749 



promoting the efficient use of available resources faces obvious ethical 

 and moral obstacles. Nevertheless the economics of health and disease 

 is a legitimate way of evaluating certain kinds of international cam- 

 paigns against disease and the techniques of cost/benefit analysis are 

 proving of value in a number of other fields of medicine. In additioii 

 to international health activities which would have to be explained and 

 justified to Congress along non-quantifiable lines, there remains the 

 possibility of satisfying the Congress as to the nature of failures and 

 successes with numbers or with concepts derived from a numerical 

 approach of one kind or another. As Dr. John Bryant states : 



The major, analytical tool used to evaluate alternative health 

 programs in the United States has been cost-benefit analy- 

 sis * * *. Benefits are generally measured in terms of number of 

 lives saved, amount of disability prevented, or amount of 

 economic loss avoided * * *, There are special problems in ex- 

 tending [these] concepts * * * to the less developed coun- 

 tries * * *. Still, the concepts of cost -benefit analysis are very 

 important, whether applied with carefullv derived data or as 

 an aid to common sense in making decisions on health 

 programs.^®^ 



Some Examples of Approax)hes to Cost/Benefit Analysis in Health 

 Programs 

 The difficulty of obtaining quantitative information about the results 

 of health nro^rrams 1vis been a liistorir^a^ obstacle to their orderly pres- 

 entation in the budget and accounting process. Nevertheless, some 

 sources of quantitative information are available, and these may not 

 be adequately exploited for policy purposes. The following is a brief 

 sampling from the literature of such sources. 



1. A study of the control of poliomyelitis in the USSR showed that 

 the cost of vaccinating 127 million people amounted to nearly 46 

 million roubles; l:>enefits were evaluated bv comparing actual incidence 

 of the disease following vaccination with estimated incidence in the 

 absence of the program : 



The benefits were evaluated by working out the number of 

 cases that would have occurred in the period 1958-1965 (as- 

 suming a continuation of the 1958 morbidity figure), the cost 

 of treating them, and the financial losses due to disablement 

 and deatli. On tl\is bapis. the l~>enefit was found to l)e over 8000 

 million roubles, or 66 roubles saved for every rouble spent. The 

 assumption of a continuation of the 1958 morbidity level may 

 well have given this estimate an upward bias, but a benefit so 

 much greater than the cost allows ample scope for more strin- 

 gent assumptions.^^^ 



2. In a Yugoslavian program to reduce infant mortality from its 

 existing level of 44 per thousand live births to 20 or below, two alter- 

 nate methods were used: (a) a child health dispensary and a 12-bed 

 unit for normal deliveries, staffed by a pediatrician and two nurses ; 

 and (b) a clinic staffed by a midwife, supported by periodic visits 

 (three times a week for six hours) of a general practitioner. "After 



'^ Bryant. "Health and the Developing World." op. cit., pnges 106-7. 



182 "Economics of Health and Disease," WHO Chronicle (January 1970), page 22. 



