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  • How can we evaluate the cost-effectiveness of health system strengthening? A typology and illustrations

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    Chalkidou196480Published.pdf (971.4Kb)
    Author(s)
    Hauck, K
    Morton, A
    Chalkidou, K
    Chi, Y-Ling
    Culyer, A
    Levin, C
    Meacock, R
    Over, M
    Thomas, R
    Vassall, A
    Verguet, S
    Smith, PC
    Griffith University Author(s)
    Chalkidou, Kalipso
    Year published
    2019
    Metadata
    Show full item record
    Abstract
    Health interventions often depend on a complex system of human and capital infrastructure that is shared with other interventions, in the form of service delivery platforms, such as healthcare facilities, hospitals, or community services. Most forms of health system strengthening seek to improve the efficiency or effectiveness of such delivery platforms. This paper presents a typology of ways in which health system strengthening can improve the economic efficiency of health services. Three types of health system strengthening are identified and modelled: (1) investment in the efficiency of an existing shared platform that ...
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    Health interventions often depend on a complex system of human and capital infrastructure that is shared with other interventions, in the form of service delivery platforms, such as healthcare facilities, hospitals, or community services. Most forms of health system strengthening seek to improve the efficiency or effectiveness of such delivery platforms. This paper presents a typology of ways in which health system strengthening can improve the economic efficiency of health services. Three types of health system strengthening are identified and modelled: (1) investment in the efficiency of an existing shared platform that generates positive benefits across a range of existing interventions; (2) relaxing a capacity constraint of an existing shared platform that inhibits the optimization of existing interventions; (3) providing an entirely new shared platform that supports a number of existing or new interventions. Theoretical models are illustrated with examples, and illustrate the importance of considering the portfolio of interventions using a platform, and not just piecemeal individual analysis of those interventions. They show how it is possible to extend principles of conventional cost-effectiveness analysis to identify an optimal balance between investing in health system strengthening and expenditure on specific interventions. The models developed in this paper provide a conceptual framework for evaluating the cost-effectiveness of investments in strengthening healthcare systems and, more broadly, shed light on the role that platforms play in promoting the cost-effectiveness of different interventions.
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    Journal Title
    Social Science & Medicine
    Volume
    220
    DOI
    https://doi.org/10.1016/j.socscimed.2018.10.030
    Copyright Statement
    © 2019 The Authors. This is an open access article distributed under the terms of the Creative Commons CC-BY license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
    Subject
    Medical and Health Sciences
    Economics
    Studies in Human Society
    Science & Technology
    Social Sciences
    Life Sciences & Biomedicine
    Public, Environmental & Occupational Health
    Social Sciences, Biomedical
    Publication URI
    http://hdl.handle.net/10072/397485
    Collection
    • Journal articles

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