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Public hospitals in developing countries. Resource use, cost, financing
Book Reviews / Healh Policy 27 (1994) 193-200
196
The text is worthwhile reading for physicians and managers with malpractice responsibilities, for scholars and analysts studying the impact of the tort system on health care costs, and for a broader general audience interested in knowing more about this complex area of health policy and practice in the United States. Thomas A. Massaro, M.D., Ph.D. Professor of Pediatrics and Business Administration Lecturer in Law The University of Virginia Charlottesville, Virginia, USA
Public Hospitals in Developing Countries. Resource Use, Cost, Financing By H. Barnum and J. Kutzin (Eds.) The John Hopkins University Press, Baltimore 335 pp., 1993, ISBN O-8018-4532-7, USS35.95.
It is not often one gets to review a wonderful book like this, ‘Published for the World Bank’, with all the intellectual rigour for which the Bank is, deservedly reputed. In this book the authors, both associated as economists with IBRD, attack the key problem of public hospitals in developing countries, a major asset of health services, while at the same time consuming the largest share of government health resources in any country studied. The structure of the book is simple: it sets out the basic issues which need understanding or discussion, and then walks the reader through them, chapter by chapter, ending up in a ‘conclusion’ chapter, which summarizes the findings and outlines research priorities. For the extremely busy professional (and who doesn’t correspond to this description these days?) the last chapter by itself constitutes a goldmine of reality-checked policy analysis. These ‘common sense’ statements however, anchored in research, only wet the appetite of the reader who is cynical of the ‘development industry’s easy ‘latest prescription’ approach, and who therefore will want to understand the thinking and the data behind these conclusions. While not easy reading, the book is written in a language accessible to noneconomists, and provides good introduction to the conceptual issues of health and hospital economics. Summarising the book, these are: and, -
cost questions; what do hospitals cost, relative to other expenditure in health and/or to GNP? what is the structure of these costs and what determines them? financing questions; where and how do hospitals obtain these resources? are there tried or potential alternatives for these mechanisms?
From society’s perspective, both types of questions have to be answered in terms of the impossible triangular challenge: ensuring full access to care, of the highest quality possible, as economically efficient as society allows. In this regard the lessons from this book, and most of all the rigour of its analysis, are not only applicable to developing countries but for all involved or preoccupied with health (care) reform: the scarcity of resources and low productivity levels in developing societies only make these questions more poignant, as there they truly are life- and death-issues. The authors build well on conceptual work first developed in/with the World Health organization’s reflection on the role of hospitals and the health care revolution (Paine and Siem Tjam 1988), and are fully in line with the strategy of primary health care as Professor Adetokunbo 0. Lucas points out in the foreword.
Book Reviews / Healh Policy 27 (1994)
193-200
197
With minor beauty spots as quoting ‘UNICEF’s program of essential drugs’ or an outdated (1985)edition of WHO’s Technical Report on ‘The selection of essential drugs’, the references and bibliography are impressive. In view of the nature of the publication, only data or studies up to 1987 could be included or reviewed, which only emphasizes the need to complete and/or update as soon as possible the research and data base, on which the book’s conclusions rest. This publication is warmly recommended to all with an interest in health policy/health care questions. While there is clearly an economic orientation to the analysis, the book is sufficiently pedagogical to make this an added attraction, not a deterrent. Dr. Xavier Leus, MD Regional Advisor for Coordination and Resource Mobilization W.H.O. Regional Office for Europe Copenhagen. Denmark
Nore This book review presents a personal opinion of the reviewer and, as such, does not engage the World Health Organization an&or its Regional Office.
Guidelines for Cholera Control By World Health Organisation (Ed.) 61 pp., ISBN 92-4-154449-X, Sw.fr.
10.50,
US$13.50.
This small booklet contains ten short chapters and five annexes on cholera prevention, treatment, control, education and management. The guidelines give comprehensive basic tips on the prevention of a cholera epidemic, the essential preparations that should be made by health facilities to prepare them for quick responses to real or threatened epidemic and the medical supplies that should be available for such epidemics. Further guidelines are given on the management of patients, measures to contain the outbreak, epidemiological and laboratory investigations, and the long term preventive measures which must be taken to prevent future outbreaks. Additional information is given in five annexes on the treatment of cholera patients, with particular emphasis on the rational use of antimicrobial drugs and the prevention and control of dehydration. Also covered in the annexes is an emphasis on the importance of basic hygienic measures such as safe drinking water, careful handling of food during food preparation and some simple health education messages. Cholera and other disease epidemics occur regularly in the poor developing countries whose capacities to provide basic resources to their populations, such as clean and adequate water, fuel, drugs, food and shelter are limited, and not necessarily due to lack of knowledge on disease prevention and management by the health personnel in these countries. Improving the capacities of these countries to provide these basic necessities, will go a long way in reducing epidemics such as cholera and others, and will enable the health personnel to put into practical use guidelines such as those given in this book. It is already known that the poor countries of the world are becoming poorer and the living conditions of their populations are becoming worse than they have ever been. It is therefore likely that, however useful these guidelines are, they will remain on the shelves of many health programme managers’ offices before they can be implemented. Dr. H. Kigutha Department of Human Nutrition Wageningen Agricultural University The Netherlands
196
The text is worthwhile reading for physicians and managers with malpractice responsibilities, for scholars and analysts studying the impact of the tort system on health care costs, and for a broader general audience interested in knowing more about this complex area of health policy and practice in the United States. Thomas A. Massaro, M.D., Ph.D. Professor of Pediatrics and Business Administration Lecturer in Law The University of Virginia Charlottesville, Virginia, USA
Public Hospitals in Developing Countries. Resource Use, Cost, Financing By H. Barnum and J. Kutzin (Eds.) The John Hopkins University Press, Baltimore 335 pp., 1993, ISBN O-8018-4532-7, USS35.95.
It is not often one gets to review a wonderful book like this, ‘Published for the World Bank’, with all the intellectual rigour for which the Bank is, deservedly reputed. In this book the authors, both associated as economists with IBRD, attack the key problem of public hospitals in developing countries, a major asset of health services, while at the same time consuming the largest share of government health resources in any country studied. The structure of the book is simple: it sets out the basic issues which need understanding or discussion, and then walks the reader through them, chapter by chapter, ending up in a ‘conclusion’ chapter, which summarizes the findings and outlines research priorities. For the extremely busy professional (and who doesn’t correspond to this description these days?) the last chapter by itself constitutes a goldmine of reality-checked policy analysis. These ‘common sense’ statements however, anchored in research, only wet the appetite of the reader who is cynical of the ‘development industry’s easy ‘latest prescription’ approach, and who therefore will want to understand the thinking and the data behind these conclusions. While not easy reading, the book is written in a language accessible to noneconomists, and provides good introduction to the conceptual issues of health and hospital economics. Summarising the book, these are: and, -
cost questions; what do hospitals cost, relative to other expenditure in health and/or to GNP? what is the structure of these costs and what determines them? financing questions; where and how do hospitals obtain these resources? are there tried or potential alternatives for these mechanisms?
From society’s perspective, both types of questions have to be answered in terms of the impossible triangular challenge: ensuring full access to care, of the highest quality possible, as economically efficient as society allows. In this regard the lessons from this book, and most of all the rigour of its analysis, are not only applicable to developing countries but for all involved or preoccupied with health (care) reform: the scarcity of resources and low productivity levels in developing societies only make these questions more poignant, as there they truly are life- and death-issues. The authors build well on conceptual work first developed in/with the World Health organization’s reflection on the role of hospitals and the health care revolution (Paine and Siem Tjam 1988), and are fully in line with the strategy of primary health care as Professor Adetokunbo 0. Lucas points out in the foreword.
Book Reviews / Healh Policy 27 (1994)
193-200
197
With minor beauty spots as quoting ‘UNICEF’s program of essential drugs’ or an outdated (1985)edition of WHO’s Technical Report on ‘The selection of essential drugs’, the references and bibliography are impressive. In view of the nature of the publication, only data or studies up to 1987 could be included or reviewed, which only emphasizes the need to complete and/or update as soon as possible the research and data base, on which the book’s conclusions rest. This publication is warmly recommended to all with an interest in health policy/health care questions. While there is clearly an economic orientation to the analysis, the book is sufficiently pedagogical to make this an added attraction, not a deterrent. Dr. Xavier Leus, MD Regional Advisor for Coordination and Resource Mobilization W.H.O. Regional Office for Europe Copenhagen. Denmark
Nore This book review presents a personal opinion of the reviewer and, as such, does not engage the World Health Organization an&or its Regional Office.
Guidelines for Cholera Control By World Health Organisation (Ed.) 61 pp., ISBN 92-4-154449-X, Sw.fr.
10.50,
US$13.50.
This small booklet contains ten short chapters and five annexes on cholera prevention, treatment, control, education and management. The guidelines give comprehensive basic tips on the prevention of a cholera epidemic, the essential preparations that should be made by health facilities to prepare them for quick responses to real or threatened epidemic and the medical supplies that should be available for such epidemics. Further guidelines are given on the management of patients, measures to contain the outbreak, epidemiological and laboratory investigations, and the long term preventive measures which must be taken to prevent future outbreaks. Additional information is given in five annexes on the treatment of cholera patients, with particular emphasis on the rational use of antimicrobial drugs and the prevention and control of dehydration. Also covered in the annexes is an emphasis on the importance of basic hygienic measures such as safe drinking water, careful handling of food during food preparation and some simple health education messages. Cholera and other disease epidemics occur regularly in the poor developing countries whose capacities to provide basic resources to their populations, such as clean and adequate water, fuel, drugs, food and shelter are limited, and not necessarily due to lack of knowledge on disease prevention and management by the health personnel in these countries. Improving the capacities of these countries to provide these basic necessities, will go a long way in reducing epidemics such as cholera and others, and will enable the health personnel to put into practical use guidelines such as those given in this book. It is already known that the poor countries of the world are becoming poorer and the living conditions of their populations are becoming worse than they have ever been. It is therefore likely that, however useful these guidelines are, they will remain on the shelves of many health programme managers’ offices before they can be implemented. Dr. H. Kigutha Department of Human Nutrition Wageningen Agricultural University The Netherlands