Ethical Issues in International Health Policy
There is currently a great deal of interest in ethical issues
of health policy, both in developed and in developing
countries. All health care systems are confronted with the
issue of how to prioritize between different interventions
when resources are scarce. A number of national commissions
have examined this issue, and the World Bank published its
report Investing in Health in 1993.
While disciplines such as economics and policy analysis are
indispensable when deciding what interventions should get
priority, there are also underlying value questions that need
to be examined. Although most policy analyses emphasize the
importance of equity when making health care
decisions, there are very few attempts to analyze
systematically how one should understand this concept. One
aim of the Bergen-Colombo collaboration in health policy is to
do that.
Here we provide a short description of the
program, which is just starting. We have also provided a
number of links to important background papers on the issue of
resource allocation.
The Bergen-Colombo
Collaboration in Health Policy
One aim of this
project is to establish a research group in Medical Ethics in
Colombo, Sri Lanka which will be a resource group and a focal
point for the examination of ethical issues in health care in
Sri Lanka. The main focus of activities of this core group
will be ethical issues in health policy. Another aim is to
examine the common health policy problems faced by all health
care systems in a comparative perspective. The project will
be carried out through regular workshops in Sri Lanka and
Norway. The main results of the collaboration will be working
papers and position papers on health policy that address
current concerns in health policy in Sri Lanka and in Norway.
The project will also train a number of researchers in the
field of ethics and health policy who can provide the needed
expertise in this area in the future. The Project is funded
by The Norwegian Universities' Committee for Development
Research and Education (NUFU)
The World Bank's Investing in
Health
The basis for the World Bank's report are detailed
calculations of the burden of disease in different
countries, by using what is called Disability Adjusted Life
Years (DALY). DALYs can be used to calculate the expected
health benefit of various health care interventions. The
basic recommendation of the report is that public resources
should be spent on interventions that yield the greatest
expected health benefit. This would entail a redistribution
of current use of public resources from interventions that
benefit the rich in urban areas to interventions of greater
effectiveness. This is the Report's emphasis on equity
. The report also recommends, however, that public
resources should only be used for a package of essential
health interventions, calculated by the DALY method. Other
interventions should be provided through a private system.
This report raises at least three important issues:
- The assumptions made in the calculation of DALYs
-
The issue of public-private mix
- The issue of equity
The calculation of DALYs
- The World Bank Home
Page
-
World Bank s Human Development Department
-
Design, content and financing of an essential package
- Argues that the government should provide a
package of essential health care services. Governments
should assure that at least poor populations have access to
these services
- The
minimum package of health services: Criteria, Methods and Data
- Explains how the World Bank Report has
arrived at the content of the minimum package
- Essential Health
Intervention Project, EHIP
- Project by the International Development Research Center
in Ottawa, Canada, with the aim of testing out whether it is
possible to identify essential health interventions using the
World Bank methodology. One project will be carried out in
Tanzania.
- Enhancing
allocation decisions in developing health systems
- Project by the International Development Research Center
(Canada), Asia Regional Office, to identify an essential
health care package.
- A
DALY Dose
- Interviews with one of the chief
architects behind the World's Bank DALY concept, C.J.L.
Murray.
-
Tools of the Trade
- Interview tih Peter Berman
on national health care accounts.
The
private-public mix
-
Private and Public Initiatives: Working Together in Health
and Education
- World Bank discussion paper
advocating a private-public partnership in providing social
services such as education and health. Gives examples of what
the World Bank considers success-stories of such
interventions.
- Incentives and Provider Payment Methods
- Working paper no 51, by Howard Barnum, Joseph Kutzin and
Helen Saxenian. Agues that mode of payment creates powerful
incentives affecting provider behavior and the efficiency,
equity and quality outcomes of health finance reforms.
Systems with mixed forms of provider payment can provide
tradeoffs to offset the disadvantages of individual modes.
- Mismatch of Need, Demand and Supply
- Working paper no 59, by Philip Musgrove. Argues that
competitive private markets ignore needs, while non-market
provision often ignores demand. Minimizing imbalances
requires the right private/public mixture.
Issues of equity in the report
- Swimming Against the Tide: Improving Equity in Health
- Working Paper no 55, by Nancy Birdsall and Robert Hecht.
Argues that to implement health policies that favor the poor,
it is necessary to swim against the tide. Traditionally, the
better off gain disproportionately because most public
spending goes toward curative, high-cots hospital care in
urban areas.
- Cost-effectiveness and health sector reform
- Working paper no 48, by Philip Musgrove. Examines whether
the proposals made in Investing in Health are
compatible with values such as equity or other ethical rules.
WHO health economics papers
- Partners for
Health-Database
- Database maintained by WHO on various
issues of health economics, still in preparation.
- Identification
of needs in health economics in developing countries
- Health
economics: a WHO perspective
- Privatization
in health
- A
guide to selected WHO literature
- WTO:
What's in it for WHO?
- Gopher
Menu for above papers
Other health policy papers
-
Proceedings of Greenwall conference
- Proceedings of a
conference sponsored by the Center for Bio-Medical Ethics in Minneapolis
on the role of bioethics in health care policy. Texts of papers on health
care reform and other issues. LONG (300 K).
- Library
Guide #3: International Health & National Health Care
Systems
- Sri Lanka
health profile
- The
Chinese Health Care System
- A report from June 1995 by the Institute of Development
Studies in Sussex, England.
- BMGK -
Austrian Health Care System
- Health of the
Nation
- Policy Paper from UK
- The
United Kingdom National Health Service
- Consideration
of the Nutrition Components of the Sick Child Initiative
- Health
in Europe, chapter 3
Sites with health policy links
- Political
Science links
- HEALTH-ECONOMICS
RESOURCE PAGE
- Idea Central's Electronic
Policy Network