Transcript Health economics - Studentportalen

Health economics
Birger Carl Forsberg
Division of International Health (IHCAR)
Dept of Public Health Sciences
Karolinska Institutet
How much is one billion
dollars??
Variable
Estimate (USD)
Actual value (USD)
Estimate/actual
Global debt
100 000 billion
4 500 billion
+ 22.2
Annual Global Total
Expenditures on Arms
(Annual Global military
expenditure)
50 billion
347 billion
(1 464 billion)
- 6.9
Annual Global Total
Expenditures on Food
750 billion
1 000 (on imports)
?
World’s annual total
expenditures on development
assistance
15 billion
122 billion
- 8.1
World’s total expenditures on aid
for health
3.5 billion
14 billion
- 4.1
The cost of building the highest
building in the world (Dubai)
30 billion
1.5 billion
+ 20
The cost of building the bridge
from Malmö to Copenhagen
0.4 billion
6.8 billion
- 17
The annual cost of running
Akademiska sjukhuset in
Uppsala
0.1 billion
0.6 billion
-6
Ingvar Kamprads fortune
30 billion
22 billion
+ 1.4
Bill Gates Fortune
27 billion
50 billion
- 0.5
Bill and Melinda Gates
Foundation
Total disbursements so far
4.5 billion
14.4 billion
- 3.0
WHO’s Annual Budget
50 billion
4.9 billion
+ 10
How much is one billion
dollars??
Stockholm County Council:
Provides health care for
1,9 million inhabitants
(0.029% of world population of 6.45
billion)
Annual expenditures are
GUESS!
• USD 7,6 billion!
• Per capita expenditure in Stockholm is USD 4500
Health economics
• Economic thinking and principles applied to
health and health care
– ”The science concerned with issues related to
the allocation of scarce resources to improve
health”
» A J Culyer
Health economics
• Some key areas of work within HE
–
–
–
–
–
–
cost-effectiveness
resource allocation
health care financing
health systems organisation
health care production
health management
Health economics
• Some key terms in health economics
– efficiency - how to make best use of a certain
amount of money (inputs)
– Output - measurable production
– outcome - welfare
– resource allocation - distribution of resources
for optimal production
– average versus marginal
Health economics
• average versus marginal
– Average: total X (for instance cost of prod.)
total Y
units prod.)
– Marginal: Cost or benefit of one additional unit
of a good
• The optimal situation is when the marginal
cost of production equals the marginal
benefit of the production
Health economics
• Some key terms in health economics
– demand and supply - markets
– incentives - what drives the actors
Cost-effectiveness
• Relates costs to effectiveness of an action
(intervention)
– Example: The cost of treating successfully a
patient with a particular disease
– Challenge: Both cost and outcome have to be
measured
Cost-effectiveness
• How do we measure costs?
• Disaggregate costs
– direct - ex. staff time spent on patient, drug costs
– indirect - ex. cost of hospital administration, patient time
spent on care seeking
– intangible - suffering of patient, loss
• measure each component
– Example: How to measure staff time spent on patient?
Cost-effectiveness
• How do we measure effectiveness?
• Years of life gained (as compared to no intervention)
- PYLL
• Years of life without disability - DALY
• Years of life with good quality -QALY
• In intervention assessment we talk about PYLLs,
DALYs, QALYs gained
Total cost of road traffic injuries
World: USD 518 billion
Low and middle income countries:
USD 65 billion (12.5%)
BUT
They account for
85% of road traffic injury
90% of the DALYs lost
CHOICE
CHOosing Interventions that are
Cost Effective
Methodology and tool developed by
WHO for cost-effectiveness
evaluation
Summary of the Total Costs of the Intervention
Go to Summary of intervention costs by
Foreign exchange rate:
0
Capacity Utilization
Economic costs
Total Costs (in
Total Costs (in US$)
Cost Profile (%)
local currency)
% Capacity
Target
Capacity
Utilisation
Capacity
Adjustment
Factor
i) Recurrent Costs
a)PHCF Recurrent Costs
PERSONNEL COSTS
0,00
0,00
0
NON-MEDICAL MATERIALS & SUPPLIES
0,00
0,00
0
Not
Not
100%
DRUGS
0,00
0,00
0
Applicable
Applicable
100%
MEDICAL SUPPLIES
0,00
0,00
0
__
__
100%
LABORATORY SUPPLIES
0,00
0,00
0
__
__
100%
TRANSPORT OPERATING COSTS
0,00
0,00
0
__
__
100%
EQUIPMENT OPERATING COST
0,00
0,00
0
__
__
100%
MAINTENANCE
0,00
0,00
0
__
__
100%
UTILITIES
0,00
0,00
0
__
__
100%
OTHER RECURRENT ITEMS
0,00
0,00
0
__
__
100%
Total Recurrent Cost:
0,00
0,00
0
% Capacity
Target
Capacity
Utilisation
Capacity
Adjustment
Total Costs (in
ii) Capital Costs
Total Costs (in US$)
Cost Profile (%)
local currency)
0
0
0
Factor
b) PHCF Capital Costs
BUILDING COSTS
0,00
0,00
0
0
0
0
TRANSPORT COSTS
0,00
0,00
0
0
0
0
EQUIPMENT/IMPLEMENTS COSTS
0,00
0,00
0
0
0
0
FURNITURE COSTS
0,00
0,00
0
0
0
0
OTHER CAPITAL COSTS
0,00
0,00
0
0
0
0
Total Capital Cost:
0,00
0,00
0
0
0
0
Grand Total Cost:
0,00
0,00
0
SOUTH EAST ASIA
Intervention
ARV, intensive monitoring
ARV, intensive monitoring plus
second-line drugs
ARV, standard monitoring
ARV, standard monitoring plus
second-line drugs
Effectiven
ess
Average Year Cost (in international
(DALYs Cost Effectiveness
[I$])
averted)
Program
me
Average
Patient
Total
21,637,940
103,605,183
123,835,278
173,513
714
21,224,063
357,465,968
377,696,062
226,582
1,667
21,637,940
71,425,554
91,655,649
110,494
830
21,224,063
205,811,374
226,041,468
141,060
1,602
CHOICE
Can be downloaded from
http://www3.who.int/whosis/
or
http://www.who.int/choice/
or
www.who.int
and write
CHOICE in the search box
• Disease Control Priorities
–www.dcp2.org
National Health Accounts
Tool developed by WHO in
collaboration with Harvard School of
Public Health and others to
standardize national health accounts
Country
India
Thailand
Liberia
South Africa
Peru
Per cap total
health exp (int
dollar)
Per cap
government
health exp (int
dollar)
Expenditure on
health as % of
GDP
Private expend.
on health as %
of total health
exp
National Health Accounts
Manual can be downloaded from
http://www.who.int/nha/
Websites
• NHA
• Cost-it – CHOICE
• IDB http://www.census.gov/ipc/www/idbnew.ht
ml
Task
• Go through the Sudan Concept Note – focus
on issues related to today’s subject and
introduction
Task
• Find any number on macro economics – like GDP,
expenditures on health etc. and list them
• Compare the numbers found to two other African
countries and two Asian
• Put the numbers in a table, compare and discuss
Variable
Sudan
Ethiopia
Uganda
India
Vietnam
Population
37
78
28
1 130
85
GDP (billion
USD)
61
47
16
2 430
178
Total health
exp as % of
GDP
2005
3.8
4.1
6.9
3.8
6.0
General govern
health exp as %
of total HE
38
61
28
22
26
Govern health
exp as % of
general
governm exp
6
10
10
3
5
Total HE/cap in
ID
65
25
63
81
125
Social security
fund as % of
general GE
11
0
0
5
33
Private
household out
of pocket
payment as %
of total private
HE
100
81
51
92
90
Task
• Can you find any numbers on costs or
effectiveness in the concept note?
• If so, list them and discuss for each of them:
– Are they relevant to the concept note?
– Source of information (where did the authors
get them from?)
– Discuss their likely validity
Task
• What additional data related to health
economics would you like to get from the
Sudan setting?
• Motivate your answer
• Suggest how they could be collected