Cost of access to health services in Zambia.

Equity is an important policy objective in the health care field. The importance of equity in health care provision can be argued from various points of view. As a result governments in all countries attempt to provide health care systems that enable equal access for everyone. Zambia is no exception. In the health care reforms the objective of the national health strategy is to provide Zambians with equity of access to health care. We focus on access defined as the costs (both monetary and time) an individual incurs when visiting a health care facility. Using a survey of 900 households, this article explores equality of access to health care among Zambians. Four areas are compared: urban high cost, urban low cost, townships and rural areas. The results of the analysis indicate that there are inequalities among residential areas, especially between rural and urban areas. In particular these differences exist because of differing distances to the nearest health facility. Large distances make it very costly for rural dwellers to seek medical care, especially during the high season for farming. The analysis suggests that obtaining equality of access to health care poses a challenge for the Zambian Government.

Patient views on choice and participation in primary health care.

Within modern health care, much attention is given to the tasks of identifying patient preferences and then delivering health care services accordingly. Standardised solutions are not always acceptable to patients with divergent needs and preferences, and the growing number of treatment alternatives makes patient participation increasingly important. In order to identify individual preferences for choice and shared decision making, a survey was conducted among 1543 primary care patients in Sweden. As suggested by earlier work, special attention was paid to the strong link between patient preferences and age. Results show both similarities and differences in attitudes among young and old patient groups, and differences could be explained by a combination of life-cycle effects, cohort effects and expectations ensuing from the need for future health care contacts.

Pharmaceutical expenditure in Sweden.

Recently, the responsibility for prescribed pharmaceuticals in Sweden was transferred from national level to the regional health authorities (county councils). The purpose was that a closer integration and balance between pharmaceuticals and other factors of production in health care should produce better opportunities for a cost-effective use of the total health care resources. The purpose of this paper is to present a deeper analysis of pharmaceuticals as a production factor in Sweden, mainly during the 1990s, and to discuss the future development and future policy decisions in Sweden. Pharmaceuticals have increased their share of total health care expenditure in Sweden, from about 9% in 1990 to about 14% in 1995. The Swedish pharmaceutical market can be divided into sub-markets, where the prescription sub-market accounts for the greater part of pharmaceutical expenditure. Further, a few disease categories account for a larger fraction of the cost of prescribed pharmaceuticals. The importance of pharmaceuticals as a production factor also differs between different age groups. Several factors are expected to contribute to a future increase in Swedish pharmaceutical expenditure, for instance an ageing population and the rapid introduction of expensive new pharmaceuticals.

Cost-effectiveness analysis of pegylated-liposomal doxorubicin and liposomal daunorubicin treatments in patients with Kaposi's sarcoma.

Economic evaluations of new AIDS treatment drugs are important. For physicians treating patients with Kaposi's sarcoma, these issues are especially meaningful since cancer treatment costs for this group of patients are high. Kaposi's sarcoma is the most frequently occurring neoplasm in AIDS patients, affecting about 15% of this population. In our study, a retrospective economic evaluation has been made based on data from two randomized phase III clinical studies of severely immune-compromised HIV-infected individuals and which compares liposomal doxorubicin with liposomal daunorubicin. We have estimated the cost and cost effectiveness of the two drugs. The costs per complete or partial response are USS 18340 for daunorubicin and USS 8871 for doxorubicin. The incremental cost per additional responder by using liposomal doxorubicin instead of liposomal daunorubicin is USS 1910. Sensitivity analysis shows that these results hold over a wide range of assumptions.

Choice and participation in the health services: a survey of preferences among Swedish residents.

Extending the possibilities for health-service consumers to choose among providers has been an important objective on the political agenda in Sweden and elsewhere. Little is known, however, about individual and group preferences concerning the demand for choices. It is often implicitly assumed that individuals can be treated as a group with similar values and demands, but is this true? To what extent do individuals want more options in health care? Do preferences vary depending on age, education and place of living? This article explores these questions, starting from a survey of 2,000 residents in four Swedish counties. The results of the survey point to many similarities, but also indicate important differences among residents. In particular, preferences seem to vary significantly depending on age and level of education. On the other hand, older people are more favourably inclined towards the free choice of physician. On the other hand, members of the younger generation, as well as well-educated residents, demand a more active part in the process of medical decision making. These differences, as well as expectations from younger generations, pose a great challenge to the future management of health services.

Economic analysis of treatment with roxithromycin in comparison with erythromycin in patients with lower respiratory tract infections.

A number of new antibiotics have lately become available for treatment of lower respiratory tract infections in out-patients. The new drugs are generally more expensive than the older ones, which might be justified by better effects, improved safety, or by other advantages. In this study, a retrospective economic analysis has been made using data from a previous trial comparing a new macrolide, roxithromycin, with an older 1, erythromycin stearate in the treatment of lower respiratory tract infections. The trial was multicentre, double blind, randomized and comparative. There were no significant differences in efficacy between treatments, although the cure rate was higher for roxithromycin, 85% vs 79% for erythromycin. 20/39 of the erythromycin-treated patients reported adverse events, vs 7/40 roxithromycin-treated subjects, a highly significant difference. More detailed information was obtained by reviewing the medical records of the participants, and from questionnaires distributed to the 3 centres that had included patients in the trial. Additional visits were found necessary for 4 patients treated with erythromycin and for 1 using roxithromycin. Using the healing rates in the present investigation, and including costs for initial drug treatments, second consultations, and failed therapy, average cost-effectiveness (SEK/patient cured) was 409 for roxithromycin-treated patients, and 488 for erythromycin-treated. Roxithromycin should then be cheaper than erythromycin stearate. With the same healing rate, roxithromycin would be less cost-effective, but indirect costs and effects on quality of life are not then taken into account.