A HANDBOOK OF HEALTH ECONOMICS AND THE FINANCING OF HEALTH SERVICES: HEALTHCARE IS COSTLY. HEALTHCARE IS A NEED, HEALTHCARE IS A RIGHT (According to ... and authored by Innocent KARENGERA)

Healthcare is costly. Healthcare is a need. Healthcare is a right (according to WHO). Economics isthe study of how people make choices on how to employ scarce resources. The scarce resources could have been available for alternative uses to produce various goods/commodities/services. Health Economics is the study of the value of health and how healthcare can be produced most efficiently and distributed to maximize social welfare. Economics is not the same as Accountancy. Economics is the costs incurred or resources used to get maximum benefits after making choices. Choices are made to get maximum benefit. Making choices to get maximum benefit is efficiency. Accountancy is the monitoring of financial transactions. Though high healthcare costs hinder access, other factors cause the under-consumption of healthcare commodities. These are Poor Reception, Long waiting time, Non-availability of drugs, Overall appreciation of the care, Cure rate, and the Availability of other providers. Health economics provides tools for making choices for planning. The Government may provide subsidies to health facilities for preventive services in the fiscal budget. The objective is to encourage the public to use Antenatal care, family planning, and immunization services to reduce maternal morbidity and mortality, population growth, and the incidence of immunizable diseases respectively. Where services are free, other motivation methods to improve the use of preventive services may be used. Where services are not free, solidarity in health financing at the level of the inputs in the system can be initiated. In solidarity, a contribution is a function of income and not a function of health status. There is a slogan that “Everyone is there for everyone else”. Health insurance is needed because there is poor predictability of the time at which healthcare is needed. Prepayment ensures safeguarded access to healthcare when one needs it. There is always uncertainty concerning the duration and the severity of illness and how much it will cost to get treatment. The lack of patients’ technical expertise in medicine gives rise to the asymmetry of information. Doctors know more about patients’ health status and potential gains from treatment than patients. Patients cannot or do not wish to act as fully informed consumers of healthcare. Instead, there is an agency relationship in which doctors act as agents on behalf of patients. Managers need to understand a health facility’s performance indicators. They need to take into account a manager’s management objectives in a health facility setting. These are Effectiveness, Efficiency, Quality Care, Safety, and Access. Managers must be able to understand how the health facility is performing in all of the stated management objectives. Understanding performance requires the use of milestones called “Indicators”. In this handbook, Management objectives, Indicators of Effectiveness and Access Utilization, the measurement of hospital performance by using the composite indicator of output, the Standard Unit of Output (SUO-Op), and Indicators of efficiency are discussed. Again in this handbook “A HANDBOOK OF health economics and THE financing of health services” Health Economics and the various methods of health financing and cost containment are discussed. This handbook comprises six Chapters: Chapter One: Economics and Health Economics, Chapter Two: The Financing of Health Systems, Chapter Three: Equity in Health and Healthcare: Concepts and Measurements, Chapter Four: National Health Account (NHA) Conceptual Overview, Chapter Five: Techniques of Economic Evaluation, and Chapter Six: Health Facility Performance Indicators and Methods for Increasing Efficiency. The author of the handbook targets Health training institutions, health facility managers, medical students, paramedical students, nurses, and other health professionals.