We shouldn’t count chickens before they hatch: results-based financing and the challenges of cost-effectiveness analysis
| Autor: | Remco van de Pas, Gorik Ooms, Valéry Ridde, Garrett Wallace Brown, Elisabeth Paul, Tim Ensor |
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| Přispěvatelé: | Centre population et développement (CEPED - UMR_D 196), Institut de Recherche pour le Développement (IRD)-Université de Paris (UP), RS: CAPHRI - R4 - Health Inequities and Societal Participation, Metamedica, RS: FHML Studio Europa Maastricht |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Economie et finances publiques
health-care debate Cost effectiveness Santé publique results-based financing [SHS]Humanities and Social Sciences 03 medical and health sciences 0302 clinical medicine 030212 general & internal medicine low- and middle-income countries pay cost-effectiveness ComputingMilieux_MISCELLANEOUS Finance 030505 public health business.industry 1. No poverty Public Health Environmental and Occupational Health Cost-effectiveness analysis PERFORMANCE Low and middle income countries Results based financing Business 0305 other medical science Results-based financing |
| Zdroj: | Critical Public Health Critical Public Health, Taylor & Francis (Routledge), 2021, 31 (3), pp.370-375. ⟨10.1080/09581596.2019.1707774⟩ Critical Public Health, 31(3), 370-375. Routledge/Taylor & Francis Group Critical public health |
| ISSN: | 0958-1596 1469-3682 |
| DOI: | 10.1080/09581596.2019.1707774⟩ |
| Popis: | Results-based financing (RBF) is subject to fierce debate and the evidence-base on its cost effectiveness is scarce. To our knowledge, only one cost-effectiveness study of RBF in a lower-middle income country has been published in a peer reviewed journal. That study – in Zambia – concludes that RBF is cost-effective, which was then uncritically repeated in an editorial accompanying its release. Here we would like to warn against readily accepting the conclusion of the cost-effectiveness study of RBF in Zambia, because its conclusions are not straightforward and could be dangerously misleading, especially for those readers unfamiliar with health economics. After outlining the results from the Zambia’s RBF cost-effectiveness study, we point to important methodological issues related to cost-effectiveness analysis, showing how key assumptions produce particular results. We then reflect on how cost-effectiveness is different from efficiency and affordability – which is important, since cost-effectiveness studies often have considerable influence on national health financing strategies and policy priorities. Finally, we provide an alternative reading of the evidence on RBF in Zambia. Namely, when examined from an efficiency point of view, the study actually demonstrates that RBF is less efficient than the simpler alternative of providing more resources to health facilities, unconditioned on performance, which will be of most interest to a government with tight budget constraints. As a result, existing claims that RBF is cost-effective are overstated, requiring further and more nuanced examination with more adequate research methods. info:eu-repo/semantics/published |
| Databáze: | OpenAIRE |
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