Thursday, July 2, 2009

Unintended irony about cost-effectiveness

Some thoughts on the unspoken history in an article from the Wall Street Journal about cost-effectiveness in global health.

I have been spending more time these past several weeks on Twitter, the short-form micro-blogging platform, rather than on the blog. (I'm @cgorman.) There are obvious limitations to Twitter's 140 character limit. But I find it's a great way to quickly pass along time-sensitive information, as well as get a kind of "temperature reading" of what some of the big issues are thought to be.

It's also exactly the right format to quickly point folks to news articles--like the one that Amy Dockser Marcus of the Wall Street Journal wrote in an intriguing piece titled, "To Fix Health Care, Some Study Developing World."

But it's hard to fit into 140 characters what I thought was missing in Marcus's article. It's a perfectly fine piece of journalism, a good introduction. But there is a lot more to this story.

You get a hint of it in Marcus's praise of the Prevention and Access to Care and Treatment (PACT) Project in Boston. That program was started by Partners in Health in 1995.

The main thrust of Marcus's article is about international programs that provide better health for less money. In other words, the benefits of cost-effectiveness--as seen in poor countries.

Regarding cost-effectiveness: PIH leaders like Paul Farmer and Joia Mukherjee will tell you over and over again that too many in global health are slaves to the idol of cost-effectiveness. (Note, these are their friends they are talking about--the folks who believe in global health.) Farmer and Mukherjee see an unthinking allegiance to cost-effectiveness as a sledge hammer that is often used to deny access to health care for the poor and marginalized.

Regarding health care in poor countries. Mukherjee recently had an op-ed in the Boston Globe slamming the IMF for cutting public sector spending in health and education amongst poor countries as a condition of receiving loans in the 1980s. Part of the reason so many countries were open to working with PIH to develop the sorts of programs praised by the WSJ was because their original government health plans were destroyed by budget cuts demanded by "structural adjustment programs."

The irony, as Mukherjee and her co-author wrote, is astounding. "Today, market-based, financial-sector strategies have failed so miserably that nothing but massive public spending can rescue even the wealthiest economies. The United States itself has used trillions of dollars of public monies to stimulate the economy and secure private institutions. Yet expansionary public spending will not be possible in poor countries if the IMF is given free reign to restrict public expenditures."

So, Twitter for short bursts of information (like headlines). Blogs for looking a little deeper. All of it is a process that sometimes even produces good products.

Related Posts:
Do We Get Our Money's Worth in Global Health?
How I Use Twitter Without Being Overwhelmed

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