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HCDF: Health Expenditures (Topic)最新文献

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Free Distribution or Cost-Sharing? Evidence from a Randomized Malaria Prevention Experiment 免费分发还是成本分摊?来自随机疟疾预防实验的证据
Pub Date : 2007-12-01 DOI: 10.2139/ssrn.1080301
Jessica L. Cohen, P. Dupas
It is widely believed that cost-sharing - charging a subsidized, positive price - for a health product is necessary to avoid wasting resources on those who will not use or do not need the product. We explore this argument in the context of a field experiment in Kenya, in which we randomized the price at which pregnant women could buy long lasting anti-malarial insecticide-treated nets (ITNs) at prenatal clinics. We find no evidence that cost-sharing reduces wastage on those that will not use the product: women who received free ITNs are not less likely to use them than those who paid subsidized positive prices. We also find no evidence that cost-sharing induces selection of women who need the net more: those who pay higher prices appear no sicker than the prenatal clients in the control group in terms of measured anemia (an important indicator of malaria). Cost-sharing does, however, considerably dampen demand. We find that uptake drops by 75 percent when the price of ITNs increases from 0 to $0.75, the price at which ITNs are currently sold to pregnant women in Kenya. We combine our estimates in a cost-effectiveness analysis of ITN prices on infant mortality that incorporates both private and social returns to ITN usage. Overall, given the large positive externality associated with widespread usage of insecticide-treated nets, our results suggest that free distribution to pregnant women is both more effective and more cost-effective than cost-sharing.
人们普遍认为,为了避免将资源浪费在那些不使用或不需要该产品的人身上,分摊费用——收取补贴的积极价格——是必要的。我们在肯尼亚的一项实地实验中探讨了这一论点,在该实验中,我们随机确定了孕妇在产前诊所购买长效抗疟疾驱虫蚊帐(ITNs)的价格。我们没有发现任何证据表明费用分摊减少了那些不使用该产品的人的浪费:获得免费ITNs的妇女使用它们的可能性并不低于支付补贴价格的妇女。我们也没有发现任何证据表明,费用分摊会促使那些更需要蚊帐的妇女做出选择:就测量的贫血(疟疾的一个重要指标)而言,那些支付更高价格的妇女似乎并不比对照组的产前客户病情更严重。然而,费用分摊确实大大抑制了需求。我们发现,当ITNs的价格从0美元提高到0.75美元(目前肯尼亚向孕妇出售ITNs的价格)时,吸收率下降了75%。我们将我们的估计结合到对婴儿死亡率的ITN价格的成本效益分析中,该分析包含了ITN使用的私人和社会回报。总体而言,考虑到广泛使用驱虫蚊帐所带来的巨大正外部性,我们的研究结果表明,与分摊费用相比,向孕妇免费发放蚊帐更为有效,也更具成本效益。
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引用次数: 706
Education and Health in G7 Countries: Achieving Better Outcomes with Less Spending 七国集团国家的教育和卫生:用更少的支出取得更好的成果
Pub Date : 2007-11-01 DOI: 10.5089/9781451868265.001
M. Verhoeven, Victoria Gunnarsson, Stéphane Carcillo
Enhancing the efficiency of education and health spending is a key policy challenge in G7 countries. The paper assesses this efficiency and seeks to establish a link between differences in efficiency across countries and policy and institutional factors. The findings suggest that reforms aimed at increasing efficiency need to take into account the nature and causes of inefficiencies. Inefficiencies in G7 countries mostly reflect lack of cost effectiveness in acquiring real resources, such as teachers and pharmaceuticals. We also find that high wage spending is associated with lower efficiency. In addition, lowering student-teacher ratios is associated with reduced efficiency in the education sector, while immunizations and doctors' consultations coincide with higher efficiency in the health sector. Greater autonomy for schools seems to raise efficiency in secondary education.
提高教育和卫生支出的效率是七国集团国家面临的一项关键政策挑战。本文对这种效率进行了评估,并试图在各国之间的效率差异与政策和制度因素之间建立联系。调查结果表明,旨在提高效率的改革需要考虑到效率低下的性质和原因。七国集团国家的低效率主要反映了在获取实际资源(如教师和药品)方面缺乏成本效益。我们还发现,高工资支出与低效率有关。此外,师生比例的降低与教育部门效率的降低有关,而免疫接种和医生咨询与卫生部门效率的提高相吻合。学校更大的自主权似乎提高了中学教育的效率。
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引用次数: 65
Financing Health Promotion: A Case Study on Thailand 促进健康筹资:以泰国为例
Pub Date : 2007-01-12 DOI: 10.2139/ssrn.1070747
P. Prakongsai, K. Bundhamcharoen, K. Tisayatikom, V. Tangcharoensathien
Objectives: To review the burden of diseases resulted from chronic non-communicable diseases and its trend between 1999 and 2004, financing health care and financing health promotion and disease prevention, with the experiences of innovative financing health promotion and policy makers views on innovative financing health promotion. Methods: The study applied several methodological approaches including literature reviews, interviews of key informants, and primary survey through self administered mail questionnaire to key stakeholders in and outside the Ministry of Public Health. Results: In view of consistent increasing trend of burden of diseases resulted from chronic NCD, the economic and health impact of NCD is far-reaching. The resources available for health promotion is far too low compared to curative services, most of this funding went to personal clinical preventive and health promotion services and little for public interventions. The resources mobilized by the Thai Health Promotion Foundation through 2% levy on tobacco and alcohol consumption, is far too small, though plays a significant catalytic role in mobilizing public awareness toward major killers such as tobacco, alcohol and road traffic injuries, to serve as a strong leverage to halt and reverse the trend of chronic NCD. Two major stakeholders, Ministry of Finance responsible for Civil Servant Medical Benefit Scheme (CSMBS) and the Social Security Office responsible for Social Health Insurance have a tunnel view, and yet to be convinced to invest more in health promotion for their beneficiaries. Recommendations: Three policy messages were proposed, (1) Increase level of financing health promotion and primary, secondary prevention of disease through significant Increase in MOPH annual budget on health promotion and amendment of CSMBS regulation and Social Security Act to incorporate health promotion and disease prevention as their mandates; (2) Increase value for money of conventional clinical prevention and health promotion services through the application of a recent publication on Disease Control Priority for Developing Countries by Jamaison et al (2006), and improve program effectiveness based on evidence; (3) Sustain and accelerate the work of Thai Health Promotion Foundation (THPF) through increase levies from 2% to 5% of tobacco and alcohol consumption and diversify THPF portfolio to cover cost effective interventions. Portfolio and social mobilization by THPF has to be guided by sound evidence.
目标:审查1999年至2004年期间慢性非传染性疾病造成的疾病负担及其趋势、保健筹资、促进健康和疾病预防筹资、促进健康创新筹资的经验和决策者对促进健康创新筹资的看法。方法:采用文献综述、关键举报人访谈、对卫生部内外主要利益相关者自行邮寄问卷的方式进行初步调查等方法。结果:慢性非传染性疾病造成的疾病负担呈持续增加趋势,非传染性疾病对经济和健康的影响是深远的。与治疗服务相比,可用于促进健康的资源太少,其中大部分资金用于个人临床预防和促进健康服务,用于公共干预的资金很少。泰国健康促进基金会通过对烟草和酒精消费征收2%的税调动的资源太少了,尽管在动员公众对烟草、酒精和道路交通伤害等主要杀手的认识方面发挥了重要的促进作用,无法作为制止和扭转慢性非传染性疾病趋势的有力杠杆。负责公务员医疗福利计划(CSMBS)的财政部和负责社会健康保险的社会保障办公室这两个主要利益攸关方的观点都很狭隘,尚未被说服在促进其受益人健康方面投入更多资金。建议:提出三个政策信息:(1)通过大幅度增加公共卫生部关于健康促进的年度预算和修订CSMBS条例和《社会保障法》,将健康促进和疾病预防纳入其职责范围,提高健康促进和一级、二级疾病预防的筹资水平;(2)通过采用Jamaison等人最近出版的《发展中国家疾病控制优先事项》(2006年),提高传统临床预防和健康促进服务的性价比,并根据证据提高方案的有效性;(3)通过将烟草和酒精消费的征税从2%提高到5%,维持和加速泰国健康促进基金会(THPF)的工作,并使THPF的投资组合多样化,以支付具有成本效益的干预措施。THPF的投资组合和社会动员必须以可靠的证据为指导。
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引用次数: 3
Health Care Cost Containment 医疗保健成本控制
Pub Date : 1995-11-01 DOI: 10.5089/9781451936537.001.A001
E. Nedde
The Administration`s proposals to reform the U.S. health care system sought to provide for universal health insurance coverage while containing the growth of health care spending. This paper focuses on the latter issue and discusses the ability of regulatory and market-oriented reforms to achieve health care cost containment from several angles: an international comparison of national cost containment measures, a review of past cost containment efforts in the United States, and a discussion of the estimated effects on health care costs of alternative proposals to reform the U.S. health care system.
政府改革美国医疗保健系统的建议寻求提供全民医疗保险,同时控制医疗保健支出的增长。本文重点关注后一个问题,并从几个角度讨论监管和市场导向改革实现医疗保健成本控制的能力:国家成本控制措施的国际比较,对美国过去成本控制努力的回顾,以及对美国医疗保健系统改革的替代建议对医疗保健成本的估计影响的讨论。
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引用次数: 0
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HCDF: Health Expenditures (Topic)
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