Policy and Health: Implications for Development in Asia

by Edited by John W. Peabody , M. Omar Rahman , Paul J. Gertler , Joyce Mann , Donna O. Farley , Jeff Luck

• ISBN13: 9780521661645
• ISBN10: 0521661641
• Format: Hardcover
• Copyright: 1999-07-28
• Publisher: Cambridge University Press

Summary

This rich volume provides a comprehensive look at how policy leads to better health in Asia. Leading RAND thinkers, working in different disciplines, create an all-encompassing framework for students, scholars, and policymakers, clarifying what is known and still needs to be known about how policy and practice lead to better health outcomes in developing countries. Drawing on their broad experience, the authors explore the health effects of macroeconomic development, education, and technology. After making compelling arguments about the need for policymakers to use and demand evidence-based policy, they investigate the epidemiology of persistent infectious diseases and the rapid ascendancy of chronic diseases in the elderly, showing how effectively appropriate clinical medicine addresses illness and promotes well-being. Emphasis is placed on examining equity-improving solutions to ascertain how and where they have helped the poor, women, and other vulnerable populations. The book concludes with a discussion of politics, priorities, the private sector, and what role health departments should play to translate policy objectives into better health.

Table of Contents

Foreword	v
Dean T. Jamison
Preface	vii
Tables	xv
Figures	xvii
Boxes	xix
Overview: The Role and Responsibility of Governments in the Health Sector	1	(29)
Health-Sector Reform In Asia	2	(1)
Asia's Health Status: From 1960 To The Present	3	(3)
Factors Driving The Improvement In Health Status	6	(11)
The Impact of Economic Development	6	(3)
The Impact of Education	9	(1)
The Impact of Medical Technology Growth	10	(2)
The Impact of Public Spending on Health	12	(1)
The Opportunity Costs and Benefits of Different Public Investment Strategies	13	(4)
The Variability of Health Status	17	(3)
Government Interventions	20	(10)
When Governments Intervene---Unique Roles	20	(4)
How Governments Intervene---Approaches to Correct Market Failures and Improve Equity	24	(1)
Why Governments Intervene---Multiple Strategies Based on Different Values	25	(4)
Health Policy Implementation at the Ministry Level	29	(1)
Evidence-Based Policy: Using Data to Inform Policy and Improve Health Outcomes	30	(44)
Overview	31	(2)
Data Sources Required For Policymaking	33	(8)
Categories of Data	33	(4)
Kinds and Sources of Data	37	(4)
Significant Data Gaps	41	(20)
Status of Data for 44 Selected Asian Countries	42	(13)
Better Data for Policymaking---The Long and Short of It	55	(6)
Discontinuities Between Policymakers and Researchers	61	(10)
Variations in Data Quality by Research Study Type	61	(5)
Interpreting Research Design and Research Data	66	(5)
Differing Perspectives	71	(1)
Policy Implications	71	(3)
Prioritizing Medical Interventions: Defining Burden of Disease and Cost-Effective Interventions in the Pursuit of Universal Primary Care	74	(60)
Overview	75	(1)
The Unfinished Agenda of Communicable Diseases	76	(8)
Current Burden of Disease in Asia	77	(4)
Future Burden of Disease in Asia	81	(3)
DALYs and Similar Measures	84	(5)
Morbidity and Mortality	84	(1)
Disability Adjusted Life Years (DALYs)	85	(1)
Health Life Years (HeaLYs)	85	(1)
Data Problems with All Classification Schemes	86	(1)
The Results of Measuring the Burden of Ill Health with Different Classification Schemes	87	(2)
The Impact of Using DALYs to Measure Burden of Ill Health in Asia	89	(1)
Costs, Effectiveness, and Other Prioritizing Factors	89	(7)
Cost-Effectiveness in Prioritizing Health Interventions	89	(4)
Setting Priorities at the National Level	93	(2)
Prioritizing by Types of Care	95	(1)
Essential, Desirable, and Undesirable Packages	96	(27)
Health Interventions That Should Be Pursued by All Developing-Country Governments in Asia	97	(19)
Health Interventions That Require a Higher National Income for Developing-Country Governments in Asia to Consider Pursuing	116	(6)
Health Interventions That Have Limited Effectiveness and Should Be Deemphasized by Developing-Country Governments in Asia	122	(1)
Funding High-Priority Interventions	123	(3)
Using Traditional Medicine and Improving Quality of Care	126	(7)
Traditional Medicine	126	(3)
Improving Quality of Care	129	(4)
Policy Implications	133	(1)
Financing and Allocating Public Expenditures: Leveraging Public Resources to Meet Objectives and Increase Private Participation	134	(50)
Overview	135	(1)
The Inadequacy Of Financing and Allocation of Public Expenditures	136	(10)
The Three Major Health Objectives That Justify Government Involvement	136	(3)
Financing and Allocating Public Expenditures in the Health Sector	139	(7)
Mobilizing Private Resources	146	(9)
What Effect Do Price Increases Have on Utilization	147	(2)
What Effect Do Price Increases Have on Access to Care?	149	(3)
What Effect Do Price Increases Have on Improving Quality of Care?	152	(3)
Choosing an Optimal Mix of Public Subsidy and Private Financing	155	(5)
Improving Health Status	156	(2)
Adjusting Resource Allocation to Better Target Subsidies to the Poor	158	(2)
Adjusting Resource Allocation to Insure Against Financial Risk	160	(1)
The Promise of Social Insurance Plans	160	(17)
Financing Social Insurance	162	(1)
Private-Sector Benefits	163	(3)
The Insurance Value of Social Insurance	166	(4)
Medical Care Cost Inflation from Moral Hazard	170	(3)
Should Low- and Middle-Income Countries Adopt Universal Social Insurance?	173	(3)
Community Financing	176	(1)
Cost Control Via Managed Care	177	(5)
Evaluating the Effectiveness of Managed Care	179	(1)
Developing-Country Experience with Managed Care	180	(1)
Necessary Conditions for Managed Care in Developing Countries	181	(1)
Policy Implications	182	(2)
Toward Better Equity and Access: Persistent Poverty, Inadequate Interventions, and the Need for Better Data and Solutions	184	(48)
Overview	185	(2)
Definitions of Equity	187	(3)
Equity in Finance	188	(1)
Equity in Delivery	188	(2)
Measures of Equity	190	(3)
Outcome Measures	190	(1)
Process Measures	190	(1)
Structural Measures	191	(1)
Usefulness of Measures for Policymakers	192	(1)
The Persistence of Inequity	193	(23)
Poverty in Asia	194	(1)
The Degree of Intercountry Inequality in Asia's Health Sector	195	(4)
Persistent, Serious Inequities Within Countries by Outcome, Income, Education, Location, and Gender	199	(17)
Options for Addressing Inequity	216	(4)
Subsidies Versus Social Insurance Expansion	220	(10)
Addressing Equity at the Low End of the Spectrum---The Potential of Specific Targeting	221	(7)
The Middle of the Spectrum---The Potential for a Two-Track Policy of Social Insurance	228	(1)
The High End of the Spectrum---The Potential of Universal Coverage	228	(2)
Policy Implications	230	(2)
Government and the Improvement of Health Behaviors	232	(44)
Overview	233	(1)
Interventions to Change Health Behaviors	234	(5)
Education and Communication Techniques	239	(5)
An Assessment of Health Education Needs	240	(1)
An Intervention Strategy	241	(1)
An Evaluation Program	242	(2)
Using Education and Communication Programs	244	(10)
Promotive Choices	244	(3)
Preventive Choices	247	(3)
Prescriptive Choices	250	(4)
Increasing the Opportunity for Changing Provider Behavior	254	(8)
Implementing Clinical Practice Guidelines and Continuing Medical Education	262	(3)
Community Participation Strategies	265	(5)
Managing Provider-Patient Relationships	265	(2)
Managing Stakeholders Using Participatory Strategies	267	(1)
Three Basic Models of Community Participating	268	(1)
Key Design Issues for Community Health Programs	269	(1)
Problems with Community Participation	270	(4)
Asian Experience with Community Development Participatory Programs	271	(1)
Asian Experience with Health Education Participatory Programs	272	(1)
Asian Experience with Customer Service Participatory Programs	273	(1)
Policy Implications	274	(2)
Implementing Policy Objectives: The Role and Responsibilities of the Ministry of Health	276	(53)
Overview	277	(1)
Understanding and Informing The Political Process	278	(4)
Informing the Political Process	282	(1)
Managing Health Sector Objectives	282	(15)
Planning, Programming, and Budgeting System (PPBS)	282	(6)
The Challenges of Planning and Evaluation	288	(2)
The Challenges of Programming and Budgeting	290	(3)
Managing Information Resources	293	(4)
Organizing Around Programs with Devolution to Local Communities	297	(8)
The Organization of the MOH	297	(2)
The Potential of Devolution	299	(6)
Private Provision of Services	305	(6)
Criteria for Public or Private Provision of Health Care	305	(3)
Challenges of Private Provision	308	(3)
Managing Technology and Developing Human Capital	311	(8)
Managing Medical Technologies	311	(5)
Developing Human Resources	316	(3)
Payment Mechanisms	319	(7)
Per-Capita Payment	321	(2)
Hospital Payments	323	(3)
Choosing A Policy	326	(1)
Policy Implications	326	(3)
Acronyms	329	(4)
Data Notes and Glossary---Chapter Two	333	(6)
References	339	(80)
Authors	419	(2)
Index	421