Health priorities in developing countries: the economist's contribution.

Abstract

Though many new techniques have been developed to assist countries in allocating their resources, there are special difficulties in using these techniques in health services. The key problem is to find an acceptable measure of health output. The author argues that health should not be measured in crude economic terms and points out why no alternative measure has yet been evolved. In view of this, systems such as PPBS (planning–programming–budgeting system) cannot be applied to health; complex health methodologies are of limited value; and the teaching of health planning should not center around the study of models. Progress can best be made by studying the total effects of particular programs where practicable in an experimental situation. The author argues that the greatest contribution which the economist can make to health planning is not in the development of models, but in cost–effectiveness studies. The value of such studies is illustrated by an example—the study of the expansion of medical education in developing countries, which could be contributing substantially less to health than if the resources were used in alternative ways.