Reducing government expenditure on tertiary health facilities

Limiting highly specialized public medical care

Description

Excluding from essential clinical services health services with very low cost-effectiveness. Examples include heart surgery; treatment (other than pain relief) of highly fatal cancers of the lung, liver and stomach; expensive drug therapies for HIV infection; and intensive care for severely premature babies.

Context

Very few cost-effective interventions depend on sophisticated hospitals and specialized physicians.

Implementation

In the 1980s Papua New Guinea, to correct over-concentration of resources on higher-level facilities, limited public spending on hospitals to 40% of the recurrent budget of the Ministry of Health – well below the level in most developing countries.

Claim

Governments in developing countries should spend at least 50% less that they now do on less cost-effective interventions and instead double or triple spending on basic public health programmes such as immunizations and on essential clinical services.