Health Service Personnel Research Articles

Cost-Effectiveness and Cost-Benefit Analyses for Public Health Programs

COST EFFECTIVENESS and are subjects which, to those who are not professional economists, evoke a somewhat less than overwhelming response. They are, however, ingredients frequently mentioned in the recipes for planning-programing-budgeting systems'and, if only for this reason, it becomes desirable to have a speaking acquaintance with these subjeots. Most persons who undertake a survey of the literature in this field quickly find the terms ''cost effectiveness and cost benefit used more or less interchangeably. Some writers, however, appear to make a firm distinctioln between the two terms, often without defining the difference. I will attempt to differentiate between those expressions in this paper, although there is some lack of uniformity in the definition of terms even among economists. In cost-benefit analysis, the monetary of a program is compared wvith its expected benefits, and these are expressed in dollars. I use the word normally to indicate that there are exceptions. Costs, benefits, or both might be expressed in nondollar terms. An example of this is a comparison of different types of training programs for health service personnel. In such an example, benefits could be shown in number of persons trained, and could be shown in number of trainers needed, perhaps under different approaches. If training manpower is limited, the number of trainers could be more important than their salaries. In a cost-benefit analysis of alternate programs, we compare the expected to determine which is the best investment. Because of the frequent emphasis on the mos't effective use of money when given a choice of possible programs, both costs alnd are usually expressed in dollars to permit ready comparison. For the same reason divided by cost, the benefit-cost ratio, is often useful in making comparisons. Cost-effectiveness analysis differs from costbenefit analysis in that costs are calculated and alternate ways are compared for achieving a specific set of results. Our objective is not just how to use funds most wisely; it also includes the constrainlt that a specified output must be achieved. Very often, this output is not expressed in dollars. If we were told to determine the best program for training 1,000 nurses in a given time (to use the previous example of training) we could obtain costs of various training programs and make comparisons, and the study could be classified as one of effectiveness. Cost-benefit studies expedite comparisons among several programs with differing objecDr. Smith is chief, Planning Systems Branch, Health Services and Mental Health Administration, Public Health Service. This paper is based on a speech given at a seminar on program planning budgeting systems, Columbia University School of Public Health and Administrative Medicine, December 11, 1967.

Administrative patterns of school health services

A survey of 230 cities in 50 states was taken to determine the present pattern of administration of school health services in the United States. The results indicate that school health services are administered predominantly by boards of education. Superintendents of schools prefer this administrative pattern in nearly 80% of the cities included in the survey. Among reasons given by superintendents of schools for recommending administration by the board of education are (1) efficiency and simplicity in single agency administration; (2) greater success in obtaining funds for school health services; (3) better understanding of the total school situation by the health service personnel; (4) more complete integration of health services and health education; (5) more emphasis placed on school health; and (6) larger and better service to school-age children.

ADMINISTRATIVE PATTERNS OF SCHOOL HEALTH SERVICES.

A survey of 230 cities in 50 states was taken to determine the present pattern of administration of school health services in the United States. The results indicate that school health services are administered predominantly by boards of education. Superintendents of schools prefer this administrative pattern in nearly 80% of the cities included in the survey. Among reasons given by superintendents of schools for recommending administration by the board of education are (1) efficiency and simplicity in single agency administration; (2) greater success in obtaining funds for school health services; (3) better understanding of the total school situation by the health service personnel; (4) more complete integration of health services and health education; (5) more emphasis placed on school health; and (6) larger and better service to school-age children.

Anticipating the Health Needs of Americans: Some Demographic Projections

Barring a major catastrophe, the health services will have to provide for massive population growth in the decades ahead. A reasonable forecast gives increases of 19 per cent for the present decade and 44 per cent for the period 1960-1980, with a corresponding increased need for medical services. This will be added to existing unfulfilled needs for the care of the aged and those suffering from chronic illness. The aged will continue to increase rapidly in number, but the largest absolute growth of population will be among children and, later, among young adults. Contrary to popular impres sions, the greatest percentage increase in future need for medical services may well be in the treatment of acute condi tions rather than chronic conditions more characteristic of the aged. Further, the general upward trend in social and eco nomic characteristics and expectations means an increased demand for all medical services over and above those arising from population change. There will be a much larger popu lation, better informed and better able to command improved medical services. Fortunately, demographic changes offer part of the solution as well as part of the problem. During the next decade, there will be a rapidly growing reservoir of young people from which to recruit nurses, doctors, and other health service personnel.