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Name	Presentation	Session	Download Slide
Joe Hirschberg University of Melbourne	Inverse test confidence intervals for the critical values in dose response and willingness to pay analysis	Economic Evaluation Methods
Judith Kabajulizi London School of Hygiene & Tropical Medicine	Macroeconomic Implications of Health Sector Reforms in Uganda: A Computable General Equilibrium Analysis	Economic Evaluation of Systems
Justyna Hartmann Hannover Medical School	Differences within high-cost patients: how do high-cost patients of different sexes and ages differ in their usage of health service sectors and their distribution of diagnoses?	Utilization of Health Care
Laura Gonzalez Università della Svizzera Italiana	Analysis of costs and quality of care in orthopedic surgery with continuous regional analgesia: Comparison of outpatient vs. inpatient setting	Hospital Quality
Li-Chen Huang Department of Health	The Introduce of Taiwan National Health Insurance Disputes Review System	Assessing Reform
Lilian Peters University of Groningen, University Medical Center Groningen	Formal health care costs predicted by frailty in a heterogeneous elderly population	Issues in Aging Populations
Luis Salvador-Carulla University of Sydney	Financing of Illness: Applicability of a new type of health economic research to the analysis of mental health care in nine European countries (REFINEMENT Project)	Mental Health Issues
Martin Hensher Department of Health & Human Services, Tasmania	Long-run economic growth and health systems: alternative scenarios for the future of economic growth and their likely consequences for health and health care	Government Financing for Health Care
María Errea Universidad Pública de Navarra	Evaluation of the Impact of Blood Donations’ Campaigns and Promotion Events in a Spanish Population: A Natural Experiment	Public Health Issues
Svenja Schauer Hannover Medical School	Using claims data to evaluate integrated care contracts: An analysis of potentials and restrictions	Economic Evaluation Methods
Young Eun Kim Swiss Tropical and Public Health Institute	Costs of scaling up onchocerciasis (river blindness) treatment toward elimination and eradication	Disease Management
David Smith Center for Health Research, Kaiser Permanente Northwest	Extrapolating Economic Findings from Pragmatic Trials in Integrated Health Systems to the Longer Term using Propensity Scoring and Decision Modeling: An example using adherence to antidepressant medication	Enhancing Cost-Effectiveness Analysis
Ed Wilson University of East Anglia	A comparison of relative value of information from different resource use data collection processes in an economic evaluation alongside a clinical trial	Enhancing Cost-Effectiveness Analysis
Jan Haeussler University of Konstanz	Diabetes prevention in a specific target group: Evaluation of the M.O.B.I.L.I.S. Program	Prevention Behaviour
Jeremy Barofsky University of Southern California	The economic effects of anti-retroviral therapy in Malawi	Economics and HIV
Joanne Flavel Flinders University	Poor health and labour market disadvantage: the effects of health on form of employment	Effect of Health Status on Employment
Joseph Lipscomb Emory University	Social Choice Foundations of Cost-Effectiveness Analysis in Health and Medicine: Defining and Satisfying the Corresponding Arrow Conditions for Rational Collective Choice	Health Economic Theory
Raja Jahangeer Pakistan Institute of Development Economics (PIDE)	Health Inequalities in Pakistan: The Role of Gender, Occupation, Household Economic Status and Place of Residence	What Affects Health I
Silvia Mendolia University of Wollongong	The Effect of Non-Cognitive Skills on Health Behaviours in Adolescence	What Affects Health I
Stefan Felder University of Basel	The dead-anyway effect from a societal perspective: Evidence from discrete choice data	Health Economic Theory

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Session: Demand and Supply Considerations for Human Papillomavirus Vaccine (HPV) Introduction in Low and Middle-Income Countries

Session Title: Demand and Supply Considerations for Human Papillomavirus Vaccine (HPV) Introduction in Low and Middle-Income Countries

Time: Monday 10:15 a.m.-11:30 a.m.
Room Bayside 104
Session Type: Abstract Driven Session

Chair: Marc Brisson (University of Laval, Centre de recherche FRSQ du CHA universitaire de Québec, Hôpital du Saint-Sacrement)

Organizer (1): Raymond Hutubessy (World Health Organization)

Session Description (476 words)

Human papillomavirus vaccines have several public goods properties that trigger public interventions directed to stimulate both supply and demand. At the macro level there are interventions to support vaccine development, pricing and vaccine procurement in low and middle-income countries (LMICs). At the micro level, there is public sector financing for HPV vaccine service delivery. Despite these interventions, some middle income-countries continue to perceive the vaccine as unaffordable. Is HPV vaccination affordable and how can the likelihood of its introduction be improved?

Purpose:
The purpose of the session is two-fold:
a) To address global and national economic factors influencing HPV introduction decisions, specifically focusing on similarities and differences between developed and developing countries;
b) To introduce and familiarize analysts in low and middle income countries with issues around affordability and value for money of HPV vaccination, together with available economic decision tools to support such decisions.

Content:
Currently decision makers face challenges regarding value for money and affordability issues on HPV vaccine introduction globally. Numerous economic analyses have been conducted to inform vaccine introduction decisions in high income countries. However these economic challenges are different in high income countries compared to low income countries. In the first group of countries the public market price, which can be as high as 130 US$ per dose, offered by vaccine manufacturers is a major obstacle for national decision makers to publicly finance the vaccine. In the low income countries where HPV vaccines prices are negotiated downwards towards relatively low prices (6US$-80US$ per dose) with support from organizations such as the GAVI Alliance or the PAHO revolving fund, the delivery costs of the vaccination program itself have becomes a major introduction barrier rather than the price of the vaccines itself. As the existing infrastructure in many low and middle income countries is not adequate to reach adolescent girls, in particular those not attending schools, substantial investments are required to start up the program in these countries. However, many low and middle income countries report lacking the technical capacity to conduct analyses about the investments they require and their value for money.

The session will start with a discussion on economic considerations that affect comprehensive cervical cancer prevention and control in low- and middle-income countries. The second session will discuss factors influencing the market dynamics of HPV vaccines that affect their affordability including an overview of the tier pricing developments of HPV vaccines globally. Next issues around costing and planning HPV vaccination delivery programs will be discussed, along with a presentation of the WHO’s comprehensive Cervical Cancer Prevention and Control Costing (C4P) tool. The last session will shed on light on the value for money of HPV vaccines in low and middle income countries along with a discussion of using the WHO supported Papillomavirus Rapid Interface for Modelling and Economics (PRIME). Case studies and country experiences will be presented in each session.

Theme: Health technology assessment
Key Terms: Economic evaluations, HPV vaccines, cervical cancer, low and middle income countries

Presentations (3)

Introduction to economic considerations and decision tools for comprehensive cervical cancer prevention and control in LMICs

Presenter: Ann Levin (Levin and Morgan)
Theme: Application
Abstract (150 words)

This paper reviews the economic considerations that affect comprehensive cervical cancer prevention and control in low- and middle-income countries. It also discusses decision tools that could be used. The authors conducted a review of key factors affecting the introduction in HPV vaccination in low and middle-income countries: burden of disease, HPV vaccine pricing, service delivery costs, and comparison of HPV vaccine with other new and under-utilized vaccines, and source of financing. Several decision tools are available for assisting with the introduction of HPV vaccine. These range from cost analysis, budget impact, epidemiological modeling, cost-effectiveness, and threshold price analysis. The decision to use any of these will depend on which question is being asked by the government. Some tools that have been developed to assist governments with decision-making on the introduction of HPV vaccine – the WHO cervical cancer prevention and control costing tool (C4P costing tool) and PRIME Cost-Effectiveness tool.

Key Terms: HPV vaccines, cervical cancer, cost analysis, cost-effectiveness analysis
Authors (2): Ann Levin (Independent Consultant. Health Economist) and Raymond Hutubessy (World Health Organization. Initiative for Vaccine Research)

Funding Sources: NONE
Is the HPV Vaccine Market favorable for introduction in LMICs?

Presenter: Claudio Politi (World Health Organization. Expanded Programme for Immunization)
Theme: Application
Abstract (293 words)

Many low and middle income countries are considering the introduction of HPV vaccine as national immunization and reproductive health programs develop strategic plans to prevent and control cervical cancer. However, the affordability of the HPV vaccine is often a major obstacle to its introduction despite some significant reductions in its price. The objective of this paper is to discuss factors influencing the market dynamics of HPV vaccines that affect their affordability. This information will assist policymakers in their decision-making on HPV vaccine introduction. Data were collected on product development, their supply, demand for the vaccines, sources of financing and implementation strategies as well as vaccine revenues and prices in the public and private sector for different countries. Both peer-reviewed and gray literature were reviewed, including summaries of regional meetings on cervical cancer control programs. The study results indicate that the supply and demand for HPV vaccines is highly dynamic as new sources of finance are becoming available for low-income and some lower-middle income countries. In the short-term, the price of the vaccines in high-income countries is likely to remain stable, despite price reductions in some countries, due to the duopoly supply situation and the high cost of production of first-generation vaccines. However, the price of vaccines is decreasing in low and middle-income countries as predictable demand and assured funding are growing and production capacity is not fully used. Demand for the HPV vaccine is gradually becoming more widespread as it becomes more widely available in low- and middle-income countries. Important issues of access to the HPV vaccine remain though for low and middle-income countries. In the longer-term, HPV vaccines created with new technologies and better dialogue between donors, developers, producers and countries are likely to be of lower cost, more suitable and affordable.

Key Terms: HPV vaccines, cervical cancer, vaccine market, vaccine prices
Authors (3): Claudio Politi (World Health Organization. Expanded Programme for Immunization) , Ann Levin (Independent Consultant. Health Economist) and Miloud Kaddar (World Health Organization. Expanded Programme for Immunization)

Funding Sources: Funds from the GAVI Alliance Business Plan 2012.

Publication History: In Review
Under review with BMC Medicine
Is it cost-effective to vaccinate girls against HPV in LMICs?

Presenter: Mark Jit (Health Protection Agency. Modelling and Economics Unit)
Theme: Application
Abstract (202 words)

Introduction: While the cost-effectiveness of vaccinating girls against HPV prior to sexual debut has been extensively investigated in high income countries, there have been fewer studies in LMICs. Assessing the cost-effectiveness of HPV vaccination often requires the use of complex models with data and expertise requirements that are prohibitive in such settings. However, some situations can be investigated using much simpler models. Methods: PRIME (Papillomavirus Rapid Interface for Modelling and Economics) is a simple Excel-based model that estimates an upper bound for the cost-effectiveness of vaccinating girls prior to sexual debut against HPV in a setting with no routine screening. PRIME was validated against published HPV cost-effectiveness studies in the literature and used with publicly available data sources to evaluate HPV cost-effectiveness in all 141 LMICs. Results: Female HPV vaccination is likely to be cost-effective in most countries at prices similar to those at which the GAVI Alliance purchases the vaccines under its Advanced Market Commitments. As prices increase above this however cost-effectiveness is less certain. Discussion: Models like PRIME offer a way of rapidly assessing the cost-effectiveness of HPV vaccination in simple situations, and are complementary to more complex models that can evaluate other situations such as catch-up and male vaccination.

Key Terms: HPV vaccines, cervical cancer, cost analysis, cost-effectiveness analysis
Authors (4): Mark Jit (Health Protection Agency. Modelling and Economics Unit) , Allison Portnoy (World Health Organization. Initiative for Vaccine Research) , Marc Brisson (University of Laval. Research Unit, Population Health) and Raymond Hutubessy (World Health Organization. Initiative for Vaccine Research)

Funding Sources: This work was funded by the World Health Organization.

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Session: Dealing With HIV

Session:Dealing With HIV

Session Title: Dealing With HIV

Time: Monday 5:15 p.m.-6:30 p.m.
Room Bayside Terrace
Session Type: Abstract Driven Session

Chair: Anna Vassall (London School of Hygiene and Tropical Medicine)

Presentations (4)

The Value of Reducing HIV Stigma

Presenter: Robert Brent (Fordham University. Economics)
Theme: Methodology
Abstract (492 words)

Abstract: Rationale: Globally, by the end of 2011 there were 34.0 million people living with HIV/AIDS. With 2.5 million new cases of HIV and 1.7 million AIDS deaths, the HIV epidemic is still on the rise. UN Secretary General, Ban Ki-Moon (2008) states that stigma is a chief reason why the AIDS epidemic continues to devastate societies worldwide. He argues that because of stigma people do not get tested and, if tested, do not seek treatment. So HIV transmission increases greatly because of the existence of stigma. If one could obtain estimates of how beneficial it would be in monetary terms to reduce HIV stigma then one could decide how much resources should be devoted to interventions that would lead to the reduction of HIV stigma. Objectives: The main objective of this paper is to show how the value of reductions in HIV stigma could be obtained by estimating the utility function and finding the marginal rate of substitution (MRS) between stigma and income. Although we will be focusing on HIV stigma reduction, it is important to recognize that stigma is a widespread phenomenon that affects access to services in many branches of the health care field. Our methods could be adapted to apply to valuing any type of stigma reduction. Methodology: We used happiness as our utility measure and happiness is increasingly being used to evaluate outcomes of economic policies, see Graham (2009). We used a recursive estimation framework whereby stigma first determined income and then the income-influenced stigma determined utility. Three different expressions for the MRS are derived and each of these leads to an alternative estimation method. To illustrate how our framework can be used we applied it to a sample of elderly people living in NYC with HIV. Data: Data for the study are related to the 2006 survey by the AIDS Community Research Initiative of America (ACRIA). This is a self-reported data set of 914 individuals with HIV in New York City. We used from this data set information on happiness (life satisfaction on a scale with 1 as the minimum and 10 as the maximum), income adequacy (ranging from $22,281 to $68,026) and HIV stigma (using the Berger scale ranging from 40 to 160). Conclusions: The total value of stigma reduction is rather large at around $1,000 per unit. The challenge to evaluators of HIV policies is to come up with interventions that impact stigma. It is unlikely that HIV stigma can be completely reduced, which for our measure was 120 points. However, interventions should be able to be identified that reduce stigma by a few points, say five. Our study can be used to value the benefits, which would be $5,000. Estimating the costs of the intervention then would allow an Economic Evaluation to be undertaken. Whether one uses an educational program, a job training scheme or anti-discriminatory regulation, one now has an estimate of how much resources should be devoted to implementing these interventions.

Biographical Details:

Currently (since 1995), Professor of Economics at Fordham University, Bronx, NY 10458.
Specializes in Cost-Benefit Analysis for policies in Developed and Developing Countries. Recent research related to evaluating interventions for HIV/AIDS.

Key Terms: HIV Stigma, Marginal Rate of Substitution (MRS), Older Adults
Author (1): Robert J. Brent (Fordham University. Economics)
An economic assessment of decentralizing anti-retroviral services from hospitals to primary health care centers in Nigeria: A matched difference-in-difference analysis

Presenter: Elaine Baruwa (Abt Associates, Inc.. International Health Division)
Theme: Application
Abstract (492 words)

Nigeria launched a ‘hub and spoke’ decentralization pilot in March 2010 for the provision of anti-retroviral therapy (ART). In this program, stable ART patients at hospitals (hubs) were downward referred to primary health care centers (spokes) for the continued provision of ART. The rationale for decentralization was to relieve congestion at the hospital level and to provide better access to care for patients not living near the hospital. The program may also save resources by moving care from more expensive hospitals to less expensive health centers. USAID’s Health Systems 20/20 project performed a costing study of ‘hub and spoke’ services. The objectives of this study are to compare the cost of ART care provided through the two levels of care, and understand the implications of cost differences for scale up of the ‘hub and spoke’ model. The study adopts a government perspective, with an analytic horizon including one year pre- and one year post-decentralization. Data were collected from facilities and patient records from Kaduna and Cross Rivers States. In Cross Rivers, data were extracted for 198 decentralized patients from four spoke sites and 200 non-decentralized patients from the hub site. These numbers were 285 and 243 respectively for the five spoke and one hub sites in Kaduna. Non-decentralized patients were matched to decentralized patients by date of ART initiation. Comparisons between patients before and after decentralization were made to assess changes in the receipt of care; difference-in-difference assessment was done between the two groups to assess differences in the receipt of care and the cost of care due to decentralization. Selected decentralized and non-decentralized patients had similar profiles in terms of age, CD4 counts, and sex when they initiated ART and again at the time when decentralized patients were referred to spoke sites, indicating a reasonable match between the comparison groups. Both groups had more visits and fewer missed visits in the year after decentralization, suggesting that decentralization may have improved access for both sets of patients. Decentralized patients had a greater decline in the number laboratory tests post-decentralization than their counterparts (p<0.05). However, fewer than the recommended number of laboratory tests was being conducted across all patients even before decentralization. Decentralized patients’ average cost of ART care was $355 per person per year in the year before decentralization and $388 after decentralization (p=0.51). For patients staying at the hospitals, these costs were $316 per person per year before decentralization and $447 after (p<0.01). In the difference-in-difference analysis, the increase in cost for non-decentralized patients was greater than that for decentralized patients (p<0.05). Decentralization of ART services appears to increase access to general ART care, but may limit access to ART laboratory services for decentralized patients. Decentralization is also likely to result in greater efficiency in the delivery of services, especially as health centers take on a greater number of patients. This study is limited by not including costs incurred above the facility level, such as training, or costs borne by patients.

Biographical Details:

Dr Elaine Baruwa is a Senior Associate and Health Economist at Abt Associates. Elaine was conducted economic evaluations of MCH and HIV programs across Africa and currently manages USAID's Health Financing and Governance Project in Haiti that focuses on health financing and human resources management. She has an MSc. in Health Management from Imperial College University and a PhD in International Health from the Johns Hopkins Bloomberg School of Public Health.

Key Terms: HIV, Decentralization, Efficiency, Costing
Authors (2): Elaine Baruwa (Abt Associates, Inc.. International Health Division) and Ben Johns (Abt Associates, Inc.. International Health Division)

Funding Sources: USAID's Health Systems 20/20 Project
Examining the links between staff flexibility, workload, and service delivery in the context of SRH and HIV service integration: a case study of selected government facilities in Kenya

Presenter: Sedona Sweeney (London School of Hygiene & Tropical Medicine. Department of Global Health and Development)
Theme: Application
Abstract (429 words)

Background: There is a great deal of interest in integrating HIV and sexual reproductive health (SRH) services in low-income countries. It is often assumed that integration can improve service access and quality while reducing the cost of service delivery. Economic theory also indicates that integration could provide a greater flexibility of use of human resources, potentially improving the efficiency of health services. On the other hand, integration often requires reorganization of existing service delivery models and health workers may be concerned about increases in workload. We therefore examine the variation in staff orientation to different tasks and workload in integrated HIV/SRH care, and explore how this may be linked to unit costs. Methods: As part of the Integra Initiative in Kenya, cost and output data were collected in 11 government health facilities supported by a project aiming to enable the integration of HIV and SRH services through training, management support and the provision of resources. Baseline data was collected for the financial year 2008-09, and endline data was collected for 2010-11. Unit costs per visit and per episode of care were estimated for family planning (FP) and provider-initiated HIV counselling and testing (PITC) services. Staff time was allocated as a percentage of clinical staff full-time equivalency (FTE) according to service mix and time use. We assessed the level of task orientation based on the number of different types of health services routinely provided by one clinical staff member. Results: From baseline to endline, flexibility in the range of services provided increased among clinical staff across facilities integrating FP and PITC (increasing from 3.8 services to 5.2 services per staff member). The effect on staff time, however, varied. District hospitals and sub-district hospitals saw minimal change in the amount of total staff time spent on FP and PITC, however health centres saw a large increase in total staff time (total FTE increased by 90%). These health centres did not see an increase in workload on individual staff members resulting from the integration, as additional staff were hired in as Kenya expanded its health workforce. The total number of PITC services delivered increased by 17%, however the number of FP services fell by 6% keeping the overall number of services delivered relatively constant. Further work is currently underway to examine the relationship between multi-tasking, service delivery and unit cost. Conclusion: Our initial results suggest that while support to enable integration can increase the multi-tasking of staff, this does not necessarily reduce the amount of time spent providing services. Further work is on-going to examine the impact of multi-tasking on service efficiency.

Key Terms: integration, human resources, HIV

Authors (6): Sedona Sweeney (London School of Hygiene and Tropical Medicine. Department of Global Health and Development) , Carol Dayo Obure (London School of Hygiene and Tropical Medicine. Department of Global Health and Development) , Anna Vassall (London School of Hygiene and Tropical Medicine. Department of Global Health and Development) , Christine Michaels-Igebokwe (London School of Hygiene and Tropical Medicine. Department of Global Health and Development) , Fern Terris-Prestholt (London School of Hygiene and Tropical Medicine. Department of Global Health and Development) and The Integra Team ( . )

Funding Sources: This work was supported by a grant from the Bill and Melinda Gates Foundation.
How effective are cash transfer programmes among Children affected and infected with HIV?: An Evaluation study from South India

Presenter: Edwin Sam Asirvatham (AIDS Prevention and Control Project. Voluntary Health Services)
Theme: Application
Abstract (433 words)

Background In India, children affected and infected with HIV are primarily from the poor households and they are deprived of basic needs in terms of food, basic health care, shelter and education. The government of Tamil Nadu responded to this situation by developing the first cash transfer program in India for the children infected and affected by HIV to address the children’s education, nutrition, medical and socioeconomic needs. This was operationalized through an Orphan and Vulnerable Children (OVC) Trust with a corpus fund of $1million. Objectives The objective of the study was to assess the effectiveness of this cash transfer program in achieving its intended purposes. Methods The study was undertaken in 10 districts that were selected from four clusters of districts in Tamil Nadu state. Out of the 655 beneficiaries, a sample of 153 beneficiaries was selected using the probability to proportionate size method from each district. Interviews were conducted using a semi-structured interview schedule. The caretakers were interviewed for children below 15 years. Biometric markers (hemoglobin and CD4) of children on ART were collected from medical records. The latest available data before the cash transfer programme and latest available data during the interviews were taken for comparison. Results Among study participants, 73% of them were HIV infected and the remaining were affected children; around 37% were double orphans, 53% were paternal orphans and 10% were maternal orphans; majority were (63.4%) from rural areas and the average age was 11.46 years. 30% of the children were under the care of their grandparents. The average age of the care givers was 44 years (Range: 20 to 85 years). Food expenditure was considered as the primary household expenditure for 89% of the respondents. The household income is positively correlated with food consumption (r=.607; p<.001) indicating less scope for other basic needs. The cash transfer programmes disbursed an average amount of INR 2617(USD 52). Most interviewees reported improvement in school attendance (98%) and performance (94%) that included high marks and participation in extracurricular activities. Around 42% reported an improvement in the food consumption pattern. Among children on ART (81), both mean hemoglobin level (10.04 mg to 10.76 mg; p<.001) and mean CD4 level (738.75 to 1014.34; p<0.01) increased significantly. Conclusion The findings provide evidence related to the effectiveness of cash transfer program among children especially in supporting their education. This program has contributed in restoring their childhood and this model can be replicated in other similar situation/area. However, the program was able to reach only a low proportion of eligible beneficiaries. It is imperative to scale up the program by adopting appropriate resource mobilization initiatives.

Key Terms: Cash Transfer Programmes, Effectiveness, Children Infected with HIV
Authors (2): Edwin Sam Asirvatham (AIDS Prevention and Control Project. Voluntary Health Services) and Bimal Charles (AIDS Prevention and Control Project. Voluntary Health Services)

Funding Sources: Nil

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Communicable diseases, HIV-AIDS, and vaccines

Dealing With HIV

Demand and Supply Considerations for Human Papillomavirus Vaccine (HPV) Introduction in Low and Middle-Income Countries

Economics and HIV

Economics of Vaccines

ePoster Session

Issues in Drug Research and Development I

The Broader Economic Impact of Vaccination in Low and Middle Income Countries_Fiscal Space Related Issues

The Global Burden of Disease 2010_Implications for Health Systems

The Treatment and Prevention of HIV

Vaccines

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Klasifikasi Keyword Abstrak

Communicable diseases, HIV-AIDS, and vaccines

Costs of care

Discrete Choice Experiments

Economic evaluations and methods

Equity and equality

Health care reform

Health financing

Health policy

Health professions

Health providers and patient choice

Hopital and hopital management

Maternal and child health

Mental health and elederly health issues

Non-communicable diseases, tobacco, and nutrition

Patient behavior and behavioral economics

Pharmaceutical and substances

Private sector in universal health coverage era

Quality of care

Service delivery, access and health care utilization

Universal Health Coverage

Download Slides

Name	Presentation	Session	Download Slide
Chean Men Rithy Chean & Jaco Research	Social health protection for NCDs in Cambodia	Demand Side Interventions to Boost Access to Affordable Health Services in Low Income Settings: The Cases of Cambodia, the Lao People’s Democratic Republic, and Rwanda
Donald Shepard Brandeis University	Cost-effectiveness of Insecticide Treated Wall Liner for Malaria Prevention in Rural Western Kenya	Malaria and Dengue: Costs and Cost-Effectiveness of Control Strategies Against Two Major Mosquito-Borne illnesses
Jason Abaluck Yale University	Dynamics of Plan Choice in Medicare Part D	Health Insurance Choice
Lo Veasnakiry Ministry of Health	Cambodia – Scaling up and consolidation of health equity fund under national health financing policy reform	Beyond Bismark and Beveridge: Innovative Financing Mechanisms for Protecting the Poor in Cambodia, Pakistan and Bangladesh
Ulla Kou Griffiths London School of Hygiene & Tropical Medicine	Cost-utility analysis of cataract surgery and refractive error correction in Zambia	Economics of Eye Health: New Methodological Approaches to Measure Costs and Benefits of Eliminating Avoidable Blindness
Yara Halasa Brandeis University	Dengue in India: Cost of illness	Malaria and Dengue: Costs and Cost-Effectiveness of Control Strategies Against Two Major Mosquito-Borne illnesses
Alex Robson Griffith University	Price Carrots and Income Tax Sticks in Private Health Insurance Markets: Fiscal Implications and Welfare Consequences	Theoretical Studies of the Impacts of Australian Healthcare Reform Policies on Healthcare Markets
Brendan Mulhern University of Sheffield	Using a Discrete Choice Experiment Incorporating Duration to Value Health States: A Feasibility Study Using EQ-5D-5L	Discrete Choice Experiments: A Review of the Methodological Challenges of Applying DCEs to Value Generic Quality of Life Measures
Marleen Dekker Leiden University	Understanding participation in community based health insurance: findings from Togo	Health Care Financing Reforms and their Effects in Sub-Saharan Africa: Case Studies from Ethiopia, Togo, Rwanda and Burundi
Sergio Prada Universidad de Icesi	A systematic measurement and new evidence of the costs of providing health care in Colombia	The Production and Costs of Health Service Across Developing Countries
Andrea Leiter-Scheiring University of Innsbruck	Risky Sports and the Value of Life Saving Information	Public Health Issues
Christopher Hollenbeak Pennsylvania State University	Efficiency Evaluation of Healthcare in Pennsylvania Prisons	Economic Evaluation of Systems
Edwine Barasa KEMRI-Wellcome Trust Research Programme	Examining Priority Setting and Resource Allocation Practices in Hospitals: The Case of a District Hospital in Kenya	Hospital Quality
Evelyn Thsehla Council for Medical Schemes	What are the key contributing factors for hospital admissions, readmission rate and day cases within the South African medical schemes community?	Hospital Quality
Filipinas Bundoc University of the Philippines	The role of frequency and timing of antenatal care seeking in securing neonatal survival: a Philippine case	Child Health
Gert Westert Radboud University Nijmegen Medical Centre	The Dutch Atlas of Health Care Variation; transparency needed to increase efficiency.	Assessing Reform
Heather McLeod Ministry of Health	Estimating the Future Need for Palliative Care: a tale of two methodologies	Economic Evaluation Methods
Hyun-Woung Shin Korea Institute for Health and Social Affairs	Determinants of Health Care Spending Growth in a Government-Funded Medical Assistance Program: Evidence from South Korea	Government Financing for Health Care
Ian Anderson World Bank	Plenty amidst scarcity: The case of Samoa, Tonga and Vanuatu	Government Financing for Health Care
Jackie Mundy AusAID Health Resource Facility	Evolving health care financing issues in East Asia and the Pacific	Government Financing for Health Care

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Laporan Semiloka

Laporan Semiloka:

Potensi dan Pengelolaan sistem telematika untuk mengembangkan RS
di daerah sulit dan melebarkan akses masyarakat terhadap pelayanan kesehatan.

Yogyakarta, 17 Juli 2013

Pengantar

Pada tanggal 16 Juli 2013 Ibu Menteri Kesehatan membuka unit Pendidikan dan Pelatihan Jarak Jauh berbasis digital di Badan PPSDM. Peresmian ditandai dengan melakukan diskusi teleconference bersama pejabat Dinas Kesehatan di 4 propinsi. Empat tahun yang lalu Pusat Kebijakan dan Manajemen Kesehatan FK UGM memulai Program Pengembangan Ilmu berbasis Web. Teknologi Web untuk menyimpan, menyiarkan secara hidup dalam bentuk audio visual semakin maju. Gadget semakin banyak dipegang oleh masyarakat. 3 tahun yang lalu, Infrastruktur IT di berbagai tempat terpencil sangat sulit. Sekarang sudah ada teknologi VSAT dipasang di seluruh Dinas Kesehatan dan RSD. Sudah ada "jalan raya besar" untuk dipergunakan. PKMK FK UGM sudah menggunakan untuk NTT dan Papua. Peresmian unit Pendidikan danPelatihan Jarak Jauh di Kemenkes menandai era baru dalam telematika.

Kegiatan Semiloka hari ini adalah:

Membahas Potensi dan Pengelolaan sistem telematika untuk mengembangkan RS di daerah sulit dan melebarkan akses masyarakat terhadap pelayanan kesehatan.

Tujuan Pertemuan:

Membahas pengalaman PKMK menggunakan teknologi telekomunikasi di Papua dan NTT ;
Memahami teknologi VSAT dan sistem jaringan Pusdatin dan Telkom untuk pengembangan.
Membahas sistem tele-training dan telemedicine yang membutuhkan struktur, dana, tenaga ahli, dan kegiatan yang terkoordinasi;
Mengembangkan telehealth dan telemedicine lebih lanjut untuk RS di daerah sulit
Membahas Proses Bisnis Sistem Pengembangan Ilmu berbasis Telematika

Hasil pertemuan

Pertemuan telah membahas pengalaman PKMK UGM menggunakan teknologi telekomunikasi di Papua dan NTT dalam pelatihan bagi Kepala Dinas Kesehatan, Kepala Puskesmas, dan staf yang dilakukan secara kombinasi dengan tatap muka. Disamping itu bekerjasama dengan RS Harapan Kita telah mencoba menggunakan telemedicine dalam berbagai kasus Obsgin di RSD Kefa. Masalah yang masih timbul adalah gangguan teknis komunikasi. Gangguan ini diantisipasi dengan menggunakan back-up berupa sambungan telepon. Adanya jaringan VSAT dari Kementerian Kesehatan bekerjasama dengan PT Telkom memberi dorongan baru untuk pengembangan dengan catatan diharapkan menaikkan kapasitas menjadi 512Kb. Saat ini baru 126 yang lebih dari cukup untuk manajemen dan pengiriman data, namun sangat kurang untuk keperluan video. Dalam pertemuan dibahas pula sistem agar kegiatan ini dapat berjalan jangka lama.

Tindak lanjut pertemuan:

Pengembangan sistem telematika untuk NTT dan Papua terus dilakukan bersama dengan Kemenkes, Pusdatin. Khusus untuk telemedicine diharapkan ada pertemuan untuk aspek hukumnya.
Perlu dilakukan pengembangan untuk isi yang dapat dimanfaatkan oleh tenaga rumahsakit, Dinas Kesehatan, dan puskesmas yang akan tersambung dengan infrastruktur SIKNAS Pusdatin.
UGM dan perguruan tinggi lain diharapkan menjadi semacam production house untuk kegiatan. Sebagai kegiatan awal akan dilakukan beberapa hal:
1. Penyusunan Program Pembelajaran untuk: Hand-washing, Manual Rujukan, dan Pemetaan Intervensi KIA dengan dana UGM dan AIPMNH
2. Penyusunan Program Pembelajaran mengenai Kepemimpinan RS dan Kepemimpinan Dinas Kesehatan, bekerja sama dengan UGM
3. Pengembangan program pembelajaran untuk peningkatan mutu pelayanan Rumahsakit.
4. Pengembangan program pembelajaran untuk Pemasangan IUD pasca persalinan.
5. Pengembangan program pembelajaran untuk Penguatan IT di Kabupaten, bekerjasama dengan SIMKES.
6. Kegiatan akan dimulai pada minggu ke empat bulan Juli 2013.
7. Disamping itu diharapkan ada Penelitian Operasional dengan tema: Penggunaan Sarana SIKNAS Pusdatin untuk pembelajaran penggunaan prinsip Health System Strengthening untuk pengendalian AIDS, TB, dan Malaria. Kerjasama diharapkan antara UGM dengan Pusdatin dengan dana Global Fund.
8. Diharapkan produk-produk ini akan ditempatkan di website PKMK http://chpm.fk.ugm.ac.id/ dan dapat diakses oleh seluruh RS dan Dinas Kesehatan di Indonesia melalui jaringan SIKNAS Pusdatin.
Direncanakan ada pertemuan nasional untuk membahas penggunaan jaringan VSAT Kemenkes Pusdatin dengan berbagai kemungkinan dan contoh isinya.

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Diskusi Bulanan PKMK - Juli Tahun 2013

Diskusi Bulanan Tahun 2013
Pembahasan Artikel Kebijakan dan Manajemen

Kelompok Kerja Kebijakan dan Manajemen Fakultas Kedokteran UGM

Ruang Kuliah R.E. 301, Lt. 3 Gedung IKM Sayap Utara, FK UGM
Jumat, 23 Juli 2013

Pengantar

Perkembangan topik dan metode penelitian manajemen berjalan dengan sangat pesat. Perkembangan ini perlu diikuti dengan cara melakukan pembahasan terhadap artikel-artikel kebijakan dan manajemen. Kegiatan ini sangat penting untuk pengembangan kapasitas para dosen, peneliti, dan konsultan yang tergabung pada kelompok kerja Kebijakan dan Manajemen Pelayanan Kesehatan FK UGM serta peminat lain. Kegiatan ini dipancarkan melalui video dan audio streaming sehingga para peserta yang berada di luar Yogyakarta dapat mengikutinya.

Tujuan

Membahas perkembangan topik yang menarik dalam kebijakan dan manajemen kesehatan
Membahas metode penelitian, pelatihan, dan konsultasi, yang dipergunakan di berbagai penelitian kebijakan dan manajemen
Menjadi forum untuk pengembangan kemampuan diri untuk para konsultan, peneliti, dan dosen di kelompok kerja kebijakan dan manajemen kesehatan
Mengembangkan forum komunikasi antara dosen, peneliti, dan konsultan dalam kebijakan dan manajemen pelayanan kesehatan.

Jadwal Acara dan Topik

Topik

Konsep-konsep Terkait

Makalah yang ditelaah

Principal-agent theory & Self-determination theory

Conflict of interest, Motivation, Classical agency theory

diskusi-bulanan-juli

Gopalan, S.S., & Durairaj, V. (2012).

Addressing maternal healthcare through demand side financial incentives: experience of Janani Suraksha Yojana program in India. BMC Health Services Research12:319 (15 September 2012). PDF

Carroll, J.K., dkk. (2012).

A 5A's communication intervention to promote physical activity in underserved populations. BMC Health Services Research12:374 (30 October 2012). PDF

Arsip Video Presentasi

Sesi 1

Sesi 2

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Reportase sesi 12

Session Tittle:
Health Insurance Market in Developing Countries

Sesi : Asuransi di Pasar Negara Berkembang

Dalam sesi ini terdapat empat paper yang akan dipresentasikan, tetapi karena adanya kendala teknis, hanya 2 paper yang dipresentasikan, yaitu:

SESI 1: Apakah skema Asuransi mikro kesehatan dan asuransi kesehatan nasional bersama-sama bergabung untuk mencakupi sektor informal dan bergerak menuju cakupan kesehatan universal (Universal Health Coverage)?
Oleh: Christina Synowiec (Results for Development Institute)

Paper ini menjelaskan tentang mikroinsurance dan hubungannya dengan universal health coverage. Dilatarbelakangi oleh kenyataan bahwa cakupan kesehatan universal (UHC), atau "suatu sistem di mana setiap orang dalam masyarakat dapat mendapatkan layanan perawatan kesehatan yang mereka butuhkan tanpa kesulitan keuangan," adalah bangunan di seluruh dunia, namun negara-negara menghadapi tantangan besar dalam memperluas cakupan ke sektor informal sektor. Sementara itu, asuransi mikro kesehatan (Health Mikro Insurance/HMI) yang sering dipimpin oleh badan swasta , telah berkembang secara bersamaan di tempat-tempat yang sama. Tapi itu belum mencapai skala, dan mengalami banyak hambatan, seperti menawarkan manfaat yang komprehensif, lintas-subsidi keberlanjutan keuangan yang sangat miskin dan jangkauannya. Kedua UHC dan asuransi mikro yang berjuang dengan cara yang berbeda, sayangnya, di sebagian besar negara mereka sebagian besar melanjutkan secara paralel, dengan berbagai kelompok pelaksana dan pendukung, meskipun memiliki tujuan yang sama.

Paper ini bermula dari hipotesis ada potensi kerja sama antara pemerintah dan microinsurers yang dapat membantu mengatasi masalah yang dihadapi oleh para pembuat kebijakan nasional dan HMIs. Dibutuhkan pemahaman hubungan antara HMI dan UHC dengan mengembangkan kerangka kerja untuk bagaimana dua gerakan bisa maju bersama, mengidentifikasi dan mendokumentasikan contoh nyata yang menggambarkan hubungan ini, dan menganalisis kasus-kasus ini untuk mengekstrak pelajaran penting dan wawasan.

Temuan tulisan ini menunjukkan bahwa ada enam peran yang menggambarkan hubungan HMI untuk UHC: pengganti, demonstrasi, yayasan, kemitraan, tambahan, dan duplikatif, dengan peran yang diinginkan HMI bergeser dari waktu ke waktu. Tulisan ini akan membahas empat peran peran komplementer HMI melalui pengalaman 8 negara yang berbeda (Kamboja, Ghana, India, Yordania, Kenya, Filipina, Tanzania, dan Thailand). Dari contoh terkenal scalling up CBHI di Ghana, untuk bermitra dengan HMI di Kenya dan Filipina, untuk menguji kebijakan-kebijakan baru dan model operasional di India dan Kamboja, untuk inovasi organik di Tanzania.

Paper ini juga berbagi checklist bagi para pembuat kebijakan yang bergulat dengan tantangan meliputi sektor informal. Banyak pemerintah memulai gerakan mereka menuju UHC dengan terlebih dahulu meliputi sektor formal, kemudian menargetkan masyarakat miskin melalui subsidi, tetapi mereka yang tetap berada di tengah cenderung datang terakhir dan yang paling menantang bagi banyak negara miskin dan berkembang untuk mencakupi semua. Bahkan jika pemerintah tidak memiliki kapasitas untuk mencakupi ekonomi informal segera, penting bagi para pembuat kebijakan untuk mempertimbangkan di mana mereka berada di sepanjang perjalanan menuju UHC dan apakah HMI dapat membantu untuk mencapai tujuan mereka. Sebuah strategi nasional perlu secara eksplisit mengakui dan mengartikulasikan peran HMI dan pembuat kebijakan dapat belajar dari pengalaman negara lain.

Demikian juga Indonesia visi untuk mencapai Universal health coverage, bukanlah hal yang mudah. Pemerintah dapat bermitra dengan HMI untuk mencakupi sektor sektor informal yang tidak mudah di jangkau oleh pemerintah. Pemerintah dapat mempertimbangkan HMI sebagai sumber daya untuk inovasi dan pembelajaran, dan melanjutkan kemitraan dengan entitas yang dapat membawa ide-ide, keuntungan, efisiensi, dan pengalaman.

SESI 2: Implikasi dari perubahan bentuk imigrasi untuk mencakup asuransi kesehatan anak?
Paula Song (Ohio State University. Health Services Management and Policy)

Paper ini mencoba melihat cakupan asuransi kesehatan untuk anak dari keluarga imigran di Amerika Serikat. Dilatarbelakangi oleh tujuan penelitian kebijakan kesehatan AS yang sangat memeprtimbangkan cakupan asuransi kesehatan untuk anak-anak, meskipun kesenjangan yang signifikan dalam cakupan ada di antara anak-anak dalam keluarga imigran. Meskipun ACA memperluas cakupan asuransi kesehatan untuk orang dewasa dan anak-anak, tetapi gagal untuk mengatasi asuransi untuk imigran. Semakin kompleks, dalam kebijakan kesehatan imigran adalah ketika komposisi campuran keluarga imigran, di mana anak-anak sering memiliki kewarganegaraan AS, sementara orang tua mereka tidak. Makalah ini membahas peran imigrasi dalam menutupi kesenjangan cakupan untuk anak-anak. Secara khusus, makalah ini bertujuan untuk:

mengidentifikasi pangsa anak yang tidak diasuransikan yang tinggal di keluarga imigran,
menunjukkan peran kewarganegaraan anak dalam memperoleh cakupan, dan
menggunakan teknik dekomposisi untuk mengidentifikasi pengurangan batas atas di tingkat asuransi anak jika anak-anak ini mendapatkan kewarganegaraan melalui tindakan legislatif.

Studi desain yang dipergunakan model probit status asuransi menggunakan data dari 2008-2011 Survei Masyarakat Amerika (ACS). ACS merupakan sampel yang representatif dari semua anak di bawah usia 18. Ini mencakup 2,5 juta anak 2008-2011, termasuk lebih dari 600.000 anak-anak dengan orang tua imigran. Karena data Sensus Amerika Serikat tidak mengumpulkan informasi tentang status imigrasi (yaitu, hukum residensi), pendekatan dekomposisi Fairlie digunakan untuk mengungkapkan potensi penurunan tingkat diasuransikan untuk anak-anak dari memperluas kewarganegaraan kepada anak-anak yang tidak memiliki dokumen.

Hasilnya menunjukkan bahwa memiliki orangtua imigran merupakan ciri khas anak-anak yang tidak diasuransikan. Sementara anak-anak dalam keluarga imigran hanya 24,1% dari semua anak di Amerika Serikat, mereka terdiri hampir setengah (42%) dari semua anak yang tidak diasuransikan di Amerika Serikat. Anak-anak ini hidup dalam keluarga imigran dan memiliki setidaknya satu orangtua imigran, tetapi 69% dari anak-anak imigran yang tidak diasuransikan sudah memegang kewarganegaraan AS. Analisis dekomposisi menunjukkan bahwa kewarganegaraan orangtua menjelaskan perbedaan terbesar dalam tingkat yang tidak diasuransikan untuk anak-anak.

Anak-anak dengan orang tua imigran hampir setengah dari semua anak yang tidak diasuransikan di Amerika Serikat. Tingginya persentase anak-anak yang tidak diasuransikan di keluarga imigran bukan karena status imigrasi anak sejak 2/3 sudah warga AS. Jika imigran kewarganegaraan mendapatkan anak, sebagian besar anak-anak akan tetap diasuransikan kecuali status imigrasi orang tua mereka juga berubah. Jadi, sementara status imigrasi anak menentukan kelayakan mereka untuk Medicaid dan manfaat publik lainnya, orang tua harus bersedia untuk mendaftarkan anak.

Makalah ini menunjukkan bahwa reformasi imigrasi yang hanya memperpanjang kewarganegaraan kepada anak-anak akan memiliki manfaat sedikit dalam mengurangi jumlah anak yang tidak diasuransikan di Amerika Serikat. Anak-anak dalam keluarga imigran akan tetap proporsional tidak diasuransikan jika reformasi imigrasi tidak mencakup orang tua mereka dewasa.

Kasus asuransi untuk keluarga imigran tidak banyak muncul di Indonesia karena sedikit adanya imigran dari luar negeri yang memasuki Indonesia baik secara legal maupun illegal. Namun demikian metode penelitan dapat diterapkan untuk menelusuri pemanfaatan asuransi kesehatan pada kelompok marginal tertentu seperti kelompok masyarakat yang melakukan urbanisasi ke kota (seperti Jakarta) dan tidak memiliki identitas lengkap, maupun tidak teregristrasi di Jakarta, sehingga program-program pemerintah Jakarta seperti kartu sehat tidak dapat mencakup kebutuhan akan kesehatan dari kelompok ini.

Pengantar

Tujuan

Jadwal Acara dan Topik

Arsip Video Presentasi

Session Tittle: Health Insurance Market in Developing Countries

More Articles ...

Session Tittle:
Health Insurance Market in Developing Countries