 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Marty Makinen, PhD, PHRplus Project, Abt Associates Inc., 4800 Montgomery Lane, Bethesda, MD 20814, 301-913-0689, marty_makinen@abtassoc.com
This paper discusses reasons that health economists might identify for the disappointing performance of health systems in developing countries. The items include many that may surprise those in the traditional disciplines of public health. Applying economic tools and methods could help address the problems and make the traditional disciplines more effective. Below is a partial listing of the sometimes-provocative topics that the paper takes up.
1. The central-planning style of organization of most government health systems. 2. The near-monopoly power of MOHs or related institutions to supply certain services and commodities (e.g., drugs) leads to corruption and under-supply. 3. User charges are not the source of all health system problems—they address a number of problems and may create some others, like many other policies, so they should be judged on their net contribution and relative to alternatives. 4. The notion that economic analysis ignores (and therefore tramples over) equity issues. 5. The idea that decentralization resolves the problems of centralized decision making. 6. The notion that more resources are the best way to solve many, if not all, of health system problems. 7. Profits are always bad and the profit motive always leads to undesired outcomes. 8. “If you build it, they will come” may be a useful maxim for baseball, but not for health services. 9. The imperfect is never good enough, particularly as applied to: mechanisms to exonerate the disadvantaged from user charges, contracting with private providers, and quality in private provision
Learning Objectives:
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.