Investment In Health Sector Research Articles

Overcoming the constraints of competitive clientelism? Explaining the success of Ghana's poorest region in reducing maternal mortality.

Maternal mortality remains a health challenge that many developing countries struggle to address. Drawing on 64 key informant interviews, this article shows how Ghana's most impoverished administrative region, the Upper East, emerged as a bureaucratic 'pocket of effectiveness' in reducing maternal mortality in a context where national political settlement dynamics are undermining progress in improving maternal health. At the national level, Ghana's progress in reducing maternal mortality has been disappointing because public investments are disproportionately directed to reforms that contribute to the short-term political survival of ruling elites. Competitive electoral pressures have contributed to greater elite commitment towards health sector investments with visual impact, while weakening elite incentives for dedicating resources to interventions that are necessary for enhancing the quality of health. The relatively better performance of the Upper East Region in reducing maternal mortality has been driven by a hybrid form of accountability that combines top-down pressures from the regional health directorate with horizontal forms of accountability that result in a competitive spirit among health workers. These findings show that even in contexts where resources are limited, the capacity of sub-national leaders in devising local solutions to local problems can lead to improved performance of health systems at the sub-national level. The findings also suggest the need for academic debates to go beyond the binary distinctions regarding the usefulness of top-down versus bottom-up accountability measures and focus on building effective and legitimate forms of accountability that run both top-down and bottom-up when seeking to improve health service delivery.

Оценки потребности в оборотном капитале при инвестициях в развитие здравоохранения

The spread of medical technologies underpins the transition to the next global economic mode and requires large-scale investments in health sector. To substantiate them, certain methods of making investment decisions which corresponds to a new stage of scientific and technological development are required. This paper proposes the methods of investment projects evaluation based on the cost and benefit analysis, that measures both costs and benefits in monetary terms, taking into account these approaches. On the one hand, economic (public) efficiency is determined with the social effects along with other public effects being highlighted. On the other hand, financial (commercial) efficiency is calculated with a detailed presentation of investment in working capital and terminal value. In applied project analysis, working capital is either not taken into account, or simplified methods are preferred. The paper focuses on the issues of modeling investments in the growth of net working capital. A comparative analysis of working capital modeling methods in the financial models of various international organizations (UNIDO, World Bank, Asian Development Bank) and official Russian methods is carried out. Also, the author's modified method for calculating investments in working capital based on separate financial turnover and liquidity ratios is proposed, which allows taking into account industry specifics of health projects. The system of the proposed methods was tested on the example of a real project of the construction of seven urban outpatient hospitals in Novosibirsk. The results of the financial analysis with three options of working capital accounting and the economic analysis with the presentation of social, tax and redistributive effects of working capital clearly show the impact of assessing working capital requirement on the results of not only financial, but also economic efficiency, including the efficiency of participation in the project. In the frame of the economic analysis, substantial social effects for patients of new outpatient hospitals and other residents of the Novosibirsk Region were highlighted, while in the frame of financial analysis, significant effects of working capital and terminal cost for direct project participants were identified.

Equity in the public social healthcare protection in Tanzania: does it matter on household healthcare financing?

Efforts to promote equity in healthcare involve implementing policies and programs that address the root causes of healthcare disparities and promote equal access to care. One such program is the public social healthcare protection schemes. However, like many other developing countries, Tanzania has low health insurance coverage, hindering its efforts to achieve universal health coverage. This study examines the role of equity in public social healthcare protection and its effects on household healthcare financing in Tanzania. The study used secondary data collected from the National Bureau of Statistics' National Panel Survey 2020/21 and stratified households based on their place of residence (rural vs. urban). Moreover, the logit regression model, ordered logit, and the endogenous switching regression model were used to provide counterfactual estimates without selection bias and endogeneity problems. The results showed greater variations in social health protection across rural and urban households, increasing disparities in health outcomes between these areas. Rural residents are the most vulnerable groups. Furthermore, education, income, and direct healthcare costs significantly influence equity in healthcare financing and the ability of households to benefit from public social healthcare protection schemes. To achieve equity in healthcare in rural and urban areas, developing countries need to increase investment in health sector by reducing the cost of healthcare, which will significantly reduce household healthcare financing. Furthermore, the study recommends that social health protection is an essential strategy for improving fair access to quality healthcare by removing differences across households and promoting equality in utilizing healthcare services.

Global Location Selection for an Oral Health Center with a Sequential Method by SWARA&TODIM

The first step to take when a healthcare facility investment is planned is to choose the most appropriate facility location. This important selection process is a planning process that takes into account economic, ecological and environmental effects, and it is necessary for managers who are decision-makers at the establishment stage to carry out the settlement planning of their organizations using analytical methods. In this study, Stepwise Weight Assessment Ratio Analysis (SWARA) and Interative Multi-criteria Decision Making (TODIM) methods with a help of Weighted Aggregated Sum Product Assessment (WASPAS) step, which are among the multi-criteria decision-making techniques, have been applied to the solution of the location selection problem, which can be considered as the first step of health sector investments for an international dental clinic. Within the scope of the study, a multi-criteria decision-making model consisting of 4 main criteria, 17 sub-criteria and 6 alternative countries has been proposed. Alternative countries including Germany, Spain, Netherlands, England, Ireland, and Belgium were evaluated on the basis of criteria gathered under the headings of country structure, demographic structure of the country, cost and risk. By solving the proposed model with the proposed sequential method, Germany was found to be the most suitable location for such a dental health center investment.

Conceptualizing monetary benchmarks for health investments toward poverty reduction in low- and lower middle-income countries.

Public spending can improve population well-being, for example, by averting or reducing poverty. We aim to conceptualize monetary benchmarks for health sector investments oriented towards poverty alleviation in low- and lower middle-income countries. These benchmarks are meant to indicate the approximate range of health sector costs incurred to avert a single case of poverty across countries. Such conceptualizations could help identify the health interventions that are worthwhile investing in from financial risk protection and social welfare standpoints. We sourced secondary data from the World Bank for low-income and lower-middle-income countries over 2002-2019, including: per capita government expenditures on health, the proportion of a country's population living under the international poverty line ($1.90 per day, 2011 Purchasing Power Parity), and the features of national social protection programs whose primary intent is poverty reduction. We then examined the associations between poverty headcount and per capita government health spending to gauge the potential relationship between this spending and poverty reduction. Subsequently, we derived a range of plausible poverty reduction benchmarks (PRBs). We also computed the per capita costs of national poverty reduction programs so as to contrast these with the estimated range of PRBs. Priority setting in low- and lower-middle-income countries could be informed by health-sector PRBs, in addition to burden of disease and cost-effectiveness considerations. The computed PRBs, expressed in dollars per poverty case averted, can possibly be viewed in a manner akin to economic evaluation thresholds which are usually expressed in dollars per disability-adjusted life year averted.

Determinants of rural-urban differential in healthcare utilization among the elderly population in India

BackgroundPopulation aging poses a demographic burden on a country such as India with inadequate social security systems and very low public investment in health sector. This challenge of accelerated demographic transition is coupled by the rural-urban disparity in access to healthcare services among the elderly people in India. An important objective of India’s National Health Policy (2017) is to “progressively achieve universal health coverage” which is posited upon mitigating the sub-national disparity that necessitates identifying the drivers of the disparity for targeted policy intervention. This study, therefore, makes an attempt towards the exploration of the prominent contributory factors behind the rural-urban gap in utilisation of healthcare among the older population in India.MethodsThe analysis has been done by using the unit level data of Social Consumption: Health (Schedule number 25.0) of the 75th round of the National sample Survey conducted during July 2017–June 2018. Two binary logistic models have been proposed to capture the crude and the adjusted association between health seeking behaviour and place of residence (rural/ urban). To compute the group differences (between rural and urban) in the rate of healthcare utilization among the elderly population in India and to decompose these differences into the major contributing factors, Fairlie’s decomposition method has been employed.ResultsThe logistic regression models established a strong association between place of residence and likelihood of healthcare utilisation among the Indian elderly people. The results of the Fairlie’s decomposition analysis revealed considerable rural-urban inequality disfavouring the rural residents and health care utilisation was found to be 7 percentage points higher among the older population residing in urban India than their rural counterparts. Level of education and economic status, both of which are indicators of a person’s Socio-Economic Status, were the two major determinants of the existing rural-urban differential in healthcare utilisation, together explaining 41% of the existing rural-urban differential.ConclusionPublic health care provisions need to be strengthened both in terms of quality and outreach by way of greater public investments in the health sector and by building advanced health infrastructure in the rural areas. Implementation of poverty alleviation programmes and ensuring social-security of the elderly are also indispensable in bringing about equity in healthcare utilisation.

The relation between length of lockdown, numbers of infected people and deaths of Covid-19, and economic growth of countries: Lessons learned to cope with future pandemics similar to Covid-19 and to constrain the deterioration of economic system

How is the relation between duration of lockdown and numbers of infected people and deaths of Coronavirus disease 2019 (COVID-19), and growth level of Gross Domestic Product (GDP) in countries? Results here suggest that, during the first wave of COVID-19 pandemic, countries with a shorter period of lockdown (about 15 days: Austria, Portugal and Sweden) have average confirmed cases divided by population higher than countries with a longer period of lockdown (about 60 days, i.e., 2 months: France, Italy and Spain); moreover, countries with a shorter period of lockdown have average fatality rate (5.45%) lower than countries with a longer length of lockdown (12.70%), whereas average variation of fatality rate from March to August 2020 (first pandemic wave of COVID-19) suggests a higher reduction in countries with a longer period of lockdown than countries with a shorter duration (−1.9% vs. −0.72%). Independent Samples Test reveals that average fatality rate of countries with a shorter period of lockdown was significantly lower than countries with a longer period of lockdown (5.4% vs. 12.7%, p-value<.05). The Mann-Whitney Test confirms that average fatality rate of countries with a shorter period of lockdown is significantly lower than countries having a longer period of lockdown (U = 0, p-value = .005). In addition, results show that lockdowns of longer duration have generated negative effects on GDP growth: average contraction of GDP (index 2010 = 100) from second quarter 2019 to second quarter of 2020 in countries applying a longer period of lockdown (i.e., about two months) is about −21%, whereas it is −13% in countries applying a shorter period of lockdown of about 15 days (significant difference with Independent Samples Test: t4 = −2.274, p-value < .085). This finding shows a systematic deterioration of economic system because of containment policies based on a longer duration of lockdown in society. Another novel finding here reveals that countries with higher investments in healthcare (as percentage of GDP) have alleviated fatality rate of COVID-19 and simultaneously have applied a shorter period of lockdown, reducing negative effects on economic system in terms of contraction of economic growth. Overall, then, using lessons learned of the first wave of COVID-19 pandemic crisis, this study must conclude that a strategy to reduce the negative impact of future epidemics similar to COVID-19 has to be based on a reinforcement of healthcare sector to have efficient health organizations to cope with pandemics of new viral agents by minimizing fatality rates; finally, high investments in health sector create the social conditions to apply lockdowns of short run with lower negative effects on socioeconomic systems.

A Study Comparing Cost-Effectiveness of Combination Therapy for Preventing Opportunistic Infections Among Human Immunodeficiency Virus–Infected Adults on Antiretroviral Therapy

ObjectivesIndia is going through an epidemiologic and demographic transition made possible by increased investment in health sector and sustained development. The country has more than 2 million people infected with human immunodeficiency virus (HIV). Information on cost-effectiveness of competing interventions is a useful contributor to decisions concerning allocation and prioritization of healthcare resources. This paper aims to study the cost, health outcomes as measured by disability-adjusted life-years (DALYs), and cost-effectiveness per DALY averted of prophylaxis for tuberculosis, diarrhea, and mouth ulcers in HIV-infected adults. MethodsData were analyzed on 375 HIV-infected persons enrolled at the ART Centre in New Delhi between April 2004 and April 2006. Using estimates of the age of onset of HIV infection, cost of medicines, and antiretroviral regimen followed, we used standard methods to calculate the cost per DALY as a measure of cost-effectiveness. Sensitivity analysis was conducted to determine the robustness of cost-effectiveness results by making reasonable changes in underlying assumptions. ResultsThe results revealed that the incremental cost-effectiveness ratio for tuberculosis prophylaxis was ₹4821.48 ($78.86) per DALY averted compared with no prophylaxis, followed by diarrhea (₹8299.08, $135.74) and mouth ulcers (₹20 058.14, $328.07). ConclusionsThe estimates are less than the per capita gross domestic product of India, indicating that the current treatments are highly cost-effective. This will help policymakers understand the best opportunities to improve population health and help researchers to develop more standardized methods in the area, thus improving quality and comparability across cost per DALY studies.

Lessons Learned from COVID-19 Pandemic Crisis to Reduce Mortality of Future Infectious Diseases in Society

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the strain of novel coronavirus that causes Coronavirus disease 2019 (COVID-19) that generates high number of infected cases and deaths worldwide. The fundamental question in this field of research is how countries can reduce fatality rates of COVID-19. This study confronts this question here by developing the first global analysis (based on more than 160 countries), which endeavors to analyze the socioeconomic sources of the reduction of mortality rates of COVID-19 in society. Results suggest that a low average fatality rate of COVID-19 is associated with countries having high level of current health expenditure expressed as a percentage of GDP, high domestic general government health expenditure per capita and a reduced exposure of population to days exceeding safe levels of particulate matter (PM2.5). These findings are important, very important to support an effective strategy to cope with future epidemics similar to COVID-19 that has to be based on high investments in health sector and environmental policy that reduces air pollution in order to be able to minimize fatality rates of future infectious diseases.

Lifestyle Acquired Immunity, Decentralized Intelligent Infrastructures, and Revised Healthcare Expenditures May Limit Pandemic Catastrophe: A Lesson From COVID-19.

Throughout history, the human race has often faced pandemics with substantial numbers of fatalities. As the COVID-19 pandemic has now affected the whole planet, even countries with moderate to strong healthcare support and expenditure have struggled to contain disease transmission and casualties. Countries affected by COVID-19 have different demographics, socioeconomic, and lifestyle health indicators. In this context, it is important to find out to what extent these parametric variations are modulating disease outcomes. To answer this, this study selected demographic, socioeconomic, and health indicators e.g., population density, percentage of the urban population, median age, health expenditure per capita, obesity, diabetes prevalence, alcohol intake, tobacco use, case fatality of non-communicable diseases (NCDs) as independent variables. Countries were grouped according to these variables and influence on dependent variables e.g., COVID-19 positive tests, case fatality, and case recovery rates were statistically analyzed. The results suggested that countries with variable median age had a significantly different outcome on positive test rate (P < 0.01). Both the median age (P = 0.0397) and health expenditure per capita (P = 0.0041) showed a positive relation with case recovery. An increasing number of tests per 100 K of the population showed a positive and negative relationship with the number of positives per 100 K population (P = 0.0001) and the percentage of positive tests (P < 0.0001), respectively. Alcohol intake per capita in liter (P = 0.0046), diabetes prevalence (P = 0.0389), and NCDs mortalities (P = 0.0477) also showed a statistical relation to the case fatality rate. Further analysis revealed that countries with high healthcare expenditure along with high median age and increased urban population showed more case fatality but also had a better recovery rate. Investment in the health sector alone is insufficient in controlling the severity of the pandemic. Intelligent and sustainable healthcare both in urban and rural settings and healthy lifestyle acquired immunity may reduce disease transmission and comorbidity induced fatalities, respectively.

Addressing the Cost Data Gap for Universal Healthcare Coverage in India: A Call to Action

The Indian health system is undergoing significant reform toward more evidence-informed and inclusive health policy as the country strives toward the achievement of Universal Health Coverage for its 1.3 billion population. Cost information plays a key role in the evidence arsenal of Universal Health Coverage–oriented policy by informing decisions such as the setting reimbursement rates for government-sponsored health insurance packages of care, strategic purchasing of health services, and in prioritizing available resources to maximize value of health sector investments. However, extensive and quality health facility cost data in India are limited. As a result, there is an increasing and urgent need to generate and disseminate healthcare cost information. This article discusses the need for cost information and the current initiatives that are progressing this agenda. The first is a national cost database and website hosting cost data collected from 200 public sector facilities across 6 Indian states at each level of the care delivery system by a consortium of health research institutes. This database is the first of its kind in India and will serve as a central resource for researchers and decision-makers for information on healthcare costs. The second is a nationwide costing study of healthcare at both private and public facilities. By improving the availability of cost data in India, raising its profile and demonstrating its utility, it is hoped that the database and new costing efforts will lead to greater recognition of the importance of good quality data to inform health policy and enable more evidence-informed decision-making.

Economics of COVID-19: challenges and the way forward for health policy during and after the pandemic.

The emergence of novel coronavirus disease 2019 (COVID-19) pandemic provides unique challenges for health system. While on the one hand, the government has to struggle with the strategies for control of COVID-19, on the other hand, other routine health services also need to be managed. Second, the infrastructure needs to be augmented to meet the potential epidemic surge of cases. Third, economic welfare and household income need to be guaranteed. All of these have complicated the routine ways in which the governments have dealt with various trade-offs to determine the health and public policies. In this paper, we outline key economic principles for the government to consider for policymaking, during, and after the COVID-19 pandemic. The pandemic rightfully places long due attention of policymakers for investing in health sector. The policy entrepreneurs and public health community should not miss this once-in-a-lifetime "policy window" to raise the level of advocacy for appropriate investment in health sector.

Public Health Expenditures and Health Outcomes: New Evidence from Ghana

The effect of government spending on population’s health has received attention over the past decades. This study re-examines the link between government health expenditures and health outcomes to establish whether government intervention in the health sector improves outcomes. The study uses annual data for the period 1980–2014 on Ghana. The ordinary least squares (OLS) and the two-stage least squares (2SLS) estimators are employed for analyses; the regression estimates are then used to conduct cost-effectiveness analysis. The results show that, aside from income, public health expenditure contributed to the improvements in health outcomes in Ghana for the period. We find that, overall, increasing public health expenditure by 10% averts 0.102–4.4 infant and under-five deaths in every 1000 live births while increasing life expectancy at birth by 0.77–47 days in a year. For each health outcome indicator, the effect of income dominates that of public spending. The cost per childhood mortality averted ranged from US$0.20 to US$16, whereas the cost per extra life year gained ranged from US$7 to US$593.33 (2005 US$) during the period. Although the health effect of income outweighs that of public health spending, high (and rising) income inequality makes government intervention necessary. In this respect, development policy should consider raising health sector investment inter alia to improve health conditions.

Can Economic Openness Improve the Health Status of Bangladesh Economy: An Empirical Analysis

Economic openness especially in developing countries like Bangladesh greatly contributes to an increase in the country’s welfare through the increase in standards of living, education, as well as health status. Through globalization, the positive effects of health is prominent as access to health technologies are readily made available which can go a long way to increase life expectancy as well as reduce infant mortality rates. This research paper empirically examines the cointegration and causal relationship between economic openness and health status of Bangladesh economy by using annual data from 1980 to 2014. As the economy becomes more open, investments in health sector also increases which facilitate improvements in health. To further explore this relationship, Augmented Dickey Fuller (ADF) test has been used to check if the variables are stationary. The Johansen cointegration method has also been used in order to check the robustness of the relationship among the variables. Vector Error Correction Model (VECM) has been estimated in order to determine the short-run dynamics of this behavior followed by the Granger causality test. The results reveal that long-run bidirectional causality runs from economic openness to health and vice versa, which provides support that rise in economic openness is both a cause and a consequence of increased health status of Bangladesh.

Health Care Expenditure in Nigeria and National Productivity: A Review

National productivity of any nation is a function of the health of such nation which is usually an offshoot of how much such nation invests into the health care system. This paper assesses the health care expenditure of Nigeria and resultant effects on the national productivity. An overview of literature shows that health care expenditure in Nigeria is very poor and low compared to other developing nations even in Africa. The little money that is made available is invested majorly in the curative aspect of health care as against preventive health care that promotes national productivity. This paper suggests that to achieve the much needed improvement in national productivity, special attention must be paid to increasing national investment in health sector especially in primary prevention.

The Political Economy of Maternal Healthcare in Ghana

Despite substantial improvements in access to health services in Ghana during the last two decades, there has been limited progress in improving maternal health, and the country as a whole was unable to meet the Millennium Development Goal (MDG 5) in relation to maternal mortality. However, some administrative regions have made significant progress, with the Upper East, one of Ghana’s most impoverished regions, surprisingly recording the most dramatic progress in the reduction of maternal mortality during the last decade. This paper explains Ghana’s limited progress in reducing maternal mortality as a product of the country’s ‘political settlement’, in which ruling elites are characterized by a perennial threat of losing power to other powerful excluded elites in tightly fought elections, incentivising those in power to direct public investments to policy measures that contribute to their short-term political survival. Competitive clientelist political pressures have contributed to greater elite commitment towards health sector investments with visual impact, while weakening elite incentives for dedicating sufficient public resources and providing consistent oversight over other essential, but less visible, interventions that are necessary for enhancing the quality of maternal health. In the absence of systemwide drivers of improved performance, sub-national variations in the quality of maternal health services are strongly shaped by the capacity and commitment of regional and district health authorities in enforcing human resource management norms within the Ghanaian health sector, thus ensuring the accountability of health workers. In the largely impoverished Upper East Region, incentives for health workers’ performance are particularly driven by a hybrid form of accountability that combines top-down pressures from the Regional Health Directorate with horizontal forms of accountability among various health facilities.

Nutrition, Health and Economic Development Nexus in Sub‐Saharan Africa: Evidence from Vector Auto Regression Models

BackgroundAdequate child nutrition in Sub‐Saharan Africa (SSA) is critical as malnutrition is responsible for a significant proportion of child mortalities and ill‐health. Also, ensuring optimal maternal health in this region is necessary due to alarming rates of mortality among women and consequent effects on child health. It has been observed that economic development results in improved health and nutrition through advances in the field of medicine, reduction in mortality rates and increase in life expectancy. Adequate child nutrition and optimum maternal and child health have the potential to positively impact economic development. The majority of research has focused on the impact of economic development on child nutrition and maternal and child health; but studies rarely examine the reverse relationship of the impact of child nutrition and child and maternal health on economic development in SSA.MethodsWe examined the bi‐directional relationship of economic growth and child nutrition and maternal/child health at different income brackets and, given such relationships, estimated the direction and magnitude. Six SSA countries were grouped according to income brackets. We then employed the Toda–Yamamoto Approach to Granger Causality which takes into consideration lag effects. We forecasted quantitatively the impact of child nutrition/health and maternal health on economic development using variance decomposition, based on annual time‐series data from the World Bank's WDI, 1960–2012.ResultsWe found no significant relationship between gross domestic product (GDP) per capita and child nutrition/health in low income countries (LIC) except in lower middle income countries (LMIC) and upper middle income countries (UMIC). In general, causality ran from child health/nutrition to GDP per capita in LMIC and UMIC. This suggests a causal effect of GDP per capita on child health/nutrition in LMIC and UMIC. In all LIC, there was evidence of causality effect of maternal education on child nutrition/health. Generally, we noted causality relationships between female life expectancy and education for all countries. Directionality results between maternal health and GDP per capita were mixed across countries. The effect of child health/nutrition to GDP per capita was generally higher than the contribution of GDP per capita to child health/nutrition at a 10‐year horizon, but the contribution of maternal health to GDP per capita was higher than the contribution of GDP per capita at a 10‐year horizon for only LMIC and UMIC.ConclusionsImproved child nutrition and maternal health may have substantial benefits on long term economic growth in SSA. The education of women is an important factor for optimum child nutrition, maternal and child health. Policies for long term economic growth should aim at investing in child nutrition, raising health sector investment especially towards women's health and strengthening the educational system of SSA countries, especially for girls.Support or Funding InformationNA

"Take in two parks and call me in the morning" - Perception of parks as an essential component of our healthcare system.

As a feature of the built neighborhood environment, parks have been associated with a range of positive health outcomes. Recognition of these contributions has prompted advocates to suggest parks are a part of our healthcare system. Despite these developments, park investments have declined over the past decade nationally, lagging behind expenditures on other community services such as health. Perhaps the idea of parks as a solution to the nation's health concerns has not diffused across the population. To date, however, public perception of parks' role in healthcare has not been documented. This study responds to this gap by assessing whether parks are perceived as an essential part of the healthcare system. Self-administered surveys were completed by a statewide sample of Pennsylvania adults (2014) and by a sample of primary care clinic visitors in Hershey, Pennsylvania (2015). Participants from both studies were asked the extent they agreed with the following statement: Parks, trails, and open space are an essential component of our healthcare system. Response was also compared across demographic characteristics to assess whether this belief was universally held. Findings indicate 73% of the statewide sample and 68% of the clinical sample agreed parks, trails, and open space are an essential element of the healthcare system. Males, those with lower levels of educational attainment, and rural residents were statistically less likely to agree with this statement. Results indicate widespread belief in parks as an essential part of the healthcare system, suggesting consideration of health-sector investments in these settings.

HTA in the nutritional care: investments' efficiency and effectiveness

La valutazione delle tecnologie sanitarie pur rappresentando un fenomeno metodologico relativamente recente, ha acquisito una crescente importanza, come ponte tra ricerca e policy making. Il presente lavoro prende avvio proprio dall’esposizione della logica sottostante l’adozione di un processo di HTA, al fine di evidenziarne caratteristiche e vantaggi. Successivamente l’attenzione e concentrata sul rischio degli investimenti in sanita, declinato nelle sue determinanti: l’equilibrio tra efficacia, efficienza ed economicita; la scarsita di risorse disponibili. Infine, la spiegazione della necessita di valutare degli investimenti in tecnologia sanitaria per le cure nutrizionali effettuando una sintesi tra variabili di natura diversa in una prospettiva di creazione di valore e contenimento dei costi per supportare l’operativita del policy maker.

Health and Economic Growth in Ghana: An Empirical Investigation

In this paper, the growth effect of health in Ghana is examined for the period 1982–2012. Life expectancy at birth is used as proxy for health, and real per capita gross domestic product (GDP) for economic growth. The autoregressive distributed lag (ARDL) bounds test approach to cointegration is used to estimate the short- and long-run effects of health on economic growth. The results show that good health significantly promotes economic growth, both in the short-run and long-run. Development policy should, therefore, aim at raising health sector investment to improve health conditions of the population.