Structuring an Argument: Cost-Effective Analysis in Public Health

Question

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Thesis

When evaluating future projects in health, we need to extend our cost-effective analysis beyond the current 1 to 10 year period towards a 2 to 3 generational period.

Why

Many interventions that are dismissed today as being cost ineffective over a 1 year period would prove to be highly cost effective over a two to three generational period. If the Russian president could have shown a cost effective analysis of treating MDR TB, with the health benefits over 3 generations, then he would have had a valid arguments to present to his people. Therefore, he would still be able to be elected.

Prompt

How do we quantify the future benefits of a project in health?

Short term analysis

Depends on the organization the company is doing the assessment for.

World Health Organization (WHO)

Norm: 1 year

Question

Do governments with longer terms or more secure regimes tend to enact longer term goals (proportional to the time they expect to be in office/ power)?

Introduction

Today we tend to quantify the future with cost-effective analysis.

General Cost Effective Analysis (GCEA) definition

Change in Cost divided by Change in Health Benefit. The smaller this fraction is, the more cost-effective an intervention is. Though, they also compare that to the results of no treatment.

Supporting Quote

"These days, if you wanted money from big donors for health projects in poor countries, if you wanted to be taken seriously, your proposals had to pass a test, called cost-effectiveness analysis." -Tracy Kidder in "Mountains Beyond Mountains"

How politics should work

Merit based presidency. Jim Kim also suggested that presidential organizations for organizations like WHO should be merit based rather than power based. Maybe then, leaders would be less concerned about being safe and maintaining their power for a second election and more concerned with being bold.

Mix short and long term goals

Aid is a political game. Ultimately, what politicians need to be re-elected is some evidence of progress which would allow them to have the popularity and support to pursue more meaningful, long term goals.

Long term analysis

10+ years, over at least 2 generations into the future. We need more projects like the human genome project which has been very successful and was carried out over a 13 year period with benefits which will last generations.

The political system needs to change

According to President Kim, mix long term goals into short term goals and switch from power to merit based presidencies. The period of time over which you run a GCEA matters.