Abstract
Expenditures on health in many developing countries are being disproportionately spent on health services that have a low overall health impact, and that disproportionately benefit the rich. Without explicit consideration of priority setting, this situation is likely to remain unchanged: resource allocation is too often dictated by historical patterns, and maintains vested interests. This paper explores how prioritization between different health interventions can be rationalised by the use of clearly defined criteria. A number of key efficiency and equity criteria are examined, in particular analysing how potential tradeoffs could be incorporated into the decision making process.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bobadilla, J.-L., Cowley, P., Musgrove, P., and Saxenian, H. (1994) Design, Content and Financing of an Essential National Package of Health Services. Bulletin of the World Health Organization 72(4), 653–662.
Calltorp, J. (1999) Priority-setting in Health policy in Sweden and a Comparison with Norway. Health Policy 50, 1–22.
Coffield, A., Maciosek, M., McGinnis, J., Harris, J., Caldwell, M., Teutsch, S., Atkins, D., Richland, J., and Haddix, A. (2001) Priorities Among Recommended Clinical Preventive Services. American Journal of Preventive Medicine 21(1), 1–9.
Commission on Macroeconomics and Health (2002) Improving Health Outcomes of the Poor. Report of Working Group 5 of the Commission on Macroeconomics and Health. (Geneva:WHO).
Daniels, N. (1985) Just Health Care. Cambridge: Cambridge University Press.
Drummond, M.F., and McGuire, A. (ed.) (2001) Economic Evaluation in Health Care: Merging Theory with Practice. Oxford: Oxford University Press.
Drummond, M.F., O’Brien, B., Stoddart, G.L., and Torrance, G.W. (1997) Methods for the Economic Evaluation of Health Care Programmes (2nd ed.). Oxford: Oxford University Press.
Drummond, M.F., and Torrance, G.W. (1993) Cost-effectiveness League Tables: More Harm Than Good? Social Science and Medicine 38(12), 1591–1688.
Garber, A.M. (2000) Advances in CE Analysis, In A.J. Culyer, and J.P. Newhouse (Eds.), Handbook of Health Economics, Vol. 1A, Amsterdam: Elsevier Science, 181–221.
Ham, C. (1997) Priority Setting in Health Care: Learning from International Experience. Health Policy 42, 49–66.
Hauck, K., Smith, P., and Goddard, M. (2003) The Economics of Priority Setting for Health Care–-A Literature Review. HNP Discussion Paper.
Hoedemaekers, R., and Dekkers, W. (2003) Key Concepts in Health Care Priority Setting. Health Care Analysis 11, 309–323.
Hoedemaekers, R., and Dekkers, W. (2003) Justice and Solidarity in Priority Setting in Health Care. Health Care Analysis 11, 325–343.
Holm, S. (1998) Goodbye to the Simple Solutions: The Second Phase of Priority Setting in Health Care. British Medical Journal 317, 1000–1007.
Horton, R. (1999) NICE: A Step Forward in the Quality of NHS Care. Lancet 353, 1028– 1029.
Hrbac, B., Ljubic, B., and Bagaric, I. (2000) Basic Package of Entitlements and Solidarity in the Federation of Bosnia and Herzegovina. Croatian Medical Journal 41(3), 287–293.
Hutubessy, R., Baltussen, R., Tan-Torres, Edejer, T., and Evans, D.B. (2002) Generalised Cost-Effectiveness Analysis: An Aid to Decision Making in Health. Applied Health Economics and Health Policy 1(2), 1–7.
Hutubessy, R., Chisholm, D., Tan-Torres, Edejer, T., and WHO-CHOICE (2003) Generalised Cost-Effectiveness Analysis for National-Level Priority-Setting in the Health Sector. Cost Effectiveness and Resource Allocation 1, 8.
Kenkel, D. (1997) On Valuing Morbidity, Cost-Effectiveness Analysis, and Being Rude. Journal of Health Economics 16, 749–757.
Liu, X (2003) Policy Tools for Allocative Efficiency of Health Services. Geneva: WHO.
Martin, D., and Singer, P. (2003) A Strategy to Improve Priority Setting in Health Care Institutions. Health Care Analysis 11, 59–68.
Maynard, A. (1999) Rationing Health Care: An Exploration. Health Policy 49, 5–11.
McIntyre, D., and Gilson, L. (2000) Redressing Dis-advantage: Promoting Vertical Equity Within South Africa. Health Care Analysis 8, 235–258.
Milton, C., and Donaldson, C. (2003) Resource Allocation in Health Care: Health Economics and Beyond. Health Care Analysis 11, 245–257.
Mossialos, E., and King, D. (1999) Citizens and Rationing: Analysis of a European survey. Health Policy 49, 75–135.
Murray, C.J.L. (1994) Quantifying the Burden of Disease: The Technical Basis for Disability-Adjusted Life Years. Bulletin of the World Health Organization 72(3), 429–445.
Murray, C.J.L., Evans, D.B., Acharya, A., and Baltussen, R. (2000) Development of WHO Guidelines on Generalized Cost-Effectiveness Analysis. Health Economics 9, 235–251.
Musgrove, P. (1999) Public Spending on Health Care: How are Different Criteria Related? Health Policy 47, 207–223.
Nord, E., Pinto, J.L., Richardson, J., Mensal, P., and Ube, P. (1999) Incorporating Societal Concerns for Fairness in Numerical Valuations of Health Programmes. Health Economics 8, 25– 39.
Politi, C., Carrin, G., Evans, D., Kuzoe, F., and Cattand, P. (1995) Cost-effectiveness Analysis of Alternative Treatments of African Gambiense Trypanosomiasis in Uganda. Health Economics 4, 273–287.
Robinson, R. (1999) Limits to Rationality: Economics, Economists and Priority Setting. Health Policy 49, 13–26.
Rutten, F., and van Busschbach, J. (2001) How to Define a Basic Package of Health Services for a Tax Funded or Social Insurance Based Health Care System. Health Economics in Prevention and Care (the European Journal of Health Economics) 2, 45–46.
Tarimo, E. (1997) Essential Health Service Packages: Uses, Abuses and Future Directions. Division of Analysis, Research and Assessment, World Health Organization.
Tengs, T. (1997) Dying Too Soon: How Cost-Effectiveness Analysis can Save Lives. Dallas: National Center for Policy Analysis. NCPA Policy Report nr 204.
Van de Gritten, T.E.D., and Kasdorp, J.P. (1999) Choices in Dutch Health Care: Mixing Strategies and Responsibilities. Health Policy 50, 105–122.
Wagstaff and van Doorslaer (2000) Equity in Health Care Finance and Delivery, Chapter 34 In Culyer and Newhouse, (Eds.), Handbook of Health Economics, Vol. 1B, Amsterdam: Elsevier Science, 1803–1862.
Williams, A. (1997) Intergenerational Equity: An Exploration of the “Fair Innings” Argument. Health Economics 6, 117–132.
Williams, A., and Cookson, R. (2000) Equity in Health, Chapter 35 In Culyer and Newhouse (Eds.), Handbook of Health Economics, Vol. 1B, Amsterdam: Elsevier Science, 1863–1910.
World Bank (1993) World Development Report 1993. Investing in health.
World Health Organization (2002) The World Health Report 2002. Reducing Risks: Promoting Health Life. Geneva: WHO.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
James, C., Carrin, G., Savedoff, W. et al. Clarifying Efficiency-Equity Tradeoffs Through Explicit Criteria, With a Focus on Developing Countries. Health Care Anal 13, 33–51 (2005). https://doi.org/10.1007/s10728-005-2568-2
Issue Date:
DOI: https://doi.org/10.1007/s10728-005-2568-2