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This paper examines how axiomatic bargaining theory can be used to analyze different rules for dividing the health care budget between two patients. This approach allows an explicit statement of the assumptions underlying the division rules and also provides a general characterization of the consequences of using these rules when the opportunity set (or number of patients) changes.
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The imperative to reduce health inequalities whilst keeping within budget means that Health Authorities must prioritise to gain maximum benefit from available resources. Health Inequality Impact Assessment (HIIA) rapid appraisal has been developed by Bro Taf Health Authority to ensure that planning produces positive effects for disadvantaged people. HIIA rapid appraisal consists of assessing the effect of deprivation on the planning topic, examining the relevant evidence, defining opportunities for action and rating these relative to their likely impact on health inequalities. The process is best carried out by a multidisciplinary team including health authority, local authority, voluntary sector and community representatives. This paper describes a HIIA rapid appraisal process, that resulted in a Trust that serves a highly disadvantaged locality agreeing to try a new method of working and to collaborate in research on breaking the cycle of deprivation.
An increase in exclusive breastfeeding prevalence can substantially reduce mortality and morbidity among infants. In this paper, estimates of the costs and impacts of three breastfeeding promotion programmes, implemented through maternity services in Brazil, Honduras and Mexico, are used to develop cost-effectiveness measures and these are compared with other health interventions. The results show that breastfeeding promotion can be one of the most cost-effective health interventions for preventing cases of diarrhoea, preventing deaths from diarrhoea, and gaining disability-adjusted life years (DALYs). The benefits are substantial over a broad range of programme types. Programmes starting with the removal of formula and medications during delivery are likely to derive a high level of impact per unit of net incremental cost. Cost-effectiveness is lower (but still attractive relative to other interventions) if hospitals already have rooming-in and no bottle-feeds; and the cost-effectiveness improves as programmes become well-established. At an annual cost of about 30 to 40 US cents per birth, programmes starting with formula feeding in nurseries and maternity wards can reduce diarrhoea cases for approximately $0.65 to $1.10 per case prevented, diarrhoea deaths for $100 to $200 per death averted, and reduce the burden of disease for approximately $2 to $4 per DALY. Maternity services that have already eliminated formula can, by investing from $2 to $3 per birth, prevent diarrhoea cases and deaths for $3.50 to $6.75 per case, and $550 to $800 per death respectively, with DALYs gained at $12 to $19 each.
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The impact of technology and the emphasis on tertiary specialty care have no inherent limits of cost escalation. Likewise, they dislocate health care resources since general and secondary care become more expensive as the impact of the high cost emphasis of health care trickles down to the costs of primary and secondary care. The change areas will involve: the principle of regionalization of specialty care and resident training, a uniform system of costs and reimbursements for all specialized medical and hospital care, the rationing of high technology specialty care and the application of prospective systems of payment to all institutional and physician specialty services.
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In accordance with the requirement of section 333A(c) of the Public Health Service Act, as amended by Public Law 101-597 (the National Health Service Corps Revitalization Amendments of 1990), this Notice establishes the criteria which the Secretary will use to make determinations under section 333A(a)(1)(A) of the health professional shortage areas (HPSAs) with the greatest shortages, using the exclusive factors specified in section 333A(b).
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In this article, Dr. Brandrup-Lukanow identifies a number of women's health issues that stand in need of attention from practitioners and policy makers responsible for providing health care services to women, especially in the countries of Central and Eastern Europe and in the Newly Independent States of the former Soviet Union. Focusing especially on issues of reproductive health, Dr. Brandrup-Lukanow examines why the incidence of maternal and infant mortality and morbidity are so much higher in these countries than they are in Western Europe. The article concludes with some specific and integrated recommendations for improvement.
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Explore the source record for details and available documents.