Accurate, country-specific data are necessary for informed policy decisions. Yet there is a dearth of cost data for most health interventions in most countries. To address this issue, the Monitoring Costs research team collects, analyzes, and offers cost data on the IHME website for policymakers to use as an input for cost effectiveness assessments of interventions and policies.
The research is part of IHME’s mission to understand how we can best dedicate resources to attain the maximum improvement in population health.
Key Activities
- Undertake cost studies in multiple countries
IHME is collaborating with UNICEF through the
Access, Bottlenecks, Costs, and Equity (ABCE) project. One significant aim of this project is to collect facility-level cost data from a broad range of health systems. This information will lead to a better understanding of the cost of care, specifically of the factors that drive costs upward. ABCE’s outputs and analyses will support policymakers, development partners, and national stakeholders in achieving better and more equitable outcomes. The project will help countries build a compelling equity investment case for health coverage by promoting a better understanding of how their systems operate and interact with populations.
The country studies combine existing datasets with new data collected through facility surveys focused on costs and constraints. The survey is also being used to collect information for analyses by the
Health Service Delivery Constraints research team. In order to develop the survey instrument, IHME researchers have assembled a survey bank that collates questions from multiple source surveys. The core costs and constraints survey, which will be tailored to each country’s context and service delivery platforms, has been developed from this bank.
IHME has begun implementing the costs and constraints survey in what will be approximately 15 countries, including Argentina, Colombia, Ghana, India, Kenya, Lebanon, Sri Lanka, Uganda, and Zambia. This work is in part funded by the
Disease Control Priorities Network project.
- Develop an enhanced budgeting tool for use by policymakers
When policymakers allocate scarce resources, several questions drive the decision-making process. Each question requires a slightly different perspective on the health system, and different tools have emerged to help. The research team is developing a tool that answers two policy-related questions:
- If I would like to attain coverage level X, given my current health system, how much will that outcome cost to achieve?
- If I have $X to invest, given my current health system, how do I invest it to ensure the greatest return? This project will draw upon lessons learned and the pros and cons of existing tools for related purposes. It will be carried out in consultation with colleagues at the University of Queensland and UNICEF as part of the ABCE project.
- Use risk adjustment to measure quality of care based on cost
Higher-quality health care doesn’t necessarily mean a higher cost of care. Higher-quality care may increase the cost of care if the number of treatments of a given intervention is constant. On the other hand, if higher-quality care cures a patient, it may decrease the number of needed interventions and thus reduce the total costs.
To better understand the relationship between higher-quality care and cost of care, the Monitoring Costs research team is capturing patient-level data by tapping the largest all-payer collection of hospital inpatient care statistical information in the United States, the Healthcare Costs and Utilization Project. Analyzing inpatient admissions data from 15 US states, researchers use risk adjustment to assess the cost of different health outcomes in relation to the different characteristics of patients and facilities.
We generated preliminary estimates of mortality from patient- and facility-level characteristics for a subset of conditions. Risk is assessed as the difference between expected and actual mortality in each instance. In addition to assessing the associated costs, the research team is identifying other factors at the facility level that influence these outcomes.
In 2012, the research team will expand the subset of conditions for which this risk adjustment is calculated to include as many major conditions as possible. This research will first focus on the US, but similar datasets available for Australia will also be assessed in collaboration with researchers at Monash University.
- Collaborate in the International Comparisons Program
IHME began collaborating with the World Bank on the International Comparisons Program (ICP) in 2009. The ICP is a worldwide statistical partnership to collect comparative price data and to estimate purchasing power parities of the world’s economies. Instead of using market exchange rates to convert currencies, purchasing power parities make it possible to compare the output of economies and the welfare of their inhabitants in real terms (that is, controlling for differences in price levels). With input from IHME, the ICP team is developing a health survey instrument to use in more than 160 countries in its next wave of data collection. IHME has advised the ICP on a specific list of pharmaceuticals to include in the survey. IHME will also jointly devise with ICP an analytic approach to calculate health-specific purchasing power parities.
Impact
IHME’s Monitoring Costs research team aims to provide information on the costs of providing health care in countries around the world. In addition, our work will provide decision-makers with tools to manage the costs and consequences of various platforms and health interventions. By quantifying the costs of health systems and health service delivery platforms, such as hospitals and community health clinics, IHME’s goal is to provide the evidence that allows policymakers to make informed decisions about how to allocate scarce resources to best improve population health.
