Reducing government expenditure on tertiary health facilities

Excluding from essential clinical services health services with very low cost-effectiveness. Examples include heart surgery; treatment (other than pain relief) of highly fatal cancers of the lung, liver and stomach; expensive drug therapies for HIV infection; and intensive care for severely premature babies.

Very few cost-effective interventions depend on sophisticated hospitals and specialized physicians.

In the 1980s Papua New Guinea, to correct over-concentration of resources on higher-level facilities, limited public spending on hospitals to 40% of the recurrent budget of the Ministry of Health – well below the level in most developing countries.

1. Governments in developing countries should spend at least 50% less that they now do on less cost-effective interventions and instead double or triple spending on basic public health programmes such as immunizations and on essential clinical services.

1. Reducing funds for research
2. Limiting availability of public facilities
3. Increasing efficiency of public spending
4. Decreasing public health costs
5. Controlling government finances

1. Reducing discriminatory use of health facilities
2. Providing public health services
3. Investing in health
4. Financing public health interventions with substantial externalities
5. Establishing primary health care

1. Reallocating government spending on health

1. Meeting specialized medical needs
2. Improving medical facilities
3. Developing medical education

1. Expanding basic medical care

1. Prohibitive cost of private medical care
2. Increasing public health costs

1. Self-government
2. Overspecialization
3. Limitedness
4. Health
5. Government
6. Care