... 2003), Namibia (Zere et al. 2006), South Africa (Kirigia et al. 2001) and Zambia (Masiye et a... more ... 2003), Namibia (Zere et al. 2006), South Africa (Kirigia et al. 2001) and Zambia (Masiye et al. ... Facilities at the level of primary care are still unstudied so far. Analyses focusing on the peripheral level were only conducted in Kenya (Kirigia et al. 2004), Sierra Leone (Renner et al. ...
Providing health care services in Africa is hampered by severe scarcity of personnel, medical sup... more Providing health care services in Africa is hampered by severe scarcity of personnel, medical supplies and financial funds. Consequently, managers of health care institutions are called to measure and improve the efficiency of their facilities in order to provide the best possible services with their resources. However, very little is known about the efficiency of health care facilities in Africa and instruments of performance measurement are hardly applied in this context. This study determines the relative efficiency of primary care facilities in Nouna, a rural health district in Burkina Faso. Furthermore, it analyses the factors influencing the efficiency of these institutions. We apply a two-stage Data Envelopment Analysis (DEA) based on data from a comprehensive provider and household information system. In the first stage, the relative efficiency of each institution is calculated by a traditional DEA model. In the second stage, we identify the reasons for being inefficient by ...
In this paper we present a meta-analysis of the Cost-of-Illness of HIV/AIDS and the socio-economi... more In this paper we present a meta-analysis of the Cost-of-Illness of HIV/AIDS and the socio-economic impact of antiretroviral therapy. We distinguish between provider costs, direct household costs, and indirect costs. There is a growing number of publications on provider costs in different countries, but the methodology and the degree of precision between these papers make it difficult to give a good estimate of the current provider costs of treating HIV/AIDS cases. There seems to be a declining interest in health economic analysis of HIV/AIDS, and usually data is rather obsolete at the date of publication. In addition, we know hardly anything about household costs not covered by health insurances (e.g., transport to the provider, special diet). There are more studies on indirect costs, but even these studies are difficult to compare due to methodological differences. Even under these conditions we can state that in highly developed countries HAART is cost-effective. Because of an increase of life expectancy, the life-time provider costs increase under this drug regime. But, on the contrary, the indirect costs strongly decrease. In particular for employed and young HIV/AIDS cases in the USA and in Europe, HAART is an investment that pays back. In countries and in compartments of the population (e.g., unemployed, pensioners) where the loss of labor can be neglected, the positive effects of HAART on the indirect costs do not necessarily justify its costs. The cost-effectiveness analysis of antiviral therapy has to be seen under the precondition that no long-term effects, such as drug resistance, occur. Future analysis might show that we strongly underestimated the long-term costs of HIV/AIDS.
Ten years have passed since the so called Wende in East Germany. The change of the economical and... more Ten years have passed since the so called Wende in East Germany. The change of the economical and political system influenced the life of the individuals in multiple ways. From a health economics' perspective one could ask for the implications of changes in lifestyle. This paper reviews economic approaches of health influencing behaviours and summarizes lifestyle research concerning the former GDR. There exist several studies from epidemiological, psychological and sociological points of view, which focus on consequences of transformation, but the issue has not been treated by a health economic analysis yet. Therefore a basic form for a health economics' analysis is introduced, which offers links for a structural model with latent variables. In a further step it has to be transformed into an econometric model and tested. --
... 2003), Namibia (Zere et al. 2006), South Africa (Kirigia et al. 2001) and Zambia (Masiye et a... more ... 2003), Namibia (Zere et al. 2006), South Africa (Kirigia et al. 2001) and Zambia (Masiye et al. ... Facilities at the level of primary care are still unstudied so far. Analyses focusing on the peripheral level were only conducted in Kenya (Kirigia et al. 2004), Sierra Leone (Renner et al. ...
Insecticide-treated nets (ITNs) are effective in substantially reducing malaria transmission. Sti... more Insecticide-treated nets (ITNs) are effective in substantially reducing malaria transmission. Still, ITN coverage in sub-Saharan Africa (SSA) remains extremely low. Policy makers are concerned with identifying the most suitable delivery mechanism to achieve rapid yet sustainable increases in ITN coverage. Little is known, however, on the comparative costs of alternative ITN distribution strategies. This paper aimed to fill this gap in knowledge by developing such a comparative cost analysis, looking at the cost per ITN distributed for two alternative interventions: subsidized sales supported by social marketing and free distribution to pregnant women through antenatal care (ANC). The study was conducted in rural Burkina Faso, where the two interventions were carried out alongside one another in 2006/07. Cost information was collected prospectively to derive both a financial analysis adopting a provider's perspective and an economic analysis adopting a societal perspective. The average financial cost per ITN distributed was US$8.08 and US$7.21 for sales supported by social marketing and free distribution through ANC, respectively. The average economic cost per ITN distributed was US$4.81 for both interventions. Contrary to common belief, costs did not differ substantially between the two interventions. Due to the district's ability to rely fully on the use of existing resources, financial costs associated with free ITN distribution through ANC were in fact even lower than those associated with the social marketing campaign. This represents an encouraging finding for SSA governments and points to the possibility to invest in programmes to favour free ITN distribution through existing health facilities. Given restricted budgets, however, free distribution programmes are unlikely to be feasible.
The aim of this study is to demonstrate the impact of increased access to primary care on provide... more The aim of this study is to demonstrate the impact of increased access to primary care on provider costs in the rural health district of Nouna, Burkina Faso. This study question is crucial for health care planning in this district, as other research work shows that the population has a higher need for health care services. From a public health perspective, an increase of utilisation of first-line health facilities would be necessary. However, the governmental budget that is needed to finance improved access was not known. The study is based on data of 2004 of a comprehensive provider cost information system. This database provides us with the actual costs of each primary health care facility (Centre de Santé et de Promotion Sociale, CSPS) in the health district. We determine the fixed and variable costs of each institution and calculate the average cost per service unit rendered in 2004. Based on the cost structure of each CSPS, we calculate the total costs if the demand for health care services increased. We conclude that the total provider costs of primary care (and therefore the governmental budget) would hardly rise if the coverage of the population were increased. This is mainly due to the fact that the highest variable costs are drugs, which are fully paid for by the customers (Bamako Initiative). The majority of other costs are fixed. Consequently, health care reforms that improve access to health care institutions must not fear dramatically increasing the costs of health care services.
The aim of our research was to collect comprehensive data about the public and physician awarenes... more The aim of our research was to collect comprehensive data about the public and physician awareness, acceptance and use of Personalized Medicine (PM), as well as their opinions on PM reimbursement and genetic privacy protection in the U.S. and Germany. In order to give a better overview, we compared our survey results with the results from other studies and discussed Personalized Medicine preconditions for its wide implementation into the medical standard. For the data collection, using the same methodology, we performed several surveys in Pennsylvania (U.S.) and Bavaria (Germany). Physicians were contacted via letter, while public representatives in person. Survey results, analyzed by means of descriptive and non-parametric statistic methods, have shown that awareness, acceptance, use and opinions on PM aspects in Pennsylvania and Bavaria were not significantly different. In both states there were strong concerns about genetic privacy protection and no support of one genetic databas...
... 2003), Namibia (Zere et al. 2006), South Africa (Kirigia et al. 2001) and Zambia (Masiye et a... more ... 2003), Namibia (Zere et al. 2006), South Africa (Kirigia et al. 2001) and Zambia (Masiye et al. ... Facilities at the level of primary care are still unstudied so far. Analyses focusing on the peripheral level were only conducted in Kenya (Kirigia et al. 2004), Sierra Leone (Renner et al. ...
Providing health care services in Africa is hampered by severe scarcity of personnel, medical sup... more Providing health care services in Africa is hampered by severe scarcity of personnel, medical supplies and financial funds. Consequently, managers of health care institutions are called to measure and improve the efficiency of their facilities in order to provide the best possible services with their resources. However, very little is known about the efficiency of health care facilities in Africa and instruments of performance measurement are hardly applied in this context. This study determines the relative efficiency of primary care facilities in Nouna, a rural health district in Burkina Faso. Furthermore, it analyses the factors influencing the efficiency of these institutions. We apply a two-stage Data Envelopment Analysis (DEA) based on data from a comprehensive provider and household information system. In the first stage, the relative efficiency of each institution is calculated by a traditional DEA model. In the second stage, we identify the reasons for being inefficient by ...
In this paper we present a meta-analysis of the Cost-of-Illness of HIV/AIDS and the socio-economi... more In this paper we present a meta-analysis of the Cost-of-Illness of HIV/AIDS and the socio-economic impact of antiretroviral therapy. We distinguish between provider costs, direct household costs, and indirect costs. There is a growing number of publications on provider costs in different countries, but the methodology and the degree of precision between these papers make it difficult to give a good estimate of the current provider costs of treating HIV/AIDS cases. There seems to be a declining interest in health economic analysis of HIV/AIDS, and usually data is rather obsolete at the date of publication. In addition, we know hardly anything about household costs not covered by health insurances (e.g., transport to the provider, special diet). There are more studies on indirect costs, but even these studies are difficult to compare due to methodological differences. Even under these conditions we can state that in highly developed countries HAART is cost-effective. Because of an increase of life expectancy, the life-time provider costs increase under this drug regime. But, on the contrary, the indirect costs strongly decrease. In particular for employed and young HIV/AIDS cases in the USA and in Europe, HAART is an investment that pays back. In countries and in compartments of the population (e.g., unemployed, pensioners) where the loss of labor can be neglected, the positive effects of HAART on the indirect costs do not necessarily justify its costs. The cost-effectiveness analysis of antiviral therapy has to be seen under the precondition that no long-term effects, such as drug resistance, occur. Future analysis might show that we strongly underestimated the long-term costs of HIV/AIDS.
Ten years have passed since the so called Wende in East Germany. The change of the economical and... more Ten years have passed since the so called Wende in East Germany. The change of the economical and political system influenced the life of the individuals in multiple ways. From a health economics' perspective one could ask for the implications of changes in lifestyle. This paper reviews economic approaches of health influencing behaviours and summarizes lifestyle research concerning the former GDR. There exist several studies from epidemiological, psychological and sociological points of view, which focus on consequences of transformation, but the issue has not been treated by a health economic analysis yet. Therefore a basic form for a health economics' analysis is introduced, which offers links for a structural model with latent variables. In a further step it has to be transformed into an econometric model and tested. --
... 2003), Namibia (Zere et al. 2006), South Africa (Kirigia et al. 2001) and Zambia (Masiye et a... more ... 2003), Namibia (Zere et al. 2006), South Africa (Kirigia et al. 2001) and Zambia (Masiye et al. ... Facilities at the level of primary care are still unstudied so far. Analyses focusing on the peripheral level were only conducted in Kenya (Kirigia et al. 2004), Sierra Leone (Renner et al. ...
Insecticide-treated nets (ITNs) are effective in substantially reducing malaria transmission. Sti... more Insecticide-treated nets (ITNs) are effective in substantially reducing malaria transmission. Still, ITN coverage in sub-Saharan Africa (SSA) remains extremely low. Policy makers are concerned with identifying the most suitable delivery mechanism to achieve rapid yet sustainable increases in ITN coverage. Little is known, however, on the comparative costs of alternative ITN distribution strategies. This paper aimed to fill this gap in knowledge by developing such a comparative cost analysis, looking at the cost per ITN distributed for two alternative interventions: subsidized sales supported by social marketing and free distribution to pregnant women through antenatal care (ANC). The study was conducted in rural Burkina Faso, where the two interventions were carried out alongside one another in 2006/07. Cost information was collected prospectively to derive both a financial analysis adopting a provider's perspective and an economic analysis adopting a societal perspective. The average financial cost per ITN distributed was US$8.08 and US$7.21 for sales supported by social marketing and free distribution through ANC, respectively. The average economic cost per ITN distributed was US$4.81 for both interventions. Contrary to common belief, costs did not differ substantially between the two interventions. Due to the district's ability to rely fully on the use of existing resources, financial costs associated with free ITN distribution through ANC were in fact even lower than those associated with the social marketing campaign. This represents an encouraging finding for SSA governments and points to the possibility to invest in programmes to favour free ITN distribution through existing health facilities. Given restricted budgets, however, free distribution programmes are unlikely to be feasible.
The aim of this study is to demonstrate the impact of increased access to primary care on provide... more The aim of this study is to demonstrate the impact of increased access to primary care on provider costs in the rural health district of Nouna, Burkina Faso. This study question is crucial for health care planning in this district, as other research work shows that the population has a higher need for health care services. From a public health perspective, an increase of utilisation of first-line health facilities would be necessary. However, the governmental budget that is needed to finance improved access was not known. The study is based on data of 2004 of a comprehensive provider cost information system. This database provides us with the actual costs of each primary health care facility (Centre de Santé et de Promotion Sociale, CSPS) in the health district. We determine the fixed and variable costs of each institution and calculate the average cost per service unit rendered in 2004. Based on the cost structure of each CSPS, we calculate the total costs if the demand for health care services increased. We conclude that the total provider costs of primary care (and therefore the governmental budget) would hardly rise if the coverage of the population were increased. This is mainly due to the fact that the highest variable costs are drugs, which are fully paid for by the customers (Bamako Initiative). The majority of other costs are fixed. Consequently, health care reforms that improve access to health care institutions must not fear dramatically increasing the costs of health care services.
The aim of our research was to collect comprehensive data about the public and physician awarenes... more The aim of our research was to collect comprehensive data about the public and physician awareness, acceptance and use of Personalized Medicine (PM), as well as their opinions on PM reimbursement and genetic privacy protection in the U.S. and Germany. In order to give a better overview, we compared our survey results with the results from other studies and discussed Personalized Medicine preconditions for its wide implementation into the medical standard. For the data collection, using the same methodology, we performed several surveys in Pennsylvania (U.S.) and Bavaria (Germany). Physicians were contacted via letter, while public representatives in person. Survey results, analyzed by means of descriptive and non-parametric statistic methods, have shown that awareness, acceptance, use and opinions on PM aspects in Pennsylvania and Bavaria were not significantly different. In both states there were strong concerns about genetic privacy protection and no support of one genetic databas...
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Papers by Paul Marschall