Twenty Years Of Antiretroviral Therapy For People Living With HIV: Global Costs, Health Achievements, Economic Benefits.

Since the introduction of azidothymidine in 1987, significant improvements in treatment for people living with HIV have yielded substantial improvements in global health as a result of the unique benefits of antiretroviral therapy (ART). ART averted 9.5 million deaths worldwide in 1995-2015, with global economic benefits of $1.05 trillion. For every $1 spent on ART, $3.50 in benefits accrued globally. If treatment scale-up achieves the global 90-90-90 targets of the Joint United Nations Programme on HIV/AIDS, a total of 34.9 million deaths are projected to be averted between 1995 and 2030. Approximately 40.2 million new HIV infections could also be averted by ART, and economic gains could reach $4.02 trillion in 2030. Having provided ART to 19.5 million people represents a major human achievement. However, 15.2 million infected people are currently not receiving treatment, which represents a significant lost opportunity. Further treatment scale-up could yield even greater health and economic benefits.

Resource requirements to fight HIV/AIDS in Latin America and the Caribbean.

OBJECTIVES: Economists and epidemiologists from 10 countries in Latin America and the Caribbean (LAC) reviewed the methods used to develop estimates for resource requirements to address HIV/AIDS prevention and care in low- and middle-income countries. METHODS: They applied their country-specific knowledge to re-estimate the costs, coverage, and capacity of their health and education systems to expand HIV/AIDS interventions by 2005. A discrepancy of 173 million US dollars exists between the model estimates and those of country specialists. RESULTS: The most important difference between the model estimates and those of country specialists was in the estimated future price of highly active antiretroviral therapy. To a large extent, the estimates of the model reflect the efficiency gains that could result from purchasing arrangements that lead LAC countries to lower prices for antiretroviral drugs. CONCLUSION: This preliminary exercise with 10 LAC countries confirmed the validity of the use of these estimates as tools at the international level, given current data limitations, both to guide the allocation of resources across diseases and countries, and for advocacy and resource mobilization. In addition, with the country revisions, these estimates have also been shown to be key tools for country-level strategic planning.

Type 2 diabetes mellitus in China: a preventable economic burden.

OBJECTIVES: To estimate the direct and indirect costs of type 2 diabetes mellitus (T2DM) in China in 2007 and project these costs for the year 2030, and to examine and compare the benefits of selected interventions. STUDY DESIGN: Annual direct costs of medical and nonmedical care and indirect costs of income losses were estimated through case calculation of data from a cross-sectional survey carried out in 4 major Chinese cities from March 2007 to September 2007. METHODS: The subjects were consecutively recruited T2DM outpatients and inpatients from 20 secondary and tertiary hospitals using selection probability proportional to size sampling. We combined the existing data from cost-effectiveness studies into the case estimation to examine the benefits of the observed regime of interventions for preventing and treating diabetes. RESULTS: Annual direct medical and direct nonmedical costs per case averaged 1320.90 USD and 180.80 USD, respectively. The mean annual indirect costs of T2DM and its complications were estimated to be 206.10 USD. Based on case numbers in 2007 and projected case numbers in 2030, the direct medical costs of T2DM and its complications were estimated to be 26.0 billion USD in 2007 and were projected to be 47.2 billion USD in 2030. CONCLUSIONS: The results indicated that T2DM consumes a large portion of healthcare expenditures and will continue to place a heavy burden on health budgets in the future. Preventive intervention, screening, and treatment strategies may effectively decrease the incidence and complications of diabetes and therefore save costs.

Critical choices in financing the response to the global HIV/AIDS pandemic.

The AIDS pandemic will enter its fiftieth year in 2031. Despite much progress, there are thirty-three million infected people worldwide, and 2.3 million adults were newly infected in 2007. Without a change in approach, a major pandemic will still be with us in 2031. Modeling carried out for the AIDS 2031 project suggests that funding required for developing countries to address the pandemic could reach $35 billion annually by 2031-three times the current level. Even then, more than a million people will still be newly infected each year. However, wise policy choices focusing on high-impact prevention and efficient treatment could cut costs by half. Investments in new prevention tools and major behavior-change efforts are needed to spur more rapid advances. Existing donors, middle-income countries with contained epidemics, philanthropists, and innovative financing could help bridge the likely funding gap.

Reproductive and child health accounts: an application to Rajasthan.

This paper describes resource flows for reproductive and child health (RCH) in the health care system of Rajasthan, India, using the integrating framework of health accounts. It analyzes sources and uses of RCH funds by provider and expenditure category. The paper provides policy options for redirecting current public and private expenditures to improve RCH indicators. Comparisons of the share of government expenditure in state gross domestic product (31%), of Rajasthan state government spending as a share of total health spending (21%) and of Rajasthan state government spending as a share of reproductive and child health spending (3%) suggest that there are imbalances to correct. Even a very large increase in RCH spending by the Government of Rajasthan, an increase bringing its share of RCH total spending up to the level of its share in health spending, would add only one percentage point to the state budget. The principal result of such an increase in public RCH spending would be a substantial reduction in currently high levels of fertility and of mortality among infants, children and women of reproductive age.

Los altos costos de la atención de salud en el Brasil / The high cost of health care in Brazil

An analysis is presented of the changes that have occurred in Brazilian health sector expenditures in recent years, and of the factors that have favored the excessive growth of curative care at the expense of health promotion- in particular, the balance between the public and the private sector, and the role the public financing, and foreign medical technology, among others. The analysis focuses on the medical-hospital system in Brazil, given its importance as an essential supplier of health services, and on the National Institute of Medical Care and Social Welfare (INAMPS), the agency that under writes the major portion of medical and hospital expenditures. The first section outlines the general features of the fee system that was adopted by the INAMPS for payments to health service suppliers, as well as the basic standards that govern the work of this agency in the context of the Brazilian health system. Notable in this regard are the policy changes adopted in the early 1980s with a view to reducing costs. The second section examines the high cost of Brazilian health care with a discussion of the following topics: the role of the physicians, the INAMPS fee schedule, high technology in medicine, behavior and health costs, choice of services, excessive rates of cesarean deliveries, and physicians and the choice of technology. One of the principal conclusions is that the cost of health care is

Los altos costos de la atención de salud en el Brasil / The high cost of health care in Brazil

An analysis is presented of the changes that have occurred in Brazilian health sector expenditures in recent years, and of the factors that have favored the excessive growth of curative care at the expense of health promotion- in particular, the balance between the public and the private sector, and the role the public financing, and foreign médical technology, among others. The analysis focuses on the médical-hospital system in Brazil, given its importance as an essential supplier of health services, and on the National Institute of Medical Care and Social Welfare (INAMPS), the agency that under writes the major portion of médical and hospital expenditures. The first section outlines the general features of the fee system that was adopted by the INAMPS for payments to health service suppliers, as well as the basic standards that govern the work of this agency in the context of the Brazilian health system. Notable in this regard are the policy changes adopted in the early 1980s with a view to reducing costs. The second section examines the high cost of Brazilian health care with a discussion of the following topics: the role of the physicians, the INAMPS fee schedule, high technology in medicine, behavior and health costs, choice of services, excessive rates of cesárean deliveries, and physicians and the choice of technology. One of the principal conclusions is that the cost of health care is

Recessão e gasto social: a conta social consolidada, 1980-1986

Reúne subsídios para encontrar respostas às questões referentes ao impacto da crise no gasto federal no campo social entre 1980, ano que marca o início do período recessivo e 1986, quando o crescimento já havia sido retomado

Política e financiamento do sistema de saúde brasileiro: uma perspectiva internacional

Estuda a evolução dos gastos em saúde do Brasil, em relação a outros paíse. Analisa os padrões de seus gastos, bem como sua distribuição pelos seus principais subprogramas. Apresenta proposta de reorientação do gasto setorial e aponta condicionantes de sua evolução, como os papéis do médico, dos aspectos comportamentais e da tecnologia de ponta. Aprecia a estrutura de financiamento do sistema de saúde brasileiro e questões relativas à política de saúde

Brazilian health care financing and health policy: an international perspective / Brazilian health care financing and health policy: an international perspective

This study reviews financial aspects of health care in Brazil with some comparisons with more developed countries. Brazil now spends less than five percent of GDP on health, but that share has risen substantially in recent years. There are substantial inequities between regions in service availability and in health status; current policy actions are aimed at correcting deficiencies of this system. The blend of private and public financing and service delivery has resulted in an unsatisfactory level of productivity and efficiency for health care programs. The role of the medical professions and, broadly, the supply of phisicians have been inappropriate to national health-care needs. The paper identifies a number of areas in which further analysis and policy development will be essential to achieve goals of equity and efficiency for the health-care system

State-level pension reform: the case of Rio Grande do Sul

Analisa o sistema de aposentadorias e pensões dos funcionários públicos do Estado do Rio Grande do Sul. Informa que o estado enfrenta sérios problemas com despesas crescentes de inativos e pensionistas. Descreve a problemática atual e mostra projeções de comportamento econômico-financeiro no horizonte de 30 anos. Apresenta algumas soluções alternativas.