Packaging health services when resources are limited: the example of a cervical cancer screening visit

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Packaging health services when resources are limited: the example of a cervical cancer screening visit

Show simple item record Kim, Jane Jooyun Salomon, Joshua A. Weinstein, Milton C. Goldie, Sue J. 2011-04-28T05:45:53Z 2006
dc.identifier.citation Kim, Jane J., Joshua A. Salomon, Milton C. Weinstein, and Sue J. Goldie. 2006. Packaging health services when resources are limited: the example of a cervical cancer screening visit. PLoS Medicine 3(11): e434. en_US
dc.identifier.issn 1549-1277 en_US
dc.description.abstract Background: Increasing evidence supporting the value of screening women for cervical cancer once in their lifetime, coupled with mounting interest in scaling up successful screening demonstration projects, present challenges to public health decision makers seeking to take full advantage of the single-visit opportunity to provide additional services. We present an analytic framework for packaging multiple interventions during a single point of contact, explicitly taking into account a budget and scarce human resources, constraints acknowledged as significant obstacles for provision of health services in poor countries. Methods and Findings: We developed a binary integer programming (IP) model capable of identifying an optimal package of health services to be provided during a single visit for a particular target population. Inputs to the IP model are derived using state-transition models, which compute lifetime costs and health benefits associated with each intervention. In a simplified example of a single lifetime cervical cancer screening visit, we identified packages of interventions among six diseases that maximized disability-adjusted life years (DALYs) averted subject to budget and human resource constraints in four resource-poor regions. Data were obtained from regional reports and surveys from the World Health Organization, international databases, the published literature, and expert opinion. With only a budget constraint, interventions for depression and iron deficiency anemia were packaged with cervical cancer screening, while the more costly breast cancer and cardiovascular disease interventions were not. Including personnel constraints resulted in shifting of interventions included in the package, not only across diseases but also between low- and high-intensity intervention options within diseases. Conclusions: The results of our example suggest several key themes: Packaging other interventions during a one-time visit has the potential to increase health gains; the shortage of personnel represents a real-world constraint that can impact the optimal package of services; and the shortage of different types of personnel may influence the contents of the package of services. Our methods provide a general framework to enhance a decision maker's ability to simultaneously consider costs, benefits, and important nonmonetary constraints. We encourage analysts working on real-world problems to shift from considering costs and benefits of interventions for a single disease to exploring what synergies might be achievable by thinking across disease burdens. en_US
dc.language.iso en_US en_US
dc.publisher Public Library of Science en_US
dc.relation.isversionof doi:10.1371/journal.pmed.0030434 en_US
dc.relation.hasversion en_US
dash.license LAA
dc.subject health economics en_US
dc.subject health policy en_US
dc.subject mental health en_US
dc.subject obstetrics en_US
dc.subject gynecology en_US
dc.subject primary care en_US
dc.subject women's health en_US
dc.subject epidemiology en_US
dc.subject screening en_US
dc.subject cervical screening en_US
dc.subject public health en_US
dc.subject general practice en_US
dc.subject family practice en_US
dc.title Packaging health services when resources are limited: the example of a cervical cancer screening visit en_US
dc.type Journal Article en_US
dc.description.version Version of Record en_US
dc.relation.journal PLoS Medicine en_US Kim, Jane Jooyun 2011-04-28T05:45:53Z
dash.affiliation.other SPH^Global Health + Population en_US
dash.affiliation.other SPH^Center for Risk Analysis en_US
dash.affiliation.other SPH^Health Policy and Management en_US
dash.affiliation.other HMS^Medicine-Brigham and Women's Hospital en_US
dash.affiliation.other SPH^Health Policy and Management en_US

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