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dc.contributor.authorKim, Jane Jooyun
dc.contributor.authorSalomon, Joshua A.
dc.contributor.authorWeinstein, Milton C.
dc.contributor.authorGoldie, Sue J.
dc.date.accessioned2011-04-28T05:45:53Z
dc.date.issued2006
dc.identifier.citationKim, 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.issn1549-1277en_US
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:4878933
dc.description.abstractBackground: 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.isoen_USen_US
dc.publisherPublic Library of Scienceen_US
dc.relation.isversionofdoi:10.1371/journal.pmed.0030434en_US
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC1635742/pdf/en_US
dash.licenseLAA
dc.subjecthealth economicsen_US
dc.subjecthealth policyen_US
dc.subjectmental healthen_US
dc.subjectobstetricsen_US
dc.subjectgynecologyen_US
dc.subjectprimary careen_US
dc.subjectwomen's healthen_US
dc.subjectepidemiologyen_US
dc.subjectscreeningen_US
dc.subjectcervical screeningen_US
dc.subjectpublic healthen_US
dc.subjectgeneral practiceen_US
dc.subjectfamily practiceen_US
dc.titlePackaging health services when resources are limited: the example of a cervical cancer screening visiten_US
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden_US
dc.relation.journalPLoS Medicineen_US
dash.depositing.authorKim, Jane Jooyun
dc.date.available2011-04-28T05:45:53Z
dash.affiliation.otherSPH^Global Health + Populationen_US
dash.affiliation.otherSPH^Center for Risk Analysisen_US
dash.affiliation.otherSPH^Health Policy and Managementen_US
dash.affiliation.otherHMS^Medicine-Brigham and Women's Hospitalen_US
dash.affiliation.otherSPH^Health Policy and Managementen_US
dc.identifier.doi10.1371/journal.pmed.0030434*
dash.contributor.affiliatedGoldie, Sue
dash.contributor.affiliatedKim, Jane
dash.contributor.affiliatedWeinstein, Milton
dash.contributor.affiliatedSalomon, Joshua
dc.identifier.orcid0000-0003-3929-5515


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