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

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. Smith

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Health 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 between investing in health system strengthening and expenditure on specific interventions. The models developed in this paper provide a conceptual framework for evaluating the cost-effectiveness of investments in strengthening healthcare systems and, more broadly, shed light on the role that platforms play in promoting the cost-effectiveness of different interventions.

LanguageEnglish
Pages141-149
Number of pages9
JournalSocial Science and Medicine
Volume220
Early online date3 Nov 2018
DOIs
Publication statusPublished - 31 Jan 2019

Fingerprint

Cost-Benefit Analysis
typology
Health
costs
health
Delivery of Health Care
Social Welfare
Health Expenditures
Health Services
Theoretical Models
Economics
Strengthening
Cost-effectiveness
efficiency
economic efficiency
community service
health service
expenditures
infrastructure

Keywords

  • health system strengthening
  • cost-effectiveness analysis
  • economies of scope
  • integrated service delivery
  • spillover effects
  • horizontal health care programs
  • constraints
  • healthcare delivery platforms

Cite this

Hauck, K. ; Morton, A. ; Chalkidou, K. ; Chi, Y-Ling ; Culyer, A. ; Levin, C. ; Meacock, R. ; Over, M. ; Thomas, R. ; Vassall, A. ; Verguet, S. ; Smith, P.C. . / How can we evaluate the cost-effectiveness of health system strengthening? A typology and illustrations. In: Social Science and Medicine. 2019 ; Vol. 220. pp. 141-149.
@article{fe274331a15e42dcbac31477495e8c7d,
title = "How can we evaluate the cost-effectiveness of health system strengthening? A typology and illustrations",
abstract = "Health 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 between investing in health system strengthening and expenditure on specific interventions. The models developed in this paper provide a conceptual framework for evaluating the cost-effectiveness of investments in strengthening healthcare systems and, more broadly, shed light on the role that platforms play in promoting the cost-effectiveness of different interventions.",
keywords = "health system strengthening, cost-effectiveness analysis, economies of scope, integrated service delivery, spillover effects, horizontal health care programs, constraints, healthcare delivery platforms",
author = "K. Hauck and A. Morton and K. Chalkidou and Y-Ling Chi and A. Culyer and C. Levin and R. Meacock and M. Over and R. Thomas and A. Vassall and S. Verguet and P.C. Smith",
year = "2019",
month = "1",
day = "31",
doi = "10.1016/j.socscimed.2018.10.030",
language = "English",
volume = "220",
pages = "141--149",
journal = "Social Science and Medicine",
issn = "0277-9536",

}

Hauck, K, Morton, A, Chalkidou, K, Chi, Y-L, Culyer, A, Levin, C, Meacock, R, Over, M, Thomas, R, Vassall, A, Verguet, S & Smith, PC 2019, 'How can we evaluate the cost-effectiveness of health system strengthening? A typology and illustrations' Social Science and Medicine, vol. 220, pp. 141-149. https://doi.org/10.1016/j.socscimed.2018.10.030

How can we evaluate the cost-effectiveness of health system strengthening? A typology and illustrations. / Hauck, K.; Morton, A.; Chalkidou, K.; Chi, Y-Ling; Culyer, A.; Levin, C.; Meacock, R.; Over, M.; Thomas, R.; Vassall, A.; Verguet, S.; Smith, P.C. .

In: Social Science and Medicine, Vol. 220, 31.01.2019, p. 141-149.

Research output: Contribution to journalArticle

TY - JOUR

T1 - How can we evaluate the cost-effectiveness of health system strengthening? A typology and illustrations

AU - Hauck, K.

AU - Morton, A.

AU - Chalkidou, K.

AU - Chi, Y-Ling

AU - Culyer, A.

AU - Levin, C.

AU - Meacock, R.

AU - Over, M.

AU - Thomas, R.

AU - Vassall, A.

AU - Verguet, S.

AU - Smith, P.C.

PY - 2019/1/31

Y1 - 2019/1/31

N2 - Health 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 between investing in health system strengthening and expenditure on specific interventions. The models developed in this paper provide a conceptual framework for evaluating the cost-effectiveness of investments in strengthening healthcare systems and, more broadly, shed light on the role that platforms play in promoting the cost-effectiveness of different interventions.

AB - Health 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 between investing in health system strengthening and expenditure on specific interventions. The models developed in this paper provide a conceptual framework for evaluating the cost-effectiveness of investments in strengthening healthcare systems and, more broadly, shed light on the role that platforms play in promoting the cost-effectiveness of different interventions.

KW - health system strengthening

KW - cost-effectiveness analysis

KW - economies of scope

KW - integrated service delivery

KW - spillover effects

KW - horizontal health care programs

KW - constraints

KW - healthcare delivery platforms

UR - https://www.journals.elsevier.com/social-science-and-medicine

U2 - 10.1016/j.socscimed.2018.10.030

DO - 10.1016/j.socscimed.2018.10.030

M3 - Article

VL - 220

SP - 141

EP - 149

JO - Social Science and Medicine

T2 - Social Science and Medicine

JF - Social Science and Medicine

SN - 0277-9536

ER -