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    Health economics in developing countries.

    Abel-Smith B


    This general discussion on health economics provides an historical overview as well as a discussion of some of the developments and deficiencies in health economics in developing countries, broadly focused on expenditure and financing studies, cost benefit and cost effectiveness, local costing studies and health planning. In 1963, it was found that as GDP rose so did health expenditures, that countries with similar per capita income spent different percentages of GDp on health services, that the private sector involvement was greater than the public, and that hospitals received most of the money. Countries were encouraged to conduct further studies. The World Bank has successfully stimulated discussion. However, lacking the expenditure studies, cost benefits are hampered by the availability of epidemiological data and poor cost information, and geared toward studies on how to cut costs for immediate goals, or specific diseases, rather than on practical advice to governments. 1 such study helped identify that most cost effective allocation of resources. The limited local cost studies are particular to understanding specific costs of immunization versus antenatal visits; however, the usefulness of such preliminary information reveals wide variability between countries. The Health for All initiatives and the limited resources in developing countries have placed health planning in a central position with Ministries of Health. Due to prior mistakes in planning an excess number of trained medical staff are underutilized and present needs have been defined as developing local PHC support staff. The WHO expectation of 5% of GNP for health service was unfulfilled because larger donor aid and local resources have not been sufficient even with strong posturing, and over ambitious plans were made unrealistically. Since 1987, WHO has provided economic strategies but the economic crises changed the needs. Many questions remain and consultants are too few, improperly trained, or unavailable for the appropriate time period: unacceptable solutions, coupled with a confusing World bank prospectus for action when more research is needed. Intersectorial collaboration has not provided answers to priorities or addressed the interactions among nutrition and agricultural policy, education and lifestyle, water and sanitation and the economy. The research agenda should include: the identification of the determinants of health, key elements of primary health care (PHC), cost of delivering PHC, hospital efficiency, health manpower mix, adequate procurement and distribution, appropriate technology, user charges for financing, health insurance, and community financing.
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