Increase In Health Expenditure Research Articles

Transfusion des personnes âgées : tenir compte de la fragilité

The conjunction of the demographic aging and the increase in the frequency of anemia with the advancing age, mean that the number of globular concentrates delivered each year increases with a consequent heavy pressure on blood collection. The etiologies of anemia in the elderly are often multifactorial and their investigation is an indispensable step and prior to any treatment. Transfusion thresholds, particularly in the elderly, are gradually evolving and a so-called restrictive strategy is now favored. Immediate and delayed complications of transfusion are more frequent in the elderly due to vulnerability factors associated with frailty and the risk of multiple transfusions. The screening of complications related to transfusion of RBCs is essential and makes it possible to avoid their recurrence. The impact of transfusion on the quality of life of elderly patients is not obvious and is a controversial issue. In addition, transfusion of red blood cells (RBCs) is accompanied by an increase in health expenditure and an increase in morbidity and mortality, whose risks can be reduced through alternatives to transfusion. Longitudinal studies, including elderly subjects, would allow a better understanding of the issues involved in the transfusion of RBCs in this population.

Economic growth and inflation rate: implications for municipal revenue and health expenditure of the municipalities of Pernambuco, Brazil.

This paper analyzes the implications of municipal budget revenue growth and the monetary policy's inflation rates goals in the availability of public health resources of municipalities. This is a descriptive, exploratory, quantitative, retrospective and longitudinal cross-sectional study covering the period 2002-2011. We analyzed health financing and expenditure variables in the municipalities of the state of Pernambuco, Brazil, describing the trend and the relationship between them. Data showed the growth of the variables and trend towards homogeneity. The exception was for the participation of Intergovernmental Transfers in the Total Health Expenditure of the Municipality. We found a significant correlation between Budget Revenue per capita and Health Expenditure per capita and a strong significant negative correlation between Inflation Rate, Budget Revenue per capita and Health Expenditure per capita. We concluded that increased health expenditure is due more to higher municipal tax revenue than to increased transfers that, in relative terms, did not increase. The strong inverse relationship between inflation rate and the Financing and Expenditure variables show that the monetary policy's inflation goals have restricted health financing to municipalities.

Dynamic linkages between sustainable tourism, energy, health and wealth: Evidence from top 80 international tourist destination cities in 37 countries

This study examines the relationship between sustainable tourism, energy, health, and wealth in a panel of 37 tourists’ induced countries that covered around top 80 international tourist destination cities. The panel Generalized Method of Moments (GMM) estimator is used to evaluate the dynamic linkages between the variables. The results show that inbound tourism has a positive relationship with energy demand, health expenditures, per capita income, FDI inflows, trade, and carbon dioxide (CO2) emissions while outbound tourism increases health expenditures. International tourism receipts and global financial crisis increases greenhouse gas (GHG) emissions and CO2 emissions respectively. Economic growth and trade openness both increases inbound tourism while FDI inflows increase tourism receipts. The study confirms Environmental Kuznets Curve (EKC) for CO2 emissions and GHG emissions, which eventually indicates that growth reduces the environmental impact of economic activity in the premises of international tourism indicators. The results further validate the tourism-led growth hypothesis in a panel of selected countries.

Aerobiological monitoring and mapping of Ambrosia plants in the province of Parma (northern Italy, southern Po valley), a useful tool for targeted preventive measures.

Ambrosia is an annual anemophilous weed producing allergenic pollen affecting public health in European countries. In Italy, the most infested region is Lombardy where, in some areas, it is the major cause of hay fever. In the Parma district, until 2007, Ambrosia seemed to be very rare, despite an observed increase of Seasonal Pollen Index (SPI), of pollen peak value and of asthma among ragweed sensitized patients. The aims of this study were to calculate ragweed pollen season and trends from 1996 to 2015, to assess the relationships between pollen season characteristics and selected meteorological data, to map plants in the territory and to evaluate the presence of beetle Ophraella communa (Ophraella), known as an eater of Ambrosia leaves. The following pollination parameters: start, end, duration, peak concentration date, peak values, SPI and the following climatic parameters: temperature, relative humidity, rainfall, were analyzed. The ragweed plants sites were mapped and the presence of Ophraella was assessed during naturalistic activities. Significant SPI and pollen peak value increase until 2011 were observed, but recently, 2012-2015 vs 2009-2011, a strong reduction (about 50%) of these parameters was observed. The spring average air temperature increased significantly. The results of the correlation analysis showed Ambrosia season characteristics significantly related. We identified the sites source of Ambrosia, even downtown at the confluence between Parma and Baganza rivers. Ophraella was observed for the first time in 2014. The results showed the spread of ragweed plants over the territory and the risk of allergy increase that ragweed could cause. It remains to evaluate the role of the Ophraella in the reduction of Ambrosia pollen concentration. It is important to consider the potential risk Ophraella may represent for sunflower and other taxonomically related crop plants and other native and exotic species. The lack of initiatives by the Health Authorities to prevent and to contrast the spread of Ambrosia in the Parma area could cause public health consequences and an increase in health expenditures.

Co-payments for general practitioners in Denmark: an analysis using two policy models

BackgroundThe increasing health expenditure for general practitioners (GPs) in Denmark requires that other ways of financing the health system are investigated. This study aims to analyse possibilities for implementing out-of-pocket payments to GPs in Denmark.MethodsThe study was conducted as a literature review with 11 articles included. The Health Policy Triangle and the Kingdon Model were used in analysing and discussing the implementation of a cost-sharing policy with an emphasis on the out-of-pocket payments method.ResultsThe Danish Parliament has expressed mixed opinions about out-of-pocket payments, whereas the Danish population, the GPs and the media are against introducing payments. The public debate and the fact that Danes are used to healthcare being free of charge both work against introducing co-payments. However, experiences from Sweden, Norway and OECD countries serve to promote implementation, but at the expense of decreased accessibility for the most vulnerable population groups.ConclusionsIntroducing out-of-pocket payments in Denmark may lead to decreased health expenditure, but also increased inequalities. Due to a lack of support from the relevant policy actors in the country, in addition to a lack of a policy window, it may not be possible to introduce out-of-pocket payments for GPs in Denmark in the short term.

Morbidity Pattern and Outcome of Swa-Prerit Adrash Gram Yojana Health Project Interventions among Rural Population, Gurugram, Haryana

Despite increasing health expenditures and unprecedented advances in modern medicine over the last century, people today in villages are not necessarily healthier. This mission of present project Swa-Prerit Adarsh Gram Yojna strives to upgrade the Basic Amenities to bring them at par with those in the Urban Areas and started for betterment of health. The main objective was to study the morbidity pattern and outcome of Swa-Prerit Adrash Gram Yojana Health Project intervention among rural population, Gurugram, Haryana. The project involved two phases; Phase 1-Collection of Basic data of health and socio-demographic variables by household survey of the village. Phase 2-Specific interventions regarding health problems eg. RCH, Immunization, Adolescent health, Reducing risk behavior were undertaken. The study was carried out in village Budhera, District Gurugram, Haryana from 01 Jan 2015 to 31 December 2016 using pre-tested schedule consisting of information on socioeconomic profile, type of living conditions, water supply, History of pregnant females within 24 months, any currently pregnant females, and immunization status of children, any chronic diseases or disabilities in the family. Analysis in gaps of health care was done specific interventions against the health disorders. Out of total 720 families, 584 families could be contacted. Total Population covered was 3838 of which 2044 were males. Sex ratio of study population was found to be 1000: 878. Majority of houses were pucca (74.5%), 84.3% houses had separate kitchen and 15% families used biomass/wooden fuel, 90.5% piped water supply, Sanitary latrines were installed in 97.6% houses. A total of 90 women had pregnancy in last 24 months. ANC registration 81%, TT coverage 98% and Iron Folic Acid Tablet (100 tablets) compliance 94%. The morbidities were studied. Specific interventions were undertaken to achieve 100% ANC registration, IFA Compliance, TT and complete Immunization from 93% to 100%. This is an integrated approach to health problems in rural health is an effort to delineate the health disorders and mitigate them by interventions.

The Impact of Health Expenditure on the Economic Growth in Sub-Saharan Africa

This paper examined the nexus between health care expenditure and economic growth in Sub-Saharan Africa over the period 1995-2014. We use the system General Method of Moments (GMM) technique to estimate the results. The findings reveal the existence of a positive and a statistically significant relationship between the two variables, precisely; health expenditure has a significant impact on the economic growth of the region. Regarding the control variables, while the effect of official development assistance on economic growth is insignificant, foreign direct investment, the active population and gross domestic savings appear as key determinants of economic growth in the region. Additionally, the results show that health care is a necessity rather than a luxury in Sub-Saharan Africa. It is therefore necessary to develop effective and efficient health care programs, increase health expenditure, make an effective use of the young population and create better environment for foreign direct investment in order to foster economic growth in Sub-Saharan Africa.

The effect of health care model on health systems' responses to economic crises

Motivation: The paper is concerned with relationships between model of health care and the responses of health systems to economic crises in OECD countries (1970–2013). The institutional arrangements are considered to affect the operation and performance of health systems in several ways; however, so far the topic has not been investigated in the economic crises context. Aim: This research attempts to bridge this gap by comparing the dynamics of health systems measures (male and female life expectancy; health expenditure; and doctors’ density) during years of recession with the average annual growth rate of the same measures for the countries clustered in four model groups. Results: The results show that the health care model applied is related with the systems’ responses to economic downturns. The Bismarck-type countries perform poorly in terms of health improvement and are incapable of containing costs during recessions. The Beveridge-type countries perform better in health improvement during stagnation; they also have effective cost-containment policies but they provide less security in terms of human resources for health than the Bismarck-type states. The market-oriented countries are in a superior position in health improvement when economies collapse; however, they fail to restrict health expenditure increase and to sustain the dynamics of doctors’ availability. The systems in transitions are characterized by a relatively low performance in female health improvement during recessions, a moderate situation in securing access to physicians and the greatest possibilities of containing costs. For the policymakers, the results imply that there is no universally superior model of health care organization.

Transplantation in Africa - an overview.

Africa is underdeveloped in terms of treatment options for patients with end-stage renal failure. Economic growth and corresponding increases in health expenditures in the African region mean that we can confidently anticipate increased demand for organ transplantation within the region over the next few years. Renal failure in Africa occurs mainly due to glomerular nephropathies, hypertension, diabetes, and HIV. For the subset of the population that might be considered medically suitable for transplantation, demand for transplantation is tightly constrained by the availability of specialist physicians and surgeons, pathology facilities, capacity to achieve acceptable graft outcomes, cultural and religious attitudes towards organ donation, trust in the health system, and the extent to which patients are able to meet the costs of surgery and ongoing immunosuppression. There are currently several countries in Africa which are building up living-related-donor transplantation. Active living-donor transplantation already takes place in South Africa, Tunisia, and Sudan, but deceased donation is only available in South Africa. Whereas living-donor transplantation might be successfully driven by a motivated individual and a single institution, deceased-donor transplantation requires dialysis programs, tissue typing and crossmatching facilities, an organ procurement program, an on-call surgical team, capacity to fund this infrastructure, and an appropriate legislative framework. A significant and recurring barrier to transplantation in the African region is the high cost of transplantation and follow-up care, and, in particular, the cost of maintenance immunosuppression. A positive environment that could potentially change this scenario will have to include governmental funding, academic support to clinicians as well as a legislative framework, which is still needed in many African countries.

Determinants of Attitude toward the Public Health Spending and Its Relationship with Voting Behavior in the 2012 South Korean Presidential Election.

This study aimed to identify the factors influencing South Korean voters’ attitudes towards increasing public expenditure on health and to identify whether the issue of healthcare expenditure influenced candidate choice in the 2012 Korean presidential election. The study used the data from a survey conducted by the Institute of Korean Politics at Seoul National University immediately following the 2012 presidential election. The survey was completed by a nationwide sample of 1,200 people aged 19 or over using a face-to-face interview method and proportional quota sampling based on sex, age, and region. About 44.3% of respondents had a positive attitude toward increasing public health expenditure. There was no significant difference by the candidate they supported (conservative Park Geun-hye or liberal Moon Jae-in). In particular, even 44.9% of conservative supporters agreed with more spending. Politically neutral respondents (OR = 1.76, 90% CI 1.22–2.54) and strong conservative party supporters (OR = 1.53, 90% CI 1.05–2.25) were more likely to support public health expenditure increase compared to strong liberal party supporters. Also, respondents who believed that the economic gap in the country was widening were 1.91 times more likely to support an increase in public health expenditures. However, the issue of health expenditure had no influence on voters’ choice of presidential candidates, and in particular no negative effect of choice of the ruling (conservative) party’s candidate. Our results should be interpreted with care; one possible reason for this lack of effect might be that constituents voted along partisan lines regardless of their attitude to the welfare issue; another possible explanation might be the success of the “left click strategy” of the conservative party. That is, the conservatives did not reject economic democratization or social welfare expansion. Further research should be done to explain why attitudes to health spending did not directly affect choice of candidate.

Subnational variation for care at birth in Tanzania: is this explained by place, people, money or drugs?

BackgroundTanzania achieved the Millennium Development Goal for child survival, yet made insufficient progress for maternal and neonatal survival and stillbirths, due to low coverage and quality of services for care at birth, with rural women left behind. Our study aimed to evaluate Tanzania’s subnational (regional-level) variations for rural care at birth outcomes, i.e., rural women giving birth in a facility and by Caesarean section (C-section), and associations with health systems inputs (financing, health workforce, facilities, and commodities), outputs (readiness and quality of care) and context (education and GDP).MethodsWe undertook correlation analyses of subnational-level associations between health system inputs, outputs, context, and rural care at birth outcomes; and constructed implementation readiness barometers using benchmarks for each health system input indicator. We used geographical information system (GIS) mapping to visualise subnational variations in care at birth for rural women, with a focus on service availability and readiness, and collected qualitative data to investigate financial flows from national to council level to understand variation in financing inputs.ResultsWe found wide subnational variation for rural care at birth outcomes, health systems inputs, and contextual indicators. There was a positive association between rural women giving birth in a facility and by C-section; maternal education; workforce and facility density; and quality of care. There was a negative association between these outcomes and proportion of all births to rural women, total fertility rate, and availability of essential commodities at facilities. Per capita recurrent expenditure was positively associated with facility births (correlation coefficient = 0.43; p = 0.05) but not with C-section. Qualitative results showed that the health financing system is complex and insufficient for providing care at birth services. Bottlenecks for care at birth included low density of health workers, poor availability of essential commodities, and low health financing in Lake and Western Zones.ConclusionsNo region meets the benchmarks for the four health systems building blocks including health finance, health workforce, health facilities, and commodities. Strategies for addressing health system inequities, including overall increases in health expenditure, are needed in rural populations and areas of highest unmet need for family planning to improve coverage of care at birth for rural women in Tanzania.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3404-3) contains supplementary material, which is available to authorised users.

The U.S. health care expenditure: evidence from 2001 to 2009

ABSTRACTThis study utilizes state-level data from 2001 to 2009 to estimate the impact of the 2007 financial crisis upon health care expenditures. Higher death rates are consistently found to have a positive and statistically significant impact on health expenditures. While mental health and COPD are not generally found to impact expenditures, increases in the percentage of the population diagnosed with cholesterol and obesity tend to increase health expenditures. Increases in health expenditures slowed considerably after the financial crisis. Even though recessions (high unemployment rates) are generally found to have a positive impact on health expenditures, the post-financial crisis time period is estimated to have much lower health expenditures than in other time periods. Our results can be used to give insight into the conditions under which the slower rate of increase in health expenditures can be expected to increase. More research will be needed to be able to more completely explore not only the reasons for these changes in health expenditures but also whether they are likely to continue into the future.

Prevention of the Post-Thrombotic Syndrome.

Post-thrombotic syndrome frequently affects patients following deep vein thrombosis. The clinical signs and symptoms of post-thrombotic syndrome reflect the underlying pathophysiology of venous obstruction, venous reflux as well as acute and chronic inflammation. Patients with post-thrombotic syndrome are at risk for long-term consequences including decreased quality of life, lost work productivity, and increased health expenditures. Unfortunately, despite recognition of pathophysiology and the clinical, physical, and economic impact of PTS, there have been few advances in prevention. PTS continues to be a frustrating condition to both prevent and manage. Preventing post-thrombotic syndrome begins with preventing deep vein thrombosis. In the setting of acute deep vein thrombosis-using available medical therapies to prevent the development of post-thrombotic syndrome is imperative. Patients should be provided optimal medical therapy with anticoagulation, maintaining therapeutic anticoagulation as much of the time as possible. Use of compression stockings, while contentious, are a low risk intervention which may provide benefit and are unlikely to be associated with harm. In the appropriate patient, considering endovenous procedures to decrease the thrombus burden and provide optimal preservation of venous valve function may be warranted.

Medicine and democracy: The importance of institutional quality in the relationship between health expenditure and health outcomes in the MENA region

Evidence suggests that the effect of health expenditure on health outcomes is highly context-specific and may be driven by other factors. We construct a panel dataset of 18 countries from the Middle East and North Africa region for the period 1995–2012. Panel data models are used to estimate the macro-level determinants of health outcomes. The core finding of the paper is that increasing health expenditure leads to health outcomes improvements only to the extent that the quality of institutions within a country is sufficiently high. The sensitivity of the results is assessed using various measures of health outcomes as well as institutional variables. Overall, it appears that increasing health care expenditure in the MENA region is a necessary but not sufficient condition for health outcomes improvements.

A Panel Study on Financial Burden and Spending of Health Expenditure of the Elderly Households : Focusing on Age groups

Korea experiences rapid population aging and increase in health expenditure. The elderly made up a record 13.1% of the total population and 37.8% of the total health spending in 2015. And this would be accelerated because the baby boomers are becoming 65 years old and more by 2020. Catastrophic Health Expenditure(CHE) is the index which can represents the households’ burden of health spending. Despite its importance, there has been few studies about CHE of the elderly households and especially no panel study yet. Therefore, this study is carried out. The study used 3-year data from the Korea Welfare Panel Study conducted from 2012 to 2014. We defined CHE if a household’s health expenditure is equal or greater than the threshold value if income remaining after subsistence needs has been met. We used 3 different threshold values which are 10%, 20% and 30%. In order to look at the elderly households which experienced CHE in depth, correspondence analysis and panel logit analysis were conducted. Also, based on the Two-part Model, Panel analysis was conducted in order to define the factors that affect the households which experienced CHE at 10% threshold level to spend health expenditure. This study showed two notable results. First, there has been a difference in CHE occurrence rates among 3 different age groups, which implies that the older people are, the more easily they can experience CHE. Secondly, the households with no private insurance are showed to have a higher CHE occurrence rate, showing that private insurance does not make a significant difference in health spendings. With the results, private insurance can play its role in protecting households from CHE as a supplement of national health insurance. Therefore, this study can be used as evidence to develop healthcare policy for the elderly. Also, it needs to conduct studies on CHE especially about different age groups.

Appropriateness of Proton Pump Inhibitor prescription in patients admitted to hospital: Attitudes of general practitioners and hospital physicians in Italy

IntroductionProton pump inhibitor (PPI) prescriptions have raised concern for both huge increase of health expenditure and possible long-term adverse effects. ObjectiveTo evaluate appropriateness of PPI prescription in ambulatory and hospital care. DesignObservational cohort study. PatientsPatients admitted to the Internal Medicine Unit of Bologna S. Orsola Hospital between 15/09/2013 and 15/12/2013. Data on clinical condition and drug therapy were collected at three time points: admission (reflecting GP's prescription), hospital stay and discharge. Main measuresAppropriateness of PPI use was evaluated as follows: (1) agreement between PPI use/non-use and appropriate clinical condition; (2) in PPI users, assessment of Medication Appropriateness Index (MAI). Differences in appropriateness among time points were analyzed by chi-square test. Logistic regression model was used to identify possible determinants of PPI appropriateness. Key resultsAmong 280 patients, 56% received PPI at least once in the three time points. Appropriateness, according to indication of use, was similar between admission and hospital stay (61% vs. 62%; p=0.82) and between hospital stay and discharge (62% vs. 59%; p=0.94). MAI score showed important, although statistically non-significant, change in appropriateness between admission and hospital stay (20% vs. 28%; p=0.16). Age≥65 was always associated with appropriate PPI use (up to OR=4.37; p<0.01), whereas cardiovascular comorbidity and conditions requiring analgesic treatment influenced appropriateness only at admission (OR=3.84; p<0.01 and OR=0.34; p<0.01, respectively). ConclusionsHospital clinicians only rarely reconsidered GP's choice to prescribe PPI. Room for improvement in PPI appropriateness is represented by (1) assessing gastrointestinal risk in each patient under analgesics and anti-inflammatory drugs, and (2) short-term re-evaluation of PPI prescription after discharge.

Healthcare expenditures growth: the red herring of demographic ageing?

Demographic ageing is often deemed responsible for the massive increase in health expenditures experienced by developed countries. As the elderly consume more medical care than the rest of the population, how could the increase in the share of the 60 + not lead to a marked expansion of healthcare public and private budgets? Despite its apparent logics, such reasoning is fallacious: it ignores that medical care consumption depends on many factors beyond age, which have tremendously evolved in the last decades and may change again in the future. Based on French stylized facts, this article provides an overview of the international literature that aimed at disentangling the respective roles of population ageing and of the non-demographic factors in explaining the dynamics of health expenditures. Paradoxically, technical medical progress has been a major contributor to the increase of healthcare spending. Results from economics research lead to qualify the impact of demographic trends and call for more attention to the public policies decisions that shape healthcare systems.

Exploring the influence of context and policy on health district productivity in Cambodia.

BackgroundCambodia has been reconstructing its economy and health sector since the end of conflict in the 1990s. There have been gains in life expectancy and increased health expenditure, but Cambodia still lags behind neighbours One factor which may contribute is the efficiency of public health services. This article aims to understand variations in efficiency and the extent to which changes in efficiency are associated with key health policies that have been introduced to strengthen access to health services over the past decade.MethodsThe analysis makes use of data envelopment analysis (DEA) to measure relative efficiency and changes in productivity and regression analysis to assess the association with the implementation of health policies. Data on 28 operational districts were obtained for 2008–11, focussing on the five provinces selected to represent a range of conditions in Cambodia. DEA was used to calculate efficiency scores assuming constant and variable returns to scale and Malmquist indices to measure productivity changes over time. This analysis was combined with qualitative findings from 17 key informant interviews and 19 in-depth interviews with managers and staff in the same provinces.ResultsThe DEA results suggest great variation in the efficiency scores and trends of scores of public health services in the five provinces. Starting points were significantly different, but three of the five provinces have improved efficiency considerably over the period. Higher efficiency is associated with more densely populated areas. Areas with health equity funds in Special Operating Agency (SOA) and non-SOA areas are associated with higher efficiency. The same effect is not found in areas only operating voucher schemes. We find that the efficiency score increased by 0.12 the year any of the policies was introduced.ConclusionsThis is the first study published on health district productivity in Cambodia. It is one of the few studies in the region to consider the impact of health policy changes on health sector efficiency. The results suggest that the recent health financing reforms have been effective, singly and in combination. This analysis could be extended nationwide and used for targeting of new initiatives. The finding of an association between recent policy interventions and improved productivity of public health services is relevant for other countries planning similar health sector reforms.Electronic supplementary materialThe online version of this article (doi:10.1186/s12962-016-0051-6) contains supplementary material, which is available to authorized users.

Factors associated with declining under-five mortality rates from 2000 to 2013: an ecological analysis of 46 African countries

ObjectiveInadequate overall progress has been made towards the 4th Millennium Development Goal of reducing under-five mortality rates by two-thirds between 1990 and 2015. Progress has been variable across African countries....

Should the Lambda (λ) Remain Silent?

When making decisions regarding the funding of new health technologies (e.g. pharmaceuticals), a key consideration should be the opportunity cost associated with a positive funding decision in terms of other patients’ health. Lambda (k) is a term that has been used to refer to a maximum acceptable value (cost-effectiveness threshold) for the incremental cost-effectiveness ratio (ICER) of a new technology, which should reflect the opportunity cost of funding decisions. In 2006, Gafni and Birch [1] discussed the ‘silence of the k’ with respect to the justification of its numerical value within the decision-making process. They noted that the use of threshold values, which do not represent the true opportunity cost of new and generally more expensive technologies, can lead to increased health expenditures with little evidence of increases in population health. In this commentary, we interpret the ‘silence of the k0 with respect to the lack of explicit recognition of the use of a cost-effectiveness threshold by national funding bodies that use the threshold in the decision-making process. We also discuss the potential impact of this silence on health systems. As an example, the Australian Pharmaceutical Benefits Advisory Committee (PBAC) makes recommendations regarding the public funding of pharmaceuticals, on the basis of clinical effectiveness, safety and cost effectiveness (value for money). No official statement has ever been made about the use of a cost-effectiveness threshold to determine whether a pharmaceutical provides value for money. Although our focus is on the Australian PBAC decisionmaking process, the discussion can be applied more widely—first, to many other national funding bodies that use economic evaluation to inform funding decisions but do not explicitly acknowledge the use of a threshold, e.g. the Medical Services Advisory Committee in Australia (MSAC) or the Canadian Agency for Drugs and Technologies in Health, and second, to any collectively funded health system that fails to consider the opportunity costs of its decisions.