Health economics for palliative care

Healthcare costs are escalating due to public demand for, and the increasing availability of, treatment. National frameworks that use economic evaluation as a basis for health technology assessment have been successful at constraining expenditure on low-value treatments primarily by explicitly considering the opportunity cost of new technology adoption or service redesign. At the end of life and in palliative contexts, such methods have not been widely applied and are underdeveloped despite evidence that healthcare costs typically increase with proximity to death. There may be a requirement for the adaptation of standard methods for healthcare resource allocation in this setting, where the goals of care may differ from a curative or preventative context. Health service and financing models may be complex and specific to this setting, with a greater consideration for third-sector provision and informal care. This chapter outlines the core concepts in health economics that are relevant in the planning of palliative services, with specific considerations in the developed and developing world contexts.

Incorporating Portfolio Uncertainty in Decision Rules for Healthcare Resource Allocation

Cost-effectiveness analysis is widely adopted as a means to inform policy and decision makers in setting priorities for healthcare resource allocation. In resource-constrained settings, decision makers are confronted with healthcare resource reallocation decisions, e.g., moving funds from one or more existing healthcare programs to fund new healthcare programs. The decision-making plane (DMP) has been developed as a means to graphically present the results of reallocating available healthcare resources when healthcare program costs and effects are uncertain. Mapping a value function over the DMP allows the analyst to value all possible combinations of net costs and net effects that may result from reallocating available healthcare resources under conditions of uncertainty. In this paper, we extend this approach to include a change in portfolio risk, stemming from a change in the portfolios of funded healthcare programs, as an additional source of uncertainty, and demonstrate how this can be incorporated into the value function over net costs and net effects for a risk-averse decision maker. The methodology presented in this paper is of particular interest to decision makers who are risk averse, as it will help to better incorporate their preferences in the process of deciding how to best allocate scarce healthcare resources.

Exploring the Effect of the Number of Primary Care Health Workers on Diarrhea Morbidity and Where the Health Resources Should Go: a Community-based Geospatial Analysis Study From China

Background: Diarrhea remains a major threat to developing countries like China. Improved water, sanitation, and hygiene (WASH) have been known as cost-effective ways for reducing the morbidity of diarrhea. Primary healthcare institutions in China have been playing pivotal roles in the maintenance of WASH facilities as well as providing health education intended for improving residents’ appropriateness and safety in using those facilities. In this study, we aimed to explore the association between the number of primary healthcare workers and diarrhea morbidity at community levels in order to provide evidence-based implications for optimizing primary healthcare resource allocations.Methods: We collected annually time series of diarrhea morbidity, the number of primary healthcare workers, and relevant data of 4,321 communities in Sichuan Province with 83.41 million residents, China, from 2017 to 2019. The global and local Moran’s I were calculated to detect the spatial clustering of diarrhea morbidity each year as well as to identify areas where increased primary healthcare resources should be allocated. The spatial lag fixed effects panel data model was adopted to explore the association between the number of primary healthcare workers and diarrhea morbidity.Results: Positive global autocorrelation of diarrhea morbidity was identified based on Global Moran’s I. Significantly high-high and low-low clusters of diarrhea cases as indicated by Local Moran’s I were found to be mainly distributed in western and eastern Sichuan during the studied period years, respectively, which demonstrated consistency with regional economic development status and primary healthcare resource allocations among different regions. The diarrhea morbidity was found to be negatively associated with the number of primary healthcare workers with a coefficient of -0.187 and the P-values <0.05, indicating that a 0.187 reduction of diarrhea morbidity (1/10,000) was associate with doubled amounts of primary healthcare workers.Conclusions: Our findings highlighted the role of primary healthcare resource allocation in the process of diarrhea prevention and control which was reflected by the number of primary healthcare workers among different regions. Our findings also implied that constant efforts should be addressed at governmental and health administrative levels in order to facilitate diarrhea prevention and control, especially in the remoted area where the regional economic development status and primary healthcare resource allocation remain relatively underdeveloped.