Guidelines for conducting health economic evaluations have become increasingly standardized, however they don't address the unique concerns of the paediatric population. The challenges of measuring ...costs and consequences in children, from neonate to late adolescence, are numerous and complex. With the growing acceptance of economic evidence to guide decisions in health systems facing economic constraints, it is imperative that these challenges be considered so that this population is not left out of evidence-based decisions. The time has come for a textbook to address economic evaluation in child health. This book is divided into three sections: Methods, Applications, and Using evidence for decision-making, with chapters contributed by international experts. The Methods section presents detailed discussions of measuring lifetime costs and consequences, capturing productivity losses, obtaining unbiased self- and proxy reports, incorporating externalities, choosing valid outcome measures, assessing utility, and designing studies using value of information. The Applications section reviews economic evidence in common childhood conditions and areas of investigation, including newborn screening, harm prevention, mental health services, brain injury, asthma, and immunization. The final section explores the use of economic evidence in decision-making, and includes a description of the WHO-CHOICE approach, the role of clinical research, how to value health gains by children, and the emerging field of health technology assessment. In addition to an emphasis on methods, a deliberate effort was made to include issues relevant to developing countries, where the burden of childhood disease is greatest, and for whom high quality economic evidence is critical. Available in OSO: http://www.oxschol.com/oso/public/content/publichealthepidemiology/9780199547494/toc.html Contributors to this volume - Moses Aikins, Senior Lecturer, School of Public Health, Department of Health Policy, Planning and Management, College of Health Sciences, University of Ghana, Legon, Accra, Ghana Philippe Beutels, Senior Lecturer, Health Economics, Centre for Health Economics Research and Modeling Infectious Diseases (CHERMID), Centre for the Evaluation of Vaccination (CEV), Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium Katherine B. Bevans, Assistant Research Professor, Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, USA Robert E. Black, Edgar Berman Professor and Chair, Johns Hopkins Bloomberg School of Public Health, Department of International Health, Johns Hopkins University, Baltimore, USA Werner B.F. Brouwer, Department of Health Policy & Management and Institute for Medical Technology Assessment, Erasmus University Medical Centre / Erasmus University, Rotterdam, The Netherlands Sarah Byford, Senior Lecturer, King's College London, Institute of Psychiatry, De Crespigny Park, London, UK Jonathan D. Campbell, Senior Post-Doctoral Fellow, Pharmaceutical Outcomes, Research and Policy Program, School of Pharmacy, University of Washington, Seattle, USA Vania Costa, Research Associate, Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada Gillian Currie, Assistant Professor, Faculty of Medicine, Departments of Paediatrics and Community Health Sciences, University of Calgary, Calgary, Canada Sarah Curtis, Assistant Professor, Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alberta, Edmonton, Canada Kim Dalziel, Senior Research Fellow, Health Economics and Policy Group, Division of Health Sciences, University of South Australia, Adelaide, Australia David B. Evans, Director, Department of Health Systems Financing, World Health Organization, Geneva, Switzerland Christopher B. Forrest, Mary D. Ames Professor of Pediatrics and Advocacy, The Children's Hospital of Philadelphia, Philadelphia, USA Tessa Tan-Torres Edejer, Coordinator, Costs, Effectiveness, Expediture and Priority Setting (CEP), Health System Financing, Health Systems and Services, World Health Organization, Geneva, Switzerland E. Michael Foster, Professor, Maternal and Child Health and Health Policy and Administration, School of Public Health, University of North Carolina, Chapel Hill, USA Andreas Gerber, Institute for Health Economics and Clinical Epidemiology, University of Cologne, Cologne, Germany Y. Ingrid Goh, Department of Pharmaceutical Science, University of Toronto, Division of Clinical Pharmacology & Toxicology, The Hospital for Sick Children, Toronto, Canada Scott D. Grosse, Senior Health Economist, Office of the Director, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, National Center on Birth Defects and Developmental Disabilities, Atlanta, USA Raymond Hutubessy, Economist, Initiative for Vaccine Research (IVR), World Health Organization (WHO), Geneva, Switzerland Terry Klassen, Professor and Chair, Regional Program Clinical Director Child Health, Capital Health, Department of Pediatrics, University of Alberta, Edmonton, Canada Gideon Koren, Senior Scientist and Director, The Motherisk Program, Professor of Medicine, Pediatrics and Physiology/Pharmacology, The University of Toronto, Ivey Chair in Molecular Toxicology, The University of Western Ontario, The Hospital for Sick Children, Toronto, Canada Stavros Petrou, Health Economist, National Perinatal Epidemiology Unit, University of Oxford (Old Road Campus), Oxford, England Ali I. Raja, Assistant Professor, Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, USA Leonie Segal, Professor, Health Economics, Health Economics and Policy Group, Division of Health Sciences, University of South Australia, Adelaide, Australia Donald S. Shepard, Professor, Schneider Institutes for Health Policy, Heller School, Brandeis University, Waltham, USA Jose A. Suaya, Schneider Institutes for Health Policy, Heller School, Brandeis University, Waltham, USA Sean D. Sullivan, Professor of Pharmacy, Public Health and Medicine; Director, Pharmacetical Outcomes Research and Policy Program, School of Pharmacy, University of Washington, Seattle, USA Lillian Sung, Scientist and Assistant Professor, Department of Paediatrics, University of Toronto, Department of Paediatric Haematology/Oncology, Division of Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada J. Mick Tilford, Associate Professor, Department of Pediatrics and Health Policy Management, College of Medicine, University of Arkansas for Medical Sciences, Center for Applied Research and Evaluation, Little Rock, USA Wendy J. Ungar, Senior Scientist, Associate Professor, The Hospital for Sick Children Research Institute, University of Toronto, Division of Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada N. Job A. van Exel, MSc, Health Economist, Department of Health Policy & Management and Institute for Medical Technology Assessment, Erasmus University Medical Centre / Erasmus University, Rotterdam, The Netherlands Damian G. Walker, Professor, Health Economics, Health Systems Program, Bloomberg School of Public Health, Department of International Health, Johns Hopkins University, Baltimore, USA Andrew R. Willan, Senior Scientist and Professor, Public Health Sciences, University of Toronto, The Hospital for Sick Children Research Institute, Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada Lara J. Wolfson, Scientist, Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
China's health system performance Liu, Yuanli, Dr; Rao, Keqin, MD; Wu, Jing, MD ...
The Lancet (British edition),
2008-Nov-29, Volume:
372, Issue:
9653
Journal Article
Peer reviewed
Summary We created a comprehensive set of health-system performance measurements for China nationally and regionally, with health-system coverage and catastrophic medical spending as major ...indicators. With respect to performance of health-care delivery, China has done well in provision of maternal and child health services, but poorly in addressing non-communicable diseases. For example, coverage of hospital delivery increased from 20% in 1993 to 62% in 2003 for women living in rural areas. However, effective coverage of hypertension treatment was only 12% for patients living in urban areas and 7% for those in rural areas in 2004. With respect to performance of health-care financing, 14% of urban and 16% of rural households incurred catastrophic medical expenditure in 2003. Furthermore, 15% of urban and 22% of rural residents had affordability difficulties when accessing health care. Although health-system coverage improved for both urban and rural areas from 1993 to 2003, affordability difficulties had worsened in rural areas. Additionally, substantial inter-regional and intra-regional inequalities in health-system coverage and health-care affordability measures exist. People with low income not only receive lower health-system coverage than those with high income, but also have an increased probability of either not seeking health care when ill or undergoing catastrophic medical spending. China's current health-system reform efforts need to be assessed for their effect on performance indicators, for which substantial data gaps exist.
Dr. Frances Sage Bradley (1862--1949) was a mediating force
between the urban world of her own education and experience, and
that of rural Americans. As a widow with four young children,
Bradley ...trained as a doctor and became one of the first women to
graduate from Cornell University Medical School. During the height
of the Progressive Era, she left her private practice to do
significant field work for the newly-created Children's Bureau,
working mainly in the Appalachian South.
In this timely biography, Barbara Barksdale Clowse details the
story of this physician, reformer, and writer, and her efforts to
extend access to healthcare to rural communities. Clowse describes
Bradley's important innovations in the field of public health,
including physical exams or "conferences" for children and infants
which simultaneously educated parents and local medical
practitioners, and her advocacy for improved nutrition and modern
medicine in rural areas. Finally, Clowse illustrates how Bradley's
work regarding maternal mortality and morbidity in America was
instrumental in demonstrating the need for what became the
Sheppard--Towner Act of 1921, also known as the Maternity and
Infancy Protection Act.
A century has passed since Bradley lived out her commitment to
social justice in healthcare, yet many of the issues that she faced
still plague the United States today. A Doctor for Rural
America presents a balanced portrait of an overlooked pioneer
and her work to establish healthcare as an obligation that the
government owed to its citizens.
Estimates of those living in rural counties vary from 46.2 to 59 million, or 14% to 19% of the U.S.
Rural communities face disadvantages compared with urban areas, including higher poverty, lower ...educational attainment, and lack of access to health services. We aimed to demonstrate rural-urban disparities in cancer and to examine NCI-funded cancer control grants focused on rural populations. Estimates of 5-year cancer incidence and mortality from 2009 to 2013 were generated for counties at each level of the rural-urban continuum and for metropolitan versus nonmetropolitan counties, for all cancers combined and several individual cancer types. We also examined the number and foci of rural cancer control grants funded by NCI from 2011 to 2016. Cancer incidence was 447 cases per 100,000 in metropolitan counties and 460 per 100,000 in nonmetropolitan counties (
< 0.001). Cancer mortality rates were 166 per 100,000 in metropolitan counties and 182 per 100,000 in nonmetropolitan counties (
< 0.001). Higher incidence and mortality in rural areas were observed for cervical, colorectal, kidney, lung, melanoma, and oropharyngeal cancers. There were 48 R- and 3 P-mechanism rural-focused grants funded from 2011 to 2016 (3% of 1,655). Further investment is needed to disentangle the effects of individual-level SES and area-level factors to understand observed effects of rurality on cancer.
.
Objective: Describe objectively the global gaps in policy, data gathering capacity, and resources to develop and implement services to support child mental health.
Methods: Report on the World ...health Organization (WHO) child and adolescent mental health resources Atlas project. The Atlas project utilized key informants and was supplemented by studies that focused on policy. This report also draws on current epidemiological studies to provide a context for understanding the magnitude of the clinical problem.
Results: Current global epidemiological data consistently reports that up to 20% of children and adolescents suffer from a disabling mental illness; that suicide is the third leading cause of death among adolescents; and that up to 50% of all adult mental disorders have their onset in adolescence. While epidemiological data appears relatively uniform globally, the same is not true for policy and resources for care. The gaps in resources for child mental health can be categorized as follows: economic, manpower, training, services and policy. Key findings from the Atlas project include: lack of program development in low income countries; lack of any policy in low income countries and absent specific comprehensive policy in both low and high income countries; lack of data gathering capacity including that for country‐level epidemiology and services outcomes; failure to provide social services in low income countries; lack of a continuum of care; and universal barriers to access. Further, the Atlas findings underscored the need for a critical analysis of the ‘burden of disease’ as it relates to the context of child and adolescent mental disorders, and the importance of defining the degree of ‘impairment’ of specific disorders in different cultures.
Conclusions: The recent finding of substantial gaps in resources for child mental health underscores the need for enhanced data gathering, refinement of the economic argument for care, and need for innovative training approaches.
In this article we have provided a perspective on the importance and value of youth mental health services for society and argued that advancing youth mental health services should be the number one ...priority of health services in Canada. Using the age period of 12–25 years for defining youth, we have provided justification for our position based on scientific evidence derived from clinical, epidemiological and neurodevelopmental studies. We have highlighted the early onset of most mental disorders and substance abuse as well as their persistence into later adulthood, the long delays experienced by most help seekers and the consequence of such delays for young people and for society in general. We have also provided a brief review of the current gross inadequacies in access and quality of care available in Canada. We have argued for the need for a different conceptual framework of youth mental disorders as well as for a transformation of the way services are provided in order not only to reduce the unmet needs but also to allow a more meaningful exploration of the nature of such problems presenting in youth and the best way to treat them. We have offered some ideas based on previous work completed in this field as well as current initiatives in Canada and elsewhere. Any transformation of youth mental health services in Canada must take into consideration the significant geographic, cultural and political diversity across the provinces, territories and indigenous peoples across this country.
Better But Not Well Frank, Richard G; Glied, Sherry A
2006, 2006-09-08, 20060101
eBook
The past half-century has been marked by major changes in the treatment of mental illness: important advances in understanding mental illnesses, increases in spending on mental health care and ...support of people with mental illnesses, and the availability of new medications that are easier for the patient to tolerate. Although these changes have made things better for those who have mental illness, they are not quite enough.
In Better But Not Well, Richard G. Frank and Sherry A. Glied examine the well-being of people with mental illness in the United States over the past fifty years, addressing issues such as economics, treatment, standards of living, rights, and stigma. Marshaling a range of new empirical evidence, they first argue that people with mental illness—severe and persistent disorders as well as less serious mental health conditions—are faring better today than in the past. Improvements have come about for unheralded and unexpected reasons. Rather than being a result of more effective mental health treatments, progress has come from the growth of private health insurance and of mainstream social programs—such as Medicaid, Supplemental Security Income, housing vouchers, and food stamps—and the development of new treatments that are easier for patients to tolerate and for physicians to manage.
The authors remind us that, despite the progress that has been made, this disadvantaged group remains worse off than most others in society. The mainstreaming of persons with mental illness has left a policy void, where governmental institutions responsible for meeting the needs of mental health patients lack resources and programmatic authority. To fill this void, Frank and Glied suggest that institutional resources be applied systematically and routinely to examine and address how federal and state programs affect the well-being of people with mental illness.
Previous research suggested a distance decay effect in health services systems, with people living closer to service facilities being more likely to use them.
In this ecological cross sectional ...study, we conducted spatial and statistical analyses in a Swiss mental health services system being legally bound to provide primary mental health care to approximately 620,000 inhabitants. We examined a cohort of all patients who were over 18 years old and who were treated in the mental health services system between January and December 2011.
There were 5574 treatment cases during the 12-month period, 2161 inpatient cases and 3413 outpatient cases. Travel time by public transportation between patients' residence and the closest mental health service facility negatively predicted the utilization of outpatient services for all mental disorders, even after controlling for variability in ecological (e.g. socioeconomic) characteristics of the communities in the service provision area. For utilization of inpatient wards no geographical distance decay effect was observed, except for organic mental disorders.
Based on these findings, outpatient clinics should be most effectively located decentralized and in the largest communities to meet the needs of the population as close as possible to where people live and to avoid remote areas being insufficiently supplied with mental health care. For mental hospitals and inpatient services decentralized location seems to be less important.
Pakistan, being a developing country, presents the dismal picture of maternal and neonatal mortality and morbidity. The majority of maternal and neonatal deaths could be avoided if Continuum of Care ...(CoC) is provided in a structured pathway from pregnancy to birth and to the first week of life of the newborn child. This study aimed to analyse the trends of CoC at all three levels (antenatal care, skilled delivery and postpartum care) and to identify various factors affecting the continuation in receiving CoC in Pakistan during 2006 to 2012.
Secondary data analysis was performed on nationally representative data from the last two iterations of Pakistan Demographic and Health Survey (PDHS), conducted during 2006/07 to 2012/13. The analysis is limited to women of the reproductive age group (15-49 years) who gave birth during the last five years preceding both surveys. This leads to a sample size of 5,724 and 7,461 respondents from PDHS 2006/07 and 2012/13 respectively. The association between CoC and several factors, including individual attributes (reproductive status), family influences, community context, as well as cultural and social values was assessed in bivariate analyses in a first step. Furthermore, odds ratios and adjusted odds ratios with 95% confidence intervals using a binary and multivariable logistic regression were calculated.
Our research presents the trends of a composite measure of CoC including antenatal care, delivery assistance and postpartum care. The largest gap in CoC was observed at antenatal care followed by delivery and postnatal care within 48 h after delivery. Results show that CoC completion rate has increased from 15% to 27% amongst women in Pakistan over time from 2006 to 2012. Women with high age at first birth, having less number of children, with higher education, belonging to richest quintile, living in Sindh province and urban areas, having high autonomy and exposure to mass media were most likely to avail complete CoC.
The findings show that women in Pakistan still lack the CoC. This calls for attention to develop and implement tailored interventions, focusing on the needs of women in Pakistan to provide CoC in an integrated manner, involving both public and private sectors by appropriately addressing the factors hindering CoC completion rates.
Integrated care models may improve health care for children and young people (CYP) with ongoing conditions.
To assess the effects of integrated care on child health, health service use, health care ...quality, school absenteeism, and costs for CYP with ongoing conditions.
Medline, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library databases (1996-2018).
Inclusion criteria consisted of (1) randomized controlled trials, (2) evaluating an integrated care intervention, (3) for CYP (0-18 years) with an ongoing health condition, and (4) including at least 1 health-related outcome.
Descriptive data were synthesized. Data for quality of life (QoL) and emergency department (ED) visits allowed meta-analyses to explore the effects of integrated care compared to usual care.
Twenty-three trials were identified, describing 18 interventions. Compared with usual care, integrated care reported greater cost savings (3/4 studies). Meta-analyses found that integrated care improved QoL over usual care (standard mean difference = 0.24; 95% confidence interval = 0.03-0.44;
= .02), but no significant difference was found between groups for ED visits (odds ratio = 0.88; 95% confidence interval = 0.57-1.37;
= .57).
Included studies had variable quality of intervention, trial design, and reporting. Randomized controlled trials only were included, but valuable data from other study designs may exist.
Integrated care for CYP with ongoing conditions may deliver improved QoL and cost savings. The effects of integrated care on outcomes including ED visits is unclear.
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