The Hidden Beauty Of Calculating Health Costs

What health services should be available and under what conditions? This is a key question for all countries that want to move towards UHC (universal health coverage). And health benefit packages (HBPs) are an answer to this question, since they refer to an explicit definition of the services that can be financed and delivered in the real circumstances in which a given country finds itself.

Calculating the cost of health benefit packages (HBP) rarely arouses passions in those who request, study or promote it. No one doubts that it is important, but it is often seen as the work of accountants, not policy makers. Discussions often focus on how to determine unit costs and frequencies and how to project these variables into the future.

But calculating the total cost is much more than knowing the total cost of a set of prioritized services . When asked the right questions, it becomes a powerful tool on the path to universal health coverage (UHC), that is, in ensuring that all people can access the health services they need. One of these key questions is how many more resources will we need to adopt PBS and the advised cost expert will say, “This will depend on where you are now with regard to the level of coverage of prioritized services and where the short, medium and short term want to go. long term”.

In fact, policy makers are often not very interested in knowing the total cost of a PBS (unless there is a clear separation between the financing function and the service delivery function) for two reasons. First, it is an illusion to think that health systems will reallocate their total budgets exclusively to financing their PBS. Most low- and middle-income countries have tight budgets, and diverting resources by divesting from services currently provided will not be politically feasible. Second, no country starts from scratch and, in most cases, countries already provide some coverage for most of the health services that are defined when designing a new PBS and already allocate part of their resources to finance them.

Infinite needs, finite resources  

The question is not so much how much it would cost them to provide a certain PBS, but how much more money they would have to mobilize to close the coverage gap. Now, when answering that question, the evidence of the current low levels of coverage emerges and this becomes an important political instrument to promote the PBS as a tool to provide real access to the most important services that a population needs (as opposed to to an aspirational wish list) put on paper.

The usefulness of calculating the cost of the gap has become more apparent to us in an IDB Criteria Network project to design and cost a PBS for Honduras. Using criteria of profitability, equity, and financial protection, we identified and ranked 74 priority health interventions. We then calculate the unit costs of intervention “from the bottom up” by estimating the required inputs (staff, drugs, examinations, etc.), and we project the population that needs each intervention using various sources, such as the Global Burden of Disease 2017. To estimate how much more resources are required, we had to estimate current coverage levels for each intervention using utilization data reported by health centers and hospitals, and present policy scenarios on how to increase them. For example, only 35% of children under the age of 5 with acute lower respiratory infections are covered.

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3 Key Lessons To Stop Covid-19 And Future Pandemics

After a year in which COVID-19 has left more than 3.2 million deaths and 150 million infected globally , we have learned that testing and contact tracing are the backbone to ensure an effective response to a pandemic. However, few countries achieved effective control, especially in Latin America and the Caribbean. The recent publication of the Inter-American Development Bank (IDB) asks how testing and contact tracing can stop the pandemic in the region? Here we share some of the key lessons regarding testing and contact tracing from the first year of COVID-19.

Lesson # 1: Coordination of governments for efficient and sustainable policy implementation

Any solution that you want to implement requires joint work between governments at the national and sub-national levels. On the one hand, it is essential that a country decentralize the performance of PCR, serological tests and the implementation of group tests in order to reach remote areas, including isolated indigenous populations. For this, this coordination is essential to identify, for example, laboratories and regional institutions that can implement these strategies. In turn, due to the inability to test the entire population, it also allows prioritization rules to be created on who receives the tests (and vaccines) according to the characteristics of each state government.

On the other hand, for the application of contact tracing, local governments can support the implementation of regulatory and legislative mechanisms that protect the personal information of the population. Likewise, operational committees can be implemented to articulate the actions between the national and state governments, which allows starting a conversation about the best practices that each sub-national government has implemented, and which in turn allows the sharing of resources between the jurisdictions.

Lesson # 2: Cost-effective technologies that reinforce contact tracing and early epidemiological surveillance

Efforts to identify and track patient zero and all those infected have resulted in the development of technological solutions (chatbot, contact tracking and notification application, among others). For those with symptoms associated with the virus, patient information is provided to the nearest health center to follow up and trace their contacts. This application uses probability models and risk assessments of populations to track and identify the steps of infected people up to 14 days before becoming infected.

However, because the development of these cost-effective technologies sometimes make use of smartphones, they must go hand in hand with the development of policies that focus on transparency and the responsible use of data. For this it is recommended:

  1. Establish security protocols for the use of information;
  2. Generate access to data in real time to the scientific and health community (researchers, health professionals and epidemiologists);
  3. Create easy to access, process and understand metrics that identify places and networks of people with high levels of infection; and
  4. Create information panels so that the community has clarity on the use of data and its usefulness in the implementation of policies

Lesson # 3: Group Testing to Cope with Resource Scarcity

Given the scarcity of resources to implement a comprehensive testing program, group tests prove to be a cost-effective option that allows savings of up to 60% of the necessary supplies , and a reduction of up to 30% of health personnel. This strategy consists of creating people grouping schemes to determine whether they have been infected or not. If the test is negative for any member of the group, all members are classified as negative. Otherwise, all its members are tested. In Wuhan, China, a group testing campaign tested more than 6 million people in 10 days, identifying asymptomatic cases and preventing an increase in the number of cases.

For its implementation, governments must guarantee low virus prevalence rates; the lower the prevalence, the greater the efficiency of group tests. Some experts indicate that they should be less than 10% of the target population . Likewise, the association with academic institutions, researchers and laboratories of the private sector is recommended. For example, scientists from the Austral University of Chile (UACh) developed a model to carry out massive tests and researchers from the Complex Systems Engineering Institute (ISCI) adapted it to be applied at the national level.

Although vaccines have already reached the countries of Latin America and the Caribbean, testing and contact tracing remain relevant strategies to continue mitigating the impact of COVID-19 or, in other words, to continue saving lives while strategies vaccination begin to develop immunity in more people. If you want to know other lessons learned and how countries can improve their testing and tracking strategies to combat COVID-19 and future pandemics, we invite you to visit the interactive site available Living with Coronavirus .…

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