Currently a lot of resources are devoted to the management and care of established chronic disease, rather than more ‘upstream’ prevention activities. What do you think the balance of resources should be across the three areas of: primary prevention, secondary prevention, and disease management/tertiary prevention?
In my view the resources should be allocated in balance manner for primary, secondary and tertiary prevention.
It is generally accepted that in the public health concept that primary prevention is much better than the others. Chronic diseases such as cancer, diabetes (type II) and cardiovascular diseases are among the most common, expensive, and preventable of all health problems. Hence, primary prevention will benefit for the whole population.
However, it does not mean that the focus is only for the primary prevention. The fact of the matter is that the incidence of chronic diseases increases with age (something that is somewhat inevitable). Moreover, those with chronic diseases suffer from more than one chronic condition that leads to not only medical but also social problems. Improving care and services can benefit for reducing secondary and emergency care such as admission and length of stay. Furthermore, this can have implications for social care because people living with long-term disability are dependent on social services such as housing adaptations and personal care. Therefore, improving chronic diseases care and management is also very important.
is there indonesia version?
ReplyDeleteHow we can calculate accurately to distribute our resource especially in restricted financial resource to cover such three issues. I hope this is not hipothetical matter.
ReplyDelete>>Tukang KetikUnfortunately not. Just try learning English.. Blogging for learning and learning for sharing.. Agree??>>YusufI think it is a though question. In limited resources, what can be done? Probably, the best thing is to order the priority depending on what the main problems are.
ReplyDeleteTo some extent I agree with you , ady….The resource should be allocated in a balance manner in the three areas.However, if I have in the position of having to choose between the three, I would rather choose the primary prevention as a major focus.This is because, firstly, the primary prevention is the cheapest, less demanding, easiest way to cope with chronic disease (CD) in communities. In fact, primary prevention is the most crucial area between the three.Take for example in diabetes mellitus type 2. By allocating most or our resources to prevent people from suffering from DM, we can greatly decrease the burden of DM type2 incidence, and of course the incidence of complication of DM type 2. Thus, the fund allocation for secondary, even tertiary prevention can be minimized.Secondly, I assume that you are acknowledged that the prevalence of people who are at risk of CD is much bigger than those of the people who already suffer from CD. And it’s even much much bigger than the prevalence of those who suffer CD with complication. More resources, on the other hand, should be allocated in the area which needs more concern. In other words, people who are healthy, but at risk of suffering of DC entitled more concern (since they are the most prevalent) than the people with CD (because the later’s number is less than the previous one). Thus, fund allocation should mostly be in primary prevention.This is only a comment from less expertise person, Ady…What do you think?
ReplyDelete>>WulanThanks for a high distinction comment. It seems that you have a rapid clear thinking on this issue.Yes, I do agree on what you said especially in taking DM (typeII) for example. In the long term, the largest proportion should be given to primary prevention (may be roughly 70%??). However, in current situation, when chronic diseases are very complex, and the complexity increases with age and co-morbidity, the money should be spent wisely to cope with this problem. One evidence shows that after considering the importance of primary prevention, the US government still spent about 78% of all health care spending for the care of people with chronic conditions. This should inevitably be funded. The question probably is when we should start to focus more on primary prevention meanwhile step by step reducing the budget for management and care of chronic diseases..
ReplyDeleteIt might be because the complexity of chronic diseases that increases with age and comorbidity. That's why nowadays, even in developed countries, the money still has been spent much more in the management and care of chronic diseases instead of the primary prevention. The options you're offered are quiet interesting, in terms of what might happened in deveoping countries such as Indonesia. I mean, a decision to fund health programs sometimes is not on the basis of appropriate approach or analysis. Rather, some programs are funded due to their benefits to individuals. This is a fact that I have experienced when I was involved in a policy process in one of remote area in Indonesia.Cheers(OOT) I would appreciate if u put ur nick name or a link in which we can discuss more about health issues.. coz I thought u have a rapid clear thinking on health issues. But if it not its Ok, Just feel free to give comment. Thank you. Thumb for you..Best RegardsAdy
ReplyDeletehi there,first of all, apologize me for being anonymous. just for the comfortability of mine, trully.Second of all, just want to add some of the options for resource allocation. one of them is using economic principle to evaluate the demand and its behavior in terms of supply provided.However, as a policy maker, this should be not the prime solution. particularly in health sector context, there should also be considered on the aspect of society, legality, ethical, etc. Also, it should be aware that policy process has a close relation to politics, since policy becomes vehicle from politician to communicate to or to address issue in society.
ReplyDeleteGood point. I like ur idea in using economic principle to evaluate the demand and its behavior in terms of supply provided. Sometimes we need to make an appropriate approach in measuring need for health resources. I terms of chronic diseases, I think 'equal resources for equal need' approach is appropriate. I mean the need is defined in terms of the extent of illness or health status. This approach takes into account population characteristics that influence the demand for services.Thanks anyway for ur worthwhile comment.
ReplyDeletecould you be more detail on equal resources for equal need, please?since, in my view, it sounds promising, but is it applicable?I mean, how to measure population characteristic which influences demand.And, do you think economic evaluation per se is reliable to achieve that?thnks
ReplyDeleteWow your questions are getting complicated... What I mean is resources are allocated on the basis of some measure of the extent of illness in the population. Some of the more community use measured include: morbidity data, eg hospital separations, standardise mortality ratio (SMR) and disability adjusted life year (DALY). This is promising but I think it's hard to imply due to many limitations on the reliable data.. Does it make sense??
ReplyDeletearguably...anyway, I was wondering, despite the limitation of data, do u believe that the measurements that u discussed could answer the question on whether prevention should be allocated more, or infact by those measurements, what would happen was the other two will be allocated more?sorry for questioning ur statements, but I believe that's the way we learn about smthing, isnt it?cheers
ReplyDeleteHi,That's why in the main post I said that the resources should across in balance manner for those three, instead of more on prevention. This is for the short term, but in the long term, probably there will be improvement in many sectors that leads to the availability of all data required. Thus what we've discussed may well be apropriate.
ReplyDeletehere's the link to Canada's Best Practice policy on health sector.hopefully would enrich the knowledge on tackling the issue.rgrdshttp://cbpp-pcpe.phac-aspc.gc.ca/about/index_e.cfm
ReplyDeleteThanks FYI,You've given a cool site on Health Policy.Best Regards
ReplyDelete