transformation trajectory for the global spending on health, with increasing domestic public funding and declining external financing. This report also presents, for the first time, spending on primary health care and specific diseases and looks closely at the relationship between spending and service coverage. The report presents key messages: Global trends in health spending confirm the transformation of the world’s funding of health services; domestic spending on health is central to universal health coverage, but there is no clear trend of increased government priority for health. Primary health care is a priority for expenditure tracking but Government spending accounts for less than 40% of primary health care spending. Allocations across disease and interventions differ between external and government sources. External funding to combat HIV/AIDS does not have a clear relationship with national prevalence or income level. The report argues that the extent of financial protection of individuals is closely associated with government spending on health.
The 2018 global health financing report presents health spending data for all WHO Member States between 2000 and 2016 based on the SHA 2011 methodology. It shows a transformation trajectory for the global spending on health, with increasing domestic public funding and declining external financing. This report presents, for the first time, spending on primary health care and specific diseases and looks closely at the relationship between spending and service coverage. The key messages include that global trends in health spending confirm the transformation of the world’s funding of health services. Domestic spending on health is central to universal health coverage, but there is no clear trend of increased government priority for health. The report further shows that primary health care is a priority for expenditure tracking. Further, allocations across disease and interventions differ between external and government sources. The report indicates that performance of government spending on health can improve.
Publish What You Fund is a new initiative to promote transparency of international aid. It consists of civil society groups from around the world, including organisations working on aid effectiveness and groups working on access to government information. They believe that, for aid to be effective, accountable and participatory, it must be transparent. Information must be available to recipient governments, affected communities and other stakeholders, as well as the general public. The campaign has been busy drafting a first set of principles. These principles have had one round of consultation (between July and August 2008) and were presented at the Accra High Level Forum on Aid Effectiveness (Ghana, 2–4 September 2008). You can add your comments on their website.
As low- and middle-income countries undertake health financing reforms to achieve universal health coverage, there is renewed interest in making allocation of pooled funds to health-care providers more strategic. To make purchasing more strategic, countries are testing different provider payment methods. They therefore need comprehensive data on funding flows to health-care providers from different purchasers to inform decision on payment methods. Tracking funding flow is the focus of several health resource tracking tools including the System of Health Accounts and public expenditure tracking surveys. This study explores whether these health resource tracking tools generate the type of information needed to inform strategic purchasing reforms, using Kenya as an example. A qualitative assessment of three counties in Kenya shows that different public purchasers, that is, county health departments and the national health insurance agency, pay public facilities through a variety of payment methods. Some of these flows are in-kind while others are financial transfers. The nature of flows and financial autonomy of facilities to retain and spend funds varies considerably across counties and levels of care. The government routinely undertakes different health resource tracking activities to inform health policy and planning. However, a good source for comprehensive data on the flow of funds to public facilities is still lacking, because these activities were not originally designed to offer such insights. The authors therefore argue that the methods could be enhanced to track such information and hence improve strategic purchasing, and also offer suggestions how this enhancement can be achieved.
An emerging consensus on solutions, combined with fresh scrutiny and a windfall of new financing, are prompting major donors to revamp years of failed efforts to stem malaria's mortal toll. The growing support from the Bill and Melinda Gates Foundation, enriched this week by a $31 billion gift from Warren E. Buffett, will provide still more impetus for change. US A.I.D. is reported to be shifting its focus from mainly backing the sale of subsidized mosquito nets in Africa to giving more of them away to poor people; to providing combination drugs given the growth of resistance to older, cheaper medicines and to supporting large-scale programs to spray insecticides, including DDT.
This report is the first ever to track what developing countries are spending on the Millennium Development Goals (MDGs). It finds that recent spending increases explain the rapid progress on the MDGs, but the vast majority of countries are spending much less than they have promised, or than is needed to achieve the MDGs or their potential successor post-2015 goals. Aid cuts, low implementation rates and low recurrent spending all threaten to reverse existing progress. The report suggests that developing countries need to make data on MDG spending more accessible to their citizens; to strengthen policies for revenue mobilisation (notably combating tax avoidance and tax havens), debt and aid management; and to spend more on agriculture, water, sanitation and hygiene, and social protection. External funders need to report and repatriate illicit outflows; end laws and investment treaties which reduce poor countries’ revenues; increase innovative financing such as financial transaction and carbon taxes; put more aid through developing country budgets; maximise budget and sector support to make spending more accountable; and report planned disbursements to developing countries. Finally, the International Monetary Fund needs to sharply increase space for sustainable spending in its programmes.