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

Publication date: Available online 3 November 2018Source: Social Science & MedicineAuthor(s): K. Hauck, A. Morton, K. Chalkidou, Y-Ling Chi, A. Culyer, C. Levin, R. Meacock, M. Over, R. Thomas, A. Vassall, S. Verguet, P.C. SmithAbstractHealth 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 b...
Source: Social Science and Medicine - Category: Psychiatry & Psychology Source Type: research