Cost Effectiveness and Resource Allocation最新文献

{"title":"The cost-effectiveness analysis of newborn screening for inherited metabolic disorders in China using tandem mass spectrometry: a real-world evidence.","authors":"Dunming Xiao, Jiaqi Yuan, Shimeng Liu, Yi Yang, Yingyao Chen","doi":"10.1186/s12962-025-00608-w","DOIUrl":"https://doi.org/10.1186/s12962-025-00608-w","url":null,"abstract":"<p><strong>Background: </strong>Inherited metabolic disorders (IMDs) are a significant cause of morbidity and death among children. To determine the cost-effectiveness of newborn screening for IMDs using tandem mass spectrometry (MS/MS) compared to the non-screened group in China.</p><p><strong>Methods: </strong>We constructed a decision tree screening model based on the Chinese clinical path of tandem MS/MS screening for inherited metabolic disorders (IMDs) from the medical health system. This model simulated the mechanism of screening in the prevention and treatment of IMDs. The IMDs screening data was collected from Children's Hospital of Shanghai between 2010 and 2021. The Quality-adjusted life years (QALYs) and life expectancy were obtained from literature, while cost data was mainly sourced from hospital records and literature.</p><p><strong>Results: </strong>In the base-case analysis, the total lifetime cost per patient was higher for the MS/MS screened group at 1,000,452 Chinese Yuan (CNY) (USD 143,515), compared to 157,303 CNY (USD 22,565) for the non-screened group. The QALYs gained were 16.47 and 3.97 for the screened and non-screened groups, respectively. The incremental cost-effectiveness ratio (ICER) of the MS/MS screened group compared to the non-screened group was 67,417 CNY (USD 9,671) per QALY gained, which is under the threshold of 3 times per capita GDP of China in 2022 (242,928 CNY, USD 34,848). The benefit-cost ratio (BCR) was 4.23, which means that for every 1 CNY (USD 0.1434506) invested, a return of 4.23 CNY (USD 0.57) can be obtained. The probability of cost-effectiveness was 100% in the MS/MS screened group compared to the non-screened group, indicating that the results of the base case analysis were robust.</p><p><strong>Conclusion: </strong>Compared to the non-screened group, the MS/MS screened group incurs higher costs but also yields significantly greater QALY gains. Considering both the costs and benefits, the MS/MS screened group is an attractive cost-effective option at the current willingness-to-pay threshold for IMDs screening in China.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"23 1","pages":"3"},"PeriodicalIF":1.7,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of Covid-19 pandemic on the primary health care utilization and cost: an interrupted time series analysis.","authors":"Mohsen Bayati, Farhad Lotfi, Mehdi Bayati, Zahra Goudarzi","doi":"10.1186/s12962-025-00606-y","DOIUrl":"10.1186/s12962-025-00606-y","url":null,"abstract":"<p><strong>Background: </strong>Changes in the demand behavior for primary care during the covid-19 pandemic may translate into changes in the overall public health situation in Iran with the increase in the prevalence of non-communicable diseases.</p><p><strong>Objective: </strong>The present study aimed to investigate the impact of the Covid-19 pandemic on the primary health care utilization and cost in Fars province of Iran.</p><p><strong>Methods: </strong>Monthly utilization and cost of primary health care was extracted from the data base of Fars province branch of Iran Health Insurance Organization (IHIO) in Iran. The interrupted time series analysis (ITSA) was used to investigate the short-term and long-term effects of Covid-19 on the utilization and cost of primary health care.</p><p><strong>Results: </strong>The mean difference test showed that the monthly utilization and cost of primary health care after Covid-19 has decreased significantly (64307 for utilization and 11581 US dollars for cost). The ITSA estimates showed that the number of monthly primary health care visits after Covid-19 has decreased significantly by 53,003 in the short term and 2,330 in the long term. Moreover, the cost of primary health care shows a significant decrease of $24,722 and $3,822 per month in the short term and in the long term, respectively.</p><p><strong>Conclusion: </strong>It found a significant reduction in the utilization of primary health care. Considering the role of primary care in controlling the burden of chronic diseases, planning for active follow-up of patients with chronic conditions should be on the agenda.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"23 1","pages":"2"},"PeriodicalIF":1.7,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11823024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness and budget impact of covering Burkitt lymphoma in children under Ghana's National Health Insurance Scheme.","authors":"Richmond Owusu, Dakota Pritchard, Lieke Fleur Heupink, Godwin Gulbi, Brian Asare, Ivy Amankwah, Joycelyn Azeez, Martha Gyansa-Lutterodt, Lydia Dsane-Selby, Ruby Aileen Mensah, William Omane-Adjekum, Francis Ruiz, Mohamed Gad, Justice Nonvignon, Lumbwe Chola","doi":"10.1186/s12962-025-00603-1","DOIUrl":"10.1186/s12962-025-00603-1","url":null,"abstract":"<p><strong>Background: </strong>Childhood cancer is not a high priority in health care financing for many countries, including in Ghana. Delayed care seeking and treatment abandonment, often due to the financial burden of care seeking to families, are common reasons for a relatively low overall survival (OS) in low-and middle-income countries. In this study, we analyzed the cost-effectiveness of extending health insurance coverage to children with Burkitt lymphoma (BL) in Ghana.</p><p><strong>Methods: </strong>We developed a Markov model in Microsoft Excel to estimate the costs and effects of BL treatment when National Health Insurance Scheme (NHIS) was provided compared to the status quo where NHIS does not cover care for childhood cancer. The analysis was undertaken from the societal and health system (payer) perspective. Both costs (measured in $) and effects, measured using disability adjusted life years (DALYs), were discounted at a rate of 3%. The time horizon was a lifetime. Probabilistic sensitivity analysis was done to assess uncertainty in the measurement of the incremental cost-effectiveness ratio (ICER). A budget impact analysis was undertaken from the perspective of the NHIS.</p><p><strong>Results: </strong>In the base-case analysis, the intervention (NHIS reimbursed treatment) was less costly than current practice ($8,302 vs $9,558). The intervention was also more effective with less DALYs per patient than the standard of care (17.6 vs 23.33). The ICER was -$219 per DALY averted from societal perspective and $113 per DALY averted from health system perspective. The probabilistic sensitivity analysis showed that the intervention is likely to be both less costly and more effective than current practice in 100% of the 1,000 simulations undertaken.</p><p><strong>Conclusion: </strong>Providing health insurance coverage to children with BL is potentially cost-effective. The effectiveness and cost-savings relating to this strategy is driven by its positive impact on treatment initiation and retention. Based on this evidence, there has been a policy change where Ghana's NHIS has prioritized financing for cancer treatment in children.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"23 1","pages":"1"},"PeriodicalIF":1.7,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11773855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of the PECUNIA reference unit costs templates in Spain: a useful tool for multi-national economic evaluations of health technologies.","authors":"Lidia García-Pérez, Renata Linertová, Aránzazu Hernández-Yumar, Cristina Valcárcel-Nazco, Jhoner Perdomo-Vielma, Pedro Serrano-Aguilar, Mencia R Gutierrez-Colosia, Luis Salvador-Carulla, Enrique Fernández-Vega, Susanne Mayer, Judit Simon","doi":"10.1186/s12962-024-00601-9","DOIUrl":"10.1186/s12962-024-00601-9","url":null,"abstract":"<p><strong>Background: </strong>The PECUNIA Project was funded by the H2020 programme in which 10 partners from six countries participated. The aim was to develop standardized, harmonized and validated methods and tools to calculate costs in different sectors (such as health and social care, education among others), with the purpose of facilitating comparability of economic evaluations of health technologies across European countries. In this paper we report the first validation of the developed reference unit cost templates in Spain.</p><p><strong>Methods: </strong>The evaluation of the PECUNIA Reference Unit Cost (RUC) Templates involved usability, transferability and feasibility assessment. Applicability tests were performed to estimate the cost of a selection of 15 resource items by means of the RUC templates in Spain and in four Spanish regions. External validation involved comparison with existing unit costs.</p><p><strong>Results: </strong>It was possible to estimate the cost of five services (dental care and general practitioner in the Canary Islands, general practitioner in Spain [tariffs], health-related day care centre and education services provided in a special education school in the Basque Country), car vandalism as an example of potential health-related consequences, and informal care in Spain. The templates were feasible although data completeness depended on the type of data needed to estimate the costs. The templates are transferable across countries although comparability depends on the services available in each jurisdiction.</p><p><strong>Conclusions: </strong>The PECUNIA RUC Templates are free and feasible tools to estimate comparable reference unit costs across countries. Although more validation exercises are needed, they seem useful tools to perform robust multi-national economic evaluations and increase the transferability of cost-effectiveness studies of health technologies in Europe. However, they cannot compensate for the lack of data across jurisdictions.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"22 1","pages":"92"},"PeriodicalIF":1.7,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11657748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Itemized point cost method in human resource cost accounting in medical service projects.","authors":"Yingqi Li, Siyuan Liang, Kui Qin, Hongtong Su, Peiyong Xia","doi":"10.1186/s12962-024-00599-0","DOIUrl":"10.1186/s12962-024-00599-0","url":null,"abstract":"<p><strong>Background: </strong>The cost accounting of medical service projects forms the basis for disease cost accounting and DRG (Diagnosis-Related Groups) cost accounting. Among the various costs involved, human resources represent a significant portion and are highly complex, making their accurate accounting a critical and challenging aspect of cost accounting for medical service projects.</p><p><strong>Methods: </strong>This paper introduces the itemized point cost (IPC) method, a novel cost accounting approach based on the RBRVS (Resource-Based Relative Value Scale) theory. It outlines the core concepts of \"points\" and \"process steps\" within the IPC framework and details its application in human cost accounting. An example of impacted tooth extraction in the stomatology department of Hospital A is used to illustrate the IPC method's implementation process.</p><p><strong>Findings: </strong>A comparative analysis with activity-based costing and time-estimation costing methods shows that the IPC method is concise, practical, and operable. It is also aligned with the principles of cost-effectiveness.</p><p><strong>Conclusions: </strong>The paper proposes strategies to promote the IPC method, including leveraging information technology, enhancing top-level design, and standardizing processes, to improve its adoption and effectiveness in medical cost accounting.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"22 1","pages":"91"},"PeriodicalIF":1.7,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11656896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IAPN: a simple framework for evaluating whether a population-based risk stratification tool will be cost-effective before implementation.","authors":"Steven Wyatt, Mohammed A Mohammed, Peter Spilsbury","doi":"10.1186/s12962-024-00594-5","DOIUrl":"10.1186/s12962-024-00594-5","url":null,"abstract":"<p><p>Risk prediction tools are widely used in healthcare to identify individuals at high risk of adverse events who may benefit from proactive interventions. Traditionally, these tools are evaluated primarily on statistical performance measures-such as sensitivity, specificity, discrimination, and positive predictive value (PPV)-with minimal attention given to their cost-effectiveness. As a result, while many published tools report high performance statistics, evidence is limited on their real-world efficacy and potential for cost savings. To address this gap, we propose a straightforward framework for evaluating risk prediction tools during the design phase, which incorporates both PPV and intervention effectiveness, measured by the number needed to treat (NNT). This framework shows that to be cost-effective, the per-unit cost of an intervention (I) must be less than the average cost of the adverse event (A) multiplied by the PPV-to-NNT ratio: I < A*PPV/NNT. This criterion enables decision-makers to assess the economic value of a risk prediction tool before implementation.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"22 1","pages":"90"},"PeriodicalIF":1.7,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11616102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost of the national malaria control program and cost-effectiveness of indoor residual spraying and insecticide-treated bed net interventions in two districts of Madagascar.","authors":"Voahirana Tantely Annick Andrianantoandro, Martine Audibert, Thomas Kesteman, Léonora Ravolanjarasoa, Milijaona Randrianarivelojosia, Christophe Rogier","doi":"10.1186/s12962-024-00598-1","DOIUrl":"10.1186/s12962-024-00598-1","url":null,"abstract":"<p><strong>Background: </strong>Madagascar has made significant progress in the fight against malaria. However, the number of malaria cases yearly increased since 2012. ITNs and IRS are key interventions for reducing malaria in Madagascar. Given the increasing number of cases and limited resources, understanding the cost-effectiveness of these strategies is essential for policy development and resource allocation.</p><p><strong>Methods: </strong>Using a societal perspective, this study aims to estimate the cost of the National Malaria Control Program (NMCP) through the first national malaria strategic plan (implemented over the period 2009-2013) and to assess the cost-effectiveness of two individually implemented malaria control interventions (ITNs and IRS) in two districts, Ankazobe and Brickaville. The cost-effectiveness ratio (CER) of ITN intervention was then compared to the CER of IRS intervention to identify the most cost-effective intervention. The cost of the NMCP and the costs incurred in the implementation of each intervention at the district level were initially estimated. On the basis of two results, the CERs of ITN or IRS correspond to the total cost of ITN or IRS divided by the number of people protected or the number of disability-adjusted life years (DALYs) averted. A deterministic univariate sensitivity analysis was conducted to assess the robustness of the results with a discount rate of 2.5% (0-5%) (costs and DALYs) and a 95% CI (person protected).</p><p><strong>Results: </strong>From 2009 to 2013, the NMCP cost USD 45.4 million (USD 43.5-47.5, r = 0-5%) per year, equivalent to USD 2.0 per capita per year. IRS implementation costs were four times higher than those of ITNs. The CER of IRS per case protected (USD 295.1 [285.1-306.1], r = 0-5%) was higher than the CER of ITNs (USD 48.6 [USD 46.0-51.5, r = 0-5%] in Ankazobe and USD 26.5 [USD 24.8-28.4, r = 0-5%] in Brickaville). The CERs per DALY averted of IRS was USD 427.6 [USD 413.0-546.3, r = 0-5%] in Ankazobe and, for ITNs, it was USD 85.4 [USD 80.8-90.5, r = 0-5%] in Ankazobe and USD 45.3 [USD 42.2-48.4, r = 0-5%] in Brickaville. Compared to the country GDP per capita (USD PPP 1494.6 in 2013), ITN intervention was \"highly cost-effective\" while the CER for IRS interventions was sensitive to parameter variation (CI, 95% of persons protected), which ranges from highly cost-effective to only cost-effective (USD 291.5-2004, r = 2.5%).</p><p><strong>Conclusion: </strong>In the Malagasy context, IRS intervention cost more and was less effective than ITN intervention. Willingness to pay for IRS is questioned. A relevant budget impact analysis should be conducted before a potential extension of this intervention.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"22 1","pages":"89"},"PeriodicalIF":1.7,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11616307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Controversies in implementing the exemption policy for the elderly healthcare services in Tanzania: experiences from the priority setting process in two selected districts.","authors":"Malale Tungu, Nathanael Sirili, Alphoncina Kagaigai, Pankras Luoga, Novatus Tesha, Thadeus Ruwaichi, Gasto Frumence","doi":"10.1186/s12962-024-00595-4","DOIUrl":"10.1186/s12962-024-00595-4","url":null,"abstract":"<p><strong>Background: </strong>Health financing system in Tanzania changed in the early 1990s as a result of the introduction of cost-sharing policies by the 1990s health sector reforms. The reforms brought about user fees which has led to inequity in access to health care services and catastrophic health expenditure among the elderly. In efforts to reduce the inequity gap among vulnerable groups, in 1994, the government introduced an exemption and waiver policy. More than three decades later, inequity in health care services access has persisted with the elderly population being more affected. The latter poses questions on the implementation efficiency of the exemption policy. We aimed to assess the implementation of the exemption policy on access to health services among the elderly in Tanzania by learning from the experiences of the priority setting process in two districts of western Tanzania.</p><p><strong>Methods: </strong>An exploratory qualitative case study adopting Key informant interviews (KIIs) was used to collect data in Nzega and Igunga districts. The key informants involved the representatives of the planning team and decision makers from the community, health facility and district level. Information saturation was attained after the 24th interview and thus data collection ended. The content analysis approach was used to analyse the data.</p><p><strong>Findings: </strong>Although there is a designated office that deals with exemptions for the elderly in health facilities, there are challenges in accessing health services. The challenges include insufficient drugs, some laboratory tests not covered by the exemption, a lengthy process to access service, poor financial mechanisms for exempted services, inadequate information and clarity of the exemption categories, and limited to no involvement of different stakeholders in the exemption process.</p><p><strong>Conclusion: </strong>The exemption policy was introduced to help disadvantaged groups, including the elderly. However, its implementation encountered challenges which burden both the elderly and the health facilities. Its implementation has thus become a controversy to its initial aim that was to relieve the elderly from high healthcare costs. Revisiting the policy through a thorough stakeholders' engagement and establishing alternative financing of the exemption policy are recommended.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"22 1","pages":"88"},"PeriodicalIF":1.7,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11613900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing diagnosis-related groups based direct medical expenditures of chronic disease patients in general hospital of lower southern Thailand.","authors":"Akemat Wongpairin, Apiradee Lim, Phattrawan Tongkumchum, Wichayaporn Thongpeth, Haris Khurram","doi":"10.1186/s12962-024-00596-3","DOIUrl":"10.1186/s12962-024-00596-3","url":null,"abstract":"<p><strong>Background: </strong>Assessment of the cost-related burden of chronic diseases is important for making informed decisions. An effective and efficient methodology for examining medical expenditures is one of the most significant challenges for stakeholders. The objective of this study was to examine the role of the variables of diagnosis-related group (DRG) in determining the direct expense of chronic diseases in lower southern Thailand and suggest the determinants having high explainability.</p><p><strong>Methods: </strong>The records of 6,147 patients admitted to Satun Hospital from 2014 to 2018 and diagnosed with chronic conditions were analyzed in this study. Descriptive analysis was used to summarize the main characteristics. Correlation was used to analyze the strength of the relationship. A log-linear regression model was used to evaluate the adjusted mean cost using determinants of DRG.</p><p><strong>Results: </strong>The overall average medical expense for chronic disease was Thailand Baht (THB) 17,985. Chronic kidney and chronic obstructive pulmonary diseases were the most expensive chronic diseases with an average expense of about THB 20,000 and 25,000. All the determinants were significantly contributing to overall expense of chronic disease with a p-value < 0.001. However, the length of stay, number of diagnoses, and number of procedures had high explainability in the expense model.</p><p><strong>Conclusions: </strong>The expense assessment model plays a significant role in controlling and preventing the medical costs associated with chronic diseases. Healthcare administrators, stakeholders, and researchers need to make strategies by considering the results of this study to improve the DRGs-based hospital cost model.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"22 1","pages":"87"},"PeriodicalIF":1.7,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11603977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health system efficiency and equity in ASEAN: an empirical investigation.","authors":"Yaqing Liu, Liwen Gong, Haoran Niu, Feng Jiang, Sixian Du, Yiyun Jiang","doi":"10.1186/s12962-024-00588-3","DOIUrl":"10.1186/s12962-024-00588-3","url":null,"abstract":"<p><strong>Background: </strong>Equity and efficiency are two fundamental principles for the sound development of health systems, as advocated by the World Health Organization (WHO). Despite the notable progress made by the Association of Southeast Asian Nations (ASEAN) in advancing their health systems, gaps persist in achieving global health goals. This paper examines the efficiency of health system stages and the fairness of health resource distribution in ASEAN countries, analyzes the underlying causes of the existing gaps, and suggests potential solutions to bridge them.</p><p><strong>Methods: </strong>Data spanning 2011 to 2019, sourced from the WHO Global Health Observatory and the World Bank Database, form the foundation of this study. This study employs an enhanced two-stage data envelopment analysis (DEA) to assess the efficiency of health system stages in ASEAN countries. Equity in health resource distribution is evaluated using health resource agglomeration degree and concentration curves across demographic, geographic, and economic aspects. Furthermore, the Entropy-Weighted TOPSIS method is utilized to integrate equity across these dimensions, measuring the overall fairness in health resource allocation across different countries. Finally, rankings of health system fairness and efficiency are compared to assess the overall development level of health systems.</p><p><strong>Results: </strong>The overall efficiency of the ASEAN health systems from 2011 to 2019 averaged 0.231, with an upward trend in the first stage efficiency at 0.559 and a downward trend in the second stage at 0.502. The health resource agglomeration degree indicated that Singapore, Brunei, and Malaysia had HRAD and HRPD values significantly greater than 1, and Cambodia, Myanmar, and Laos predominantly had indices significantly less than 1. The concentration curve for hospital beds was the closest to the line of absolute equity. During the study period, the health resource concentration curve increasingly approached absolute equity, shifting from above to below the concentration curve. Singapore, Brunei, and Malaysia consistently remained in the first quadrant of the quadrant plot, and Myanmar and Cambodia were consistently in the third quadrant.</p><p><strong>Conclusion: </strong>ASEAN countries face two key challenges in their healthcare systems: first, while many nations such as Indonesia, Thailand, and Vietnam have improved resource allocation efficiency, this hasn't yet translated into better health services. To address this, establishing national health sector steering committees, focusing on workforce training and retention, and implementing centralized monitoring systems are crucial. Second, there is a growing disparity in healthcare development across ASEAN. Promoting balanced resource distribution and leveraging ASEAN's economic integration for regional collaboration will help bridge these gaps and foster more equitable healthcare systems.</p>","PeriodicalId":47054,"journal":{"name":"Cost Effectiveness and Resource Allocation","volume":"22 1","pages":"86"},"PeriodicalIF":1.7,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11590474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}