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PubMedDate not supplied

[The demographic situation in the Croatian Republic].

Croatia is a low-natality region characterized by slowing growth rate of its total population and a decrease of its proportion in total population of Yugoslavia. This declining trend in Croatia, in accordance with its developmental features, is primarily the result of a fall in natural population increment due to a constant decline in natality/fertility and to mild increase in mortality. These features of the natural movement of population are typical for the areas in which the process of demographical transition has been completed. However, the decrease in the total population of Croatia, together with a decline in natural population increment has also contributed to a negative migration balance (both in internal and external migrations). These characteristics of the natural movement of population have brought about considerable imbalances in its age structure through a decrease in the number and proportion of young people, a mild increase in the working age population and through an intensive increase in the number and proportion of old people. Such tendencies will have numerous unfavourable consequences on the further development of population and on socio-economic development of Croatia.

Birth Rate↗
PubMedDate not supplied

[Current problems in assessing drug prices].

Two reasons provide historical justification for controlling drug prices: safeguarding the consumer and safeguarding public demand. Due to the increased presence of the "third payer" in public health systems this second reason has become more important. Nevertheless, over the last decade, a third purpose has attached to public control of prices: promotion of drug manufacturers economic development. The justification offered for this is that development of pharmaceutical companies contributes to the economic growth of the host country by creating employment, exports and research activity. The situations in Germany, Great Britain and United States are often cited in support of this thesis. As a model for price policy in Italy, however, it has not been successful. The rapid growth of prices in fact has not created greater employment and the foreign exchange deficit has risen rapidly. In other words the growing cost of drugs to the National Health Service has not produced hoped-for economic benefits. It would therefore be opportune to modify the mechanisms of price control by seeking a better balance in the interests involved (safeguarding public demand versus manufacturers economic growth). Methodologies available point to the evaluation of the therapeutic utility of a drug as a useful tool for this purpose. By this method the price of a new drug may only be higher than that of a drug already on the market if its therapeutic utility (which does not coincide only with clinical effectiveness) is greater. Appropriate evaluation techniques of benefits deriving from a new drug (cost-effectiveness and cost-utility) do exist and can be taken into consideration in a new method of calculating drug price.

Consumer Advocacy↗
PubMed1993

What about dental economics for the 1990s?

A slowdown in per capita dental expenditures is projected through the year 2000. However, reduction in the "production" of new dentists will offset these economic developments and result in a continued favorable economic environment.

Dentists↗
PubMed1993

Economic evaluation of health care technologies.

Despite two decades of developments, economic evaluation of medical therapies is still in its infancy. The first decade was mainly a search for a relevant methodology, a period when it was important to establish that new medical technologies carried not only costs but also economic benefits. The costs-of-illness methodology was the most convenient to use and served well to show that new medical technology produced economic benefits. It was obvious, however, that the method had its limitations, particularly in health care systems devoting more and more resources to the elderly, not an economically active part of the population. For other people also, health per se is more important than health as a human capital that improves work capacity. The studies undertaken in the 1970s were mainly based on epidemiological data and undertaken at arms' length from clinical activities in hospitals and in general practice. At the beginning of the 1980s, it became clear that in order to become more relevant, economic evaluations have to be linked much more closely to the clinical evaluation of new technologies. Clinicians and economists have to work together to produce good and relevant studies. The beginning of the 1980s saw such an increase in collaboration between economists and clinicians, and some important studies were undertaken. These studies were mainly concerned with calculating costs for different clinical actions and determining cost-effectiveness using, for example, number of life-years gained. During the last 5 years, interest has been focused on the problems and opportunities of including quality of life and utility estimates in economic evaluations.(ABSTRACT TRUNCATED AT 250 WORDS)

Cimetidine↗
PubMed1998

International perspectives in early emotional development.

This article provides a unique look at development-the lessons highly industrialized nations can learn from the rest of the world. Thailand, for example, created a comprehensive child development program through integration of health, education, economic development, social welfare, and community involvement. The program was proven to improve developmental outcomes that included IQ and nutritional status.

Child↗
PubMedDate not supplied

Organizational development and privatization: a Bolivian success story.

This article presents a case study of a US Agency for International Development-sponsored privatization effort in Bolivia. This privatization effort differs from AID's more common approach in that rather than merely helping already existing organizations to expand, this project has created a new organization. More ambitious and encompassing, this approach is also preferable because it directly addresses one of the most serious bottlenecks to economic development, viz., organizational development. The article describes the evolution of PROSALUD, a private, non-profit network of 17 community-sponsored health centers. The article describes factors and characteristics which have either conditioned or have directly contributed to PROSALUD's success. First, PROSALUD's health care environment is analysed, starting with a broad brush profile of select characteristics and trends which exist throughout the health sector of Bolivia, then narrows the focus to the local health sector. The structure and operations of PROSALUD are then analysed, focusing on the organization's managerial practices and financing and the series of tradeoffs it has been forced to strike: in its pricing strategy, between striving for financial viability and maintaining access to care; between, on the one hand, responding to community needs and demands and improving coverage by opening more facilities, and, on the other hand, focusing managerial efforts and outreach on a more limited number of clinics and neighborhoods; between providing a socially desirable mix of services--in particular, continuing to provide a great deal of free preventive care--and focusing care on more lucrative curative services; between maintaining commitments to neighborhoods and communities and eliminating the less economically viable (especially rural) clinics.

Bolivia↗
PubMed1993

Determining malaria effects in rural Colombia.

Good health is an integral component of the quality of human life, a prerequisite for developing human potential and an important determinant of economic development. When a person is ill from a tropical disease in an agricultural economy, a complex interaction between the individual's welfare and the family's welfare is set in motion. So complex are these interactions that few empirical studies exist on this subject and even where they do, empirical quantification of these interactions and economic losses places the analyst in the minefield of valuing time, ability and contribution to economic welfare. Placing monetary values on these commodities is always a little unsatisfactory since dollar values do not adequately reflect the nature of the losses. Secondly, the ill person's struggle to minimize the economic effects of disease on family income will mask its true impact; thirdly, tropical diseases disproportionately affect low-income groups and therefore measuring the income effects of disease amongst these groups will only reach at the earnings effect, and underestimate the economic implications of tropical disease control. Despite these difficulties, quantification of the economic impact of disease is important from a public health point of view. This study is an attempt at such a task, and focuses on the intra-familial struggle to minimize economic losses due to malaria. Using a case-control approach, time-losses and labour reallocations within the household are examined in an attempt to understand the economic consequences of the disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed2002

Trends in international health development.

"... Good population health is a crucial input into poverty reduction, economic growth and long-term economic development... This point is widely recognised by analysts and policy makers, but is greatly underestimated in its qualitative and quantitative significance, and in the investment allocations of many developing country and donor governments."--Commission on Macroeconomics and Health PURPOSE OF ARTICLE: The international health development scene has changed rapidly during the past 5 years. From being a merely bilateral effort together with a few multilateral organisations and many NGOs new global partnerships have entered the scene and become major funding agencies. The provision of aid has also changed from small-scale project basis to financial support of large programmes. The purpose of this article is to describe some of the major transformations taken place in the organising, delivery and objective of international health development. But before presenting the new international health development agenda, a short introduction to the challenges inducing the need for renewed thinking about international aid is shortly presented.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Medicinal plant genetic resources and international cooperation: the Brazilian perspective.

Brazil is a gene rich country, host to 24% of known primate species, between 10 and 15 million species of insects, and 22% of the world's higher plant species. The debate over how and by whom these resources should be protected has intensified over the last few years due to a growing awareness of the links between sustainable utilization of natural resources, conservation of biodiversity, and economic development. Within this context the pharmaceutical exploitation of natural products for drug development has a prominent place. For a significant portion of Brazilian society, fair cooperation is welcome and can facilitate drug discovery. Nevertheless, the complexity of the consequences of patenting and utilization of natural resources calls for a thorough cost/benefit analysis in order to promote policies that can ensure significant and long term benefits for the country.

Brazil↗
PubMed2000

Genetic differentiation of Euterpe edulis Mart. populations estimated by AFLP analysis.

Heart-of-palm (Euterpe edulis Mart.) is a wild palm with a wide distribution throughout the Atlantic Rainforest. Populations of E. edulis represent important renewable natural resources but are currently under threat from predatory exploitation. Furthermore, because the species is indigenous to the Atlantic Rainforest, which is located in the most economically developed and populated region of Brazil, social and economic pressures have devastated heart-of-palm forests. In order to estimate the partitioning of genetic variation of endangered E. edulis populations, 429 AFLP markers were used to analyse 150 plants representing 11 populations of the species distribution range. Analysis of the genetic structure of populations carried out using analysis of molecular variance (AMOVA) revealed moderate genetic variation within populations (57. 4%). Genetic differentiation between populations (FST = 0.426) was positively correlated with geographical distance. These results could be explained by the historical fragmentation of the Atlantic coastal region, together with the life cycle and mating system. The data obtained in this work should have important implications for conservation and future breeding programmes of E. edulis.

Base Sequence↗
PubMed1994

Geographic imbalances of physician supply: an international comparison.

This study was undertaken to compare geographic imbalances of physician manpower in developed and developing countries and to evaluate the success of policies designed to alleviate the imbalances. Data were drawn from a mail survey of countries conducted by the World Health Organization, from national statistical summaries, and from published information on national policies and programs. Information was available from 26 developing countries and 15 developed countries. Among developing countries, the degree of urbanization and rural economic development appeared to be the most important determinants of the level of geographic imbalance. Among developed countries, those with very high overall physician/population ratios tended to have the least degree of imbalance, but this effect was not consistent. At the national level in most countries, the effect of policies or programs specifically designed to redistribute physician manpower appeared to be limited.

Developing Countries↗
PubMed2004

Defence, counterattack, retreat?

Cardio-thoracic surgery is facing changes which are imposed upon us from two sources, medical development within cardiology and the general demographic and economic development of the western world. These two developments have to be faced. This treaty describes one way of thinking in our response to the changes. Using old strategic principles our options are attack, defence and retreat. The three options are described in some detail. In order to be well prepared, knowledge and preparation for all three options is necessary in meeting the challenges of the future.

Cardiac Surgical Procedures↗
PubMedDate not supplied

Health financing policy formulation in the Eastern Caribbean.

Stakeholders formulating policies on national health insurance (NHI) in the Eastern Caribbean have circled the abstract concept called NHI like the proverbial blind men explaining the elephant. Definitions of NHI have shifted depending on their perspectives and philosophical leanings, their understanding of the issues, and their degree of influence on the process. Based on NHI feasibility studies, market research, and stakeholder analysis conducted in five countries, this article analyses the policy formulation stage of NHI development in these tiny countries. Given the level of economic development and the existing administrative capacity of the governments, this 'phase one' NHI could be a pragmatic first step in introducing a health insurance component into the social security systems of the countries, and gradually reforming other aspects of the health sector. The article is structured around key questions which help to define the positions and relationships of key stakeholders, and then evaluate NHI plans in terms of economic viability, equity, administrative feasibility and efficiency, cost containment incentives, and political palatability. These are the elements that--in combination with economic and political context--will determine the success or failure of NHI in the Eastern Caribbean.

Developing Countries↗
PubMed1969

Use of local variations in trachoma endemicity in depicting interplay between socio-economic conditions and disease.

A trachoma prevalence survey was conducted in 1960-61 in Taiwan prior to the introduction of a large-scale treatment campaign. Marked local differences in endemicity of trachoma were encountered in neighbouring administrative areas (lin). Use is made of these local variations in depicting the interactions between socio-economical factors and endemicity of the disease.The study demonstrates the interaction between the socio-economic development of the household, on the one hand, and of the community of which the household forms a part, on the other. In a community of low trachoma endemicity, persons who do not share in the general socio-economic level of development nevertheless benefit from a low risk of infection, while in a community of high endemicity those in the upper socio-economic groups suffer from an enhanced risk of infection, though to an appreciably lesser extent than the general average for the community.The study indicates a possibility of an absence of association between various bio-physical environmental factors; for example, in a small community, better housing does not necessarily mean a better water supply. However, if any of the factors are considered, whether there is an implied pattern in the other factors or not, the most striking index of relative prevalence appears to be provided by the number of persons per unit (i.e., ping; about 3.3 m(2)) of sleeping area.

Adolescent↗
PubMed1992

[Consequences of international migration for Austria. Population scenarios until 2031].

"The consequences of international immigration on population development and the labour market [in Austria] are assessed on the basis of four scenarios of possible political and economic developments in Europe. In case of massive immigration (net +50,000 per year) the residential population of Austria...will grow to 9.5 million within 40 years.... With a net immigration of +25,000 persons per year the residential population will grow to 8.3 inhabitants.... Without any immigration or with immigration and emigration of equal proportion, the population of Austria will shrink to somewhat above 7.1 million...." (SUMMARY IN ENG)

Austria↗
PubMed2026

An Application of Iterative Health Economic Evaluation: An Update on the Early Cost Effectiveness of Whole-Genome Sequencing in Advanced Non-small-Cell Lung Cancer.

OBJECTIVE: Whole genome sequencing (WGS) can identify more druggable targets than the standard of care (SoC) panels, however, its health effects and costs are highly uncertain. Given the rapidly evolving treatment landscape and pricing, an iterative approach is crucial to continuously reassess evidence and adapt economic models. Our objective was to update a previously developed economic model for WGS. METHODS: We used a structured approach to identify and report model elements requiring updates, based on established tools and methodological guidance, and applied it to the probabilistic decision model by Simons et al.(2021), which compared SoC, WGS, and SoC followed by WGS in patients with inoperable stage IIIB, C/IV NSCLC in the Dutch setting. RESULTS: Updates included a new treatment (sotorasib), revised drug and diagnostic costs, and adherence to the latest guidelines. Drug and WGS diagnostics costs fell by 8% and 26%, respectively. SoC diagnostic prices increased by 17%. We explored the impact of the prevalence of druggable targets, effectiveness of off-label treatments, (academic-specific) diagnostic costs, and price negotiations. The ICER of WGS versus SoC decreased from €737,197 to €419,053/QALY. WGS would become cost-effective if diagnostic costs descended from €2,180 to €1,246 or if additional druggable targets were identified in ≥3.3% of patients. CONCLUSION: Our structured approach effectively identified items in the original analysis requiring updates and provides a foundation for further developing a checklist to guide iterative HTA. Continued monitoring and assessment of new treatment options, the dynamic diagnostics and costs throughout the life-cycle remain necessary to determine when WGS can be considered cost-effective.

NSCLC↗
PubMed1982

The contribution of medical measures to the decline of mortality from respiratory tuberculosis: an age-period-cohort model.

The decline of mortality in the more developed nations has been related to two major influences, economic development and the introduction of medical measures. The contribution of medical measures has been a source of continuing controversy. Most previous studies employ either a birth cohort or calendar year arrangement of mortality data to address this controversy. The present study applies an age-period-cohort model to mortality from respiratory tuberculosis in England and Wales, Italy, and New Zealand in an attempt to separate economic influences from that of medical measures. The results of the analysis indicate that while the overall contribution of medical measures is small when examined by calendar year, specific birth cohorts both in Italy and in England and Wales benefited substantially from these measures. The environmental conditions in New Zealand, however, were such that the introduction of medical measures barely affected declining mortality levels from respiratory tuberculosis.

Adolescent↗