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Global studies in Health Affairs' March issue

Health Affairs

English National Health Service's Savings Plan May Have Helped Reduce The Use Of Three 'Low-Value' Procedures by Sophie Coronini-Cronberg of Imperial College London (UK) and co-authors

A flattening budget coupled with growing service demand drove the UK's National Health Service (NHS) to seek spending cumulative efficiency savings of 17 percent over four years beginning in 2011. Identifying ineffective, overused, or inappropriate procedures was largely left to the local commissioning organizations to implement. The authors identified six high-volume but low-value procedures and two benchmark procedures in England and compared their rates between 2002 and 2011 with the changes seen in the first year of efficiency savings, beginning in fiscal year 2011. The authors found significant reductions in three of the six procedures in the program's first year and no change in benchmark procedures, compared to prior years' trends.

People In Sub-Saharan Africa Rate Their Health And Health Care Among The Lowest In The World by Angus S. Deaton of Princeton University (US) and co-author

A large share of Western aid to developing countries goes to sub-Saharan Africa, a region where spending on health care is around $100 per person in 2005 price-adjusted terms. This region, which experienced large gains in life expectancy in the years following World War II, suffered health-related setbacks in the closing years of the twentieth century as a result of the HIV/AIDS epidemic. This study used data from the Gallup Organization's 2012 World Poll to investigate health and health care perceptions in the region in 2012 compared to other regions of the world. The poll found that sub-Saharan Africans' overall evaluation of their well-being was lower than that of any other population in the world. Additionally, only 42.4 percent of residents in that region were satisfied with the availability of high-quality health care in their community, also the lowest level in the world. Finally, when sub-Saharan Africans were asked to name the issues that should be the highest priorities for their government, health care was not seen as the most pressing issue.

New Analysis Reexamines The Value Of Cancer Care In The United States Compared To Western Europe by Samir Soneji of Dartmouth College (US) and co-author

Despite sharp increases in spending on cancer treatment since 1970 in the United States compared to Western Europe, US cancer mortality rates have decreased only modestly. This has raised questions about the additional value of US cancer care derived from this additional spending. The authors calculated the number of US cancer deaths averted, compared to the situation in Western Europe, between 1982 and 2010 for twelve cancer types. Compared to Western Europe, for three of the four costliest US cancers--breast, colorectal, and prostate--there were approximately 67,000, 265,000, and 60,000 averted US deaths, respectively, and for lung cancer there were roughly 1,120,000 excess deaths in the study period. The authors' results suggest that cancer care in the United States may provide less value than corresponding cancer care in Western Europe for many leading cancers.

In Tanzania, The Many Costs Of Pay-For-Performance Leave Open To Debate Whether The Strategy Is Cost-Effective by Josephine Borghi of the London School of Hygiene and Tropical Medicine (UK) and co-authors

Pay-for-performance programs in health care are widespread in low- and middle-income countries. However, there are no studies of these programs' costs or cost-effectiveness. The authors conducted a cost-effectiveness analysis of a pay-for-performance pilot program in Tanzania and modeled costs of its national expansion. In 2012 US dollars, the financial cost of the pay-for-performance pilot was $1.2 million, and the economic cost was $2.3 million. While the authors concluded that pay-for-performance programs can stimulate the generation and use of health information by health workers and managers for strategic planning purposes, the time involved could divert attention from service delivery. However, they also felt that pay-for-performance programs may become more cost effective when integrated into routine systems over time.

Compulsory Licensing Often Did Not Produce Lower Prices For Antiretrovirals Compared To International Procurement by Reed F. Beall of the University of Ottawa (Canada) and co-authors

Compulsory licensing has been widely suggested as a legal mechanism for bypassing patents to introduce lower-cost generic antiretrovirals for HIV/AIDS in developing countries. For this study the authors systematically constructed a case-study database of compulsory licensing activity for antiretrovirals and compared compulsory license prices to those in the World Health Organization's (WHO's) Global Price Reporting Mechanism and the Global Fund's Price and Quality Reporting Tool. They found that compulsory license prices exceeded the median international procurement prices in nineteen of the thirty case studies they examined, often with a price gap of more than 25 percent. They concluded that there is an ongoing need for multilateral and charitable actors to work collectively with governments and medicine suppliers on policy options.

Reflections On The 20th Anniversary Of Taiwan's Single-Payer National Health Insurance System by Tsung-Mei Cheng of Princeton University (US)

The author, Tsung-Mei Cheng, has been a long-time observer of Taiwan's National Health Insurance (NHI) System. On its twentieth anniversary, Cheng notes that the NHI stands out as a high-performing insurance system that provides universal health coverage to Taiwan's 23.4 million residents based on egalitarian ethical principles. While she notes that the system has encountered myriad challenges over the years, including serious financial deficits, Taiwan's government has managed those crises through successive policy adjustments and reforms. She concludes that although Taiwan's NHI faces challenges, including balancing the system's budget, improving the quality of health care, and achieving greater cost-effectiveness, that country's experience shows that a single-payer approach can work and control health care costs effectively.

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