ISSN:1057-9230    

DOI:10.1002/hec.4730020102

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

ISSN:1057-9230    

DOI:10.1002/hec.4730020103

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractHealth care finance and provision in Italy is unusual by international standards: public financing relies heavily on both general taxation and social insurance, and although the vast majority of expenditure is publicly financed, the majority of care is provided by the private sector. The system suffers, however, from a chronic failure to control expenditures and its record on perinatal and infant mortality is poor. Hospitals in Italy have a low bed‐occupancy rate by international standards and the per diem system of reimbursing private hospitals encourages unduly long stays. Costs per inpatient day are high by international standards, but costs per admission are close to the OECD average. Ambulatory care costs are extremely low, but this appears to be due to the fact that GPs see so many patients that their role is inevitably mainly administrative. Consumption of medicines is extremely high, but because the cost per item is low, expenditure per capita is not unduly high. Despite the emphasis on social insurance, the financing system appears to be progressive. There is evidence of inequalities in health in Italy, and some evidence that health care is not provided equally to those in the same degree of nee

ISSN:1057-9230    

DOI:10.1002/hec.4730020104

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractDuring the 1980s, Nigeria faced difficult economic conditions resulting in a severely constrained budget for public health services. To assess more carefully the costs and efficiency of the public and private health sectors, the Federal Ministry of Health in Nigeria undertook a comprehensive survey of health care facilities in Ogun State in 1987, the analysis of which is presented in this study. The findings suggest that there is potential to increase service delivery within existing budgets by more cost‐effective allocation of inputs. Many public and private providers are not operating at full technical capacity. It also appears that public facilities are not using cost‐minimizing combinations of high and low‐level health workers, in particular, too many low‐level staff are being used to support high‐level workers. The cost analysis indicates that there are short‐run increasing returns to scale for inpatient and nearly constant returns to scale for outpatient services. Economies of scope for joint production of inpatient and outpatient services are not being realized. A major implication of such analysis is that improved resource allocation decisions heavily depend on the existence of information systems at the health facility level which carefully integrate financial information with other appropriate and adequate measures of service inputs, health care quality, facility utilization and ultimately he

ISSN:1057-9230    

DOI:10.1002/hec.4730020105

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractAs the policy relevance of screening has increased, the application of the techniques of economic evaluation to screening has become widespread. This paper critically reviews the literature, and in so doing, highlights several ways in which future evaluations might be improved. These include: the adoption of a broader perspective regarding the questions to be addressed and the relevant margins; a reconsideration of the nature of the benefits and how they might be valued; and a greater emphasis being placed upon the role of individual behaviour and its potential impact on the outcome of economic evaluations.

ISSN:1057-9230    

DOI:10.1002/hec.4730020106

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractHigh population compliance is seen as a prerequisite for an equitable screening service. To achieve high compliance fixed appointments are usually advocated. However, the costs of achieving high compliance have not previously been described. To assess the costs of achieving high compliance we have used a randomised trial of two common appointment methods: 800 women aged 45‐49 living within 20 miles of Aberdeen were selected at random from the Community Health Index. They were randomly assigned to receive one of two letters—one offering a fixed appointment, the other inviting them to telephone to make an appointment.For a defined population fixed appointments achieved high compliance but only by reducing the opportunities for screening; for every 100 women screened, 110 additional women were denied the opportunity of a screening test. In contrast the open letters of invitation achieved efficiency by increasing the number of women screened with given resources within a larger population. Thus for screening services with fixed budgets, high compliance is achieved only by screening fewer peo

ISSN:1057-9230    

DOI:10.1002/hec.4730020107

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractThis paper examines some of the difficulties in using QALY league tables in priority setting. Such tables sometimes are seen as being ‘the’ way to prioritise in health care and in particular, at present, with respect to priority setting among purchasers in the UK NHS. However the paper highlights the fact that the base on which such tables is built is small—relatively few studies in the English language using CUA have been conducted anywhere. Further, four issues which require handling with care are set out: (i) the relevant measure of cost in QALY league tables has to be restricted to health service resource use; (ii) the relevant measure of benefit in QALY league tables is clearly restricted to QALYs, thereby the utility of health gains and indeed the maximisation of the utility of health gains; (iii) in incorporating the results of CUA studies into QALY league tables there is a need for greater clarification on what the margin constitutes; and (iv) those who might use CUA results in QALY league tables need to ascertain whether the original context of the study will allow the results to be transferred to the local context of the decision maker. The paper suggests that there is a need to be quite clear what goal QALY league tables serve. The authors argue that the only legitimate (and clearly important) goal of QALY league tables is the maximisation of the utility of health gains within a health service budget.Thethinkingunderlying QALY league tables, adjusted to take account of the caveats in this paper, is the key to rational priority setting at a local level. It is this thinking that is to be emphasised rather than the use of ‘imported’ league tables or the use of results from CUA studies conducted elsewhere in the country or indeed in other countries. If results from elsewhereareto be used, the study context has to be examined carefully to establish the extent of its relevance to thelocalcircumstances facing the purchasing

ISSN:1057-9230    

DOI:10.1002/hec.4730020108

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

摘要:

AbstractIn this paper it is shown that there have been significant structural changes in the composition of the Hospital and Community Health Services (HCHS) workforce over the 1980s. The number of doctors, nurses and other medical professionals has grown at the expense of support staff such as ancillaries and maintenance workers. The number of agency and contract staff has risen rapidly, partly offsetting the loss of directly‐employed support staff.Changes in the workforce have been compared with changes in activity, as measured by the cost‐weighted activity index. According to this measure labour productivity has grown by a compound rate of 1.9% annually. Adjusting the labour force index for the wage bill of each group reveals productivity growth of 1.5%. The effectiveness of treatment, as proxied by the decline in avoidable perinatal mortality, has grown by 3.4% annually.Unit labour costs have fallen over the period at an average annual rate of 0.3%. The trend conceals wide fluctuations, with labour costs falling slowly during the first half of the decade, and rising strongly during the second half. Medical professionals benefited disproportionately from wage increases in comparison with other HCHS groups during the mid to late 19

ISSN:1057-9230    

DOI:10.1002/hec.4730020109

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

ISSN:1057-9230    

DOI:10.1002/hec.4730020110

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY

ISSN:1057-9230    

DOI:10.1002/hec.4730020111

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1993

数据来源: WILEY