The impact of economic crisis on health-care consumption in Korea.

This study uses urban household income-expenditure survey data, national health insurance claims data, and public health centre surveys to examine the impact of economic crisis on the consumption of health services in Korea. The analysis shows that the health-care consumption of Korean households has been adversely affected by the recent economic crisis, as measured by amount of expenditure on health. Distributional implications for health sector use are also found. Whereas the use of medical services by upper income groups is only slightly affected by the economic crisis, lower income groups are spending relatively less on medical services. Of all households, unemployed households are hit hardest by the crisis. Analysis shows that for all households, the rate of expenditure decrease is relatively higher for drug expenditure than for expenditure on medical services. That is, facing declining income, people cut their spending in the area where the need is non-essential or less inevitable.

Assessment of the humoral immune response against Plasmodium falciparum rhoptry-associated proteins 1 and 2.

Naturally occurring antibody responses to Plasmodium falciparum rhoptry-associated proteins 1 and 2 (RAP-1 and RAP-2) were measured with recombinant and parasite-derived forms of the antigens. For comparative purposes, responses to multiple forms of three other malarial antigens were also examined. The sera of 100 Papua New Guineans were screened for antibodies. Eighty-six and 82% of individuals over 30 years of age had antibodies that recognized parasite-derived RAP-1 and RAP-2, respectively. Importantly, we found that recombinant and native antigens share linear epitopes seen by the human immune system; thus, the recombinant proteins may be adequate human immunogens. However, antibodies affinity purified on recombinant RAP-1 reacted with other antigens in addition to parasite-derived RAP-1. Thus, the antigenicity of RAP-1 may have been overestimated previously. The recognition of RAP-1 and RAP-2 correlated with age and with the recognition of recombinant forms of the ring-infected erythrocyte surface antigen, merozoite surface protein 1, and merozoite surface antigen 2 (MSA2) antigens. Antibodies to these antigens appear to be generated in response to the total exposure to malaria of the host. Antibodies to conserved regions of MSA2 had stronger correlations with both age and the recognition of other antigens than did the full-length recombinant MSA2 molecule. In contrast to results with the other antigens, there was no significant difference in the ages of individuals with a certain antibody titer to the full-length recombinant or parasite-derived MSA2 molecule, but antibodies to these two antigens did correlate with parasitemia. For all antigens tested, antibody levels after two infections can approach the peak levels of antibodies obtained in immune individuals.

The economics of schistosomiasis chemotherapy.

The optimal choice o f chemotherapy regime arises in the design o f every schistosomiasis control programme. This choice is o f particular contemporary interest for two reasons. At one extreme the development of effective single-dose oral drugs such as praziquantel and oxamniquine makes mass chemotherapy a practical option. At the other extreme there has been a revival o f advocacy for some form o f selective treatment. But all developing countries that contemplate schistosomiasis control face severe budget constraints, requiring careful analysis o f the economics o f chemotherapy. In this article, Nick Prescott presents a generalized framework For resource allocation in schistosomiasis chemotherapy, demonstrating that the optimal choice o f chemotherapy regime depends critically on the level of budget constraint, the unit costs o f screening and treatment, and rates o f compliance with screening and chemotherapy-all factors which are usually neglected in the choice o f control strategy.

[Estimation of the impact of the principal diseases in rural Mali]. / Estimation de l'impact des principales maladies en zone rurale malienne.

The authors assess the health impact of major diseases in the circles of Kita, Bafoulabé and Kenieba (Western Mali) by measuring, for each of them, the number of healthy days of life lost through illness, disability and death. Malaria, birth diseases, infant gastro-enteritis and pneumopathies, measles, malnutrition and hemoglobinopathies account for 58.1% of healthy life lost due to all studied diseases. Parasitic diseases (except malaria), tuberculosis, leprosy are less important than usually said; on the contrary, the impact of hepatic, cardiovascular, and eyes diseases is great. In developing countries assessing the number of healthy days lost by the community due to different diseases is usefull to choose the health priorities and to compare the cost/effectiveness ratio of different health programs.

The distribution and impact of health resource availability in China.

Since 1949, China's progress in mortality reduction has far exceeded that experienced by other developing countries with comparable levels of national income. This achievement has taken place in the context of a development strategy oriented, in part, to the elimination of the worst aspects of poverty. Using recent cross-section data, this paper provides a statistical assessment of the extent to which health resources are evenly distributed in contemporary China, and the degree to which improvements in health resource availability may account for the observed variation in mortality levels. Contrary to expectation, the analysis finds that substantial inequalities do remain in the distribution of health resources, and that these differentials are principally associated with levels of urban income and urbanization. However, these differences in health resource availability do not appear to explain the significant variation which also persists in mortality levels, a finding consistent with the results of similar analyses for developed countries.

The analysis and assessment of health programs.

There is a vast gap between methodology and practice in the analysis and assessment of health programs. This presents an acute problem in developing countries where resource allocation decisions at the tight budgetary margin have important practical consequences. The prospects for improving this primitive situation depend critically on progress in analysis of the affordability and effectiveness of health programs. The analysis of affordability--especially on the recurrent cost side--is a necessary condition which can help ensure that proposed programs are unlikely to be vulnerable to implementation delays or underfinancing of operating costs which may seriously compromise the benefits expected from new investments. Improved analysis of effectiveness is also essential in order to help planners choose the best pattern of resource use from among the various combinations of programs that are affordable. To do this will require the devotion of substantial analytical effort to fill the great void of organized empirical knowledge available to those seeking to assess the effectiveness of health interventions. In particular there must be a shift in focus from single interventions directed at communicable diseases in children to a broader concern with multi-purpose interventions, including those directed against the emerging problems of non-communicable disease in adults.

The economics of blindness prevention in Upper Volta under the Onchocerciasis Control Program.

This paper proposes a new approach to the economics of blindness prevention under the Onchocerciasis Control Program in Upper Volta. It differs from previous economic analyses of onchocerciasis control in three important respects. First, it uses empirical data as the basis of an estimate of the epidemiological effectiveness of the intervention. Second, it focuses on the prevention of permanent disability and premature death due to onchocercal blindness as the major health improvement attributable to onchocerciasis control. Third, it emphasizes cost-effectiveness rather than cost-benefit analysis. This limitation is imposed by the difficulty of undertaking a comprehensive assessment of the benefits of onchocerciasis control. In particular, the extent to which control of partial visual impairment and infection without ocular involvement would increase the effective supply of labor, and also the extent to which control would increase the effective supply of land by inducing new settlement in the river valleys, have not been clearly established. The cost-effectiveness approach is limited because it foregoes the opportunity provided by cost-benefit analysis to compare the relative desirability of investing in onchocerciasis control with alternative investments in other sectors. However, it does permit useful judgments to be made about the relative efficiency of allocating scarce resources to onchocerciasis control compared to other possible investments within the health sector. For this purpose, an illustrative comparison is made with estimates of the cost-effectiveness of measles immunization.

Cost-effectiveness of blindness prevention by the Onchocerciasis Control Programme in Upper Volta.

The article presents a cost-effectiveness analysis of the Onchocerciasis Control Programme in Upper Volta. The analysis uses a new approach to the measurement of health project effectiveness, by considering the number of healthy years of life added by the prevention of permanent disability and premature death attributable to onchocercal blindness. The approach emphasizes the central role of social value judgements in allocating health resources-in particular the relative weights assigned to preventing disability and postponing death, present and future health benefits, and health gains among productive and non-productive individuals. The quantitative results yield the following cost-effectiveness estimates for blindness prevention through onchocerciasis control: US$20 per year of healthy life and per productive year of healthy life added, and US$150 per discounted year of healthy life and per discounted productive year of healthy life added. As an illustrative example, a comparison is made with estimates of the cost-effectiveness of measles immunization.

Selected economic issues in helminth control.

This paper examines four main economic issues in the formulation of helminth control policies: whether, what, how and with whose resources to control helminthiasis. The paper argues that (i) although helminth control would have a negligible impact on mortality, its nutrition-mediated effects on improved labor productivity and intellectual performance may be significant; (ii) that reduction of helminth disease rather than infection should be the target of control policy, although the preferred intervention may still be eradication rather than continuous control; and (iii) that although the case for public subsidy of helminth control interventions is strong, the existence of serious fiscal constraints and some evidence of private willingness-to-pay for anthelminthic chemotherapy indicates a potential for partial cost recovery which should be explored.