Health Economics

Health Economics Indian Medical PG Question 1: In a programme, analysis of results in comparison to cost is known as

• A. Cost effective analysis
• B. Cost benefit analysis (Correct Answer)
• C. Management by objectives
• D. Cost utility study

Health Economics Explanation: ***Cost benefit analysis*** - In **cost-benefit analysis**, the **benefits of a program** are quantified in monetary terms and then compared directly with the **monetary cost** of the program. - This method is used to determine if the **monetary gain (or benefit)** from a program outweighs its monetary expenditure. *Cost effective analysis* - **Cost-effectiveness analysis** compares the **costs of alternative programs** with their effectiveness, usually measured in natural units suitable for the health outcome (e.g., lives saved, cases cured). - It does not assign a monetary value to the health outcome but rather identifies the intervention that achieves the **desired outcome at the lowest cost** or the maximum outcome for a given cost. *Management by objectives* - **Management by objectives (MBO)** is a strategic management model that aims to improve organizational performance by clearly defining objectives that are agreed to by both management and employees. - This concept is primarily about **setting goals and tracking performance** within an organization, not about analyzing program costs versus outcomes. *Cost utility study* - A **cost-utility analysis (CUA)** is a type of cost-effectiveness analysis where the health outcome is measured in **quality-adjusted life years (QALYs)** or disability-adjusted life years (DALYs). - It accounts for both the **quantity and quality of life**, but it still does not express benefits in direct monetary terms.

Health Economics Indian Medical PG Question 2: Which of the following is the sensitive indicator to assess the availability, utilization, and effectiveness of healthcare in a community?

• A. Infant mortality rate (Correct Answer)
• B. Maternal mortality rate
• C. Immunization coverage
• D. Disability-adjusted life years

Health Economics Explanation: ***Infant mortality rate*** - The **infant mortality rate (IMR)** is widely considered a sensitive indicator of a community's health status, including access to and quality of healthcare, nutrition, and environmental conditions. - A high IMR often reflects inadequate maternal and child health services, poor sanitation, and socioeconomic disparities within a population. *Maternal mortality rate* - While a critical indicator of the health system's ability to provide safe pregnancy and childbirth services, the **maternal mortality rate (MMR)** specifically reflects women's health during gestation and postpartum. - It does not encompass the broader spectrum of health determinants that affect infants, such as postnatal care, nutrition, and infectious disease control, as comprehensively as IMR. *Immunization coverage* - **Immunization coverage** is an excellent indicator of the reach and effectiveness of preventive health services for infectious diseases. - However, it is a specific measure of program implementation, not a comprehensive indicator of overall healthcare availability, utilization, or effectiveness across all health domains. *Disability-adjusted life years* - **Disability-adjusted life years (DALYs)** measure the total healthy life years lost due to premature mortality and disability from specific diseases and injuries. - While a valuable concept for burden of disease analysis, DALYs are a complex measure of population health outcome, rather than a direct and sensitive indicator of the operational aspects of healthcare like availability and utilization.

Health Economics Indian Medical PG Question 3: In community health programs, a population of 1000 is typically covered by which healthcare worker?

• A. ASHA worker (Correct Answer)
• B. ANM (Auxiliary Nurse Midwife)
• C. AWW (Anganwadi Worker)
• D. Trained dai

Health Economics Explanation: ***ASHA worker*** - An **ASHA (Accredited Social Health Activist) worker** is the primary community health worker who covers a population of **1,000** in community health programs. - Under the **National Health Mission (NHM)**, one ASHA is appointed for every **1,000 population** in rural areas or per village. - Their roles include facilitating access to health services, health awareness, promoting institutional deliveries, immunization, and serving as a bridge between the community and the public health system. *Trained dai* - **Trained dais (Traditional Birth Attendants)** were historically used but this program has been largely discontinued. - The focus has shifted from home deliveries by dais to **institutional deliveries** assisted by skilled birth attendants. - While they may have covered populations in the past, they are not part of the current structured community health workforce. *ANM (Auxiliary Nurse Midwife)* - An **ANM** serves a **much larger population** of approximately **5,000** at the sub-center level. - They provide primary health services including maternal and child health, family planning, immunization, and basic curative care. - One ANM is typically posted at each sub-center. *AWW (Anganwadi Worker)* - An **AWW** covers a **smaller population** of approximately **400-800 in rural areas** and up to **1,000 in urban/tribal areas**. - They primarily focus on **early childhood care and development** through Anganwadi centers under the ICDS scheme. - Their functions include supplementary nutrition, preschool education, and health and nutrition education for women and children.

Health Economics Indian Medical PG Question 4: Consider the following definitions: 'Effectiveness measures the extent to which predetermined objectives are achieved. Efficiency measures how well the resources are utilized.' In view of these definitions, which of the following assertions are true? 1. Percentage of bed occupancy measures effectiveness 2. Immunization coverage rate measures efficiency 3. Cost per patient treated measures efficiency 4. Reduction in mortality measures effectiveness Select the correct answer using the code given below:

• A. 2 and 3 only
• B. 1 and 2
• C. 2, 3 and 4
• D. 3 and 4 only (Correct Answer)

Health Economics Explanation: ***Correct: 3 and 4 only*** **Analysis of each assertion:** - **Assertion 1 (Percentage of bed occupancy measures effectiveness)** - FALSE - Bed occupancy rate reflects how well bed resources are being utilized - This is an **efficiency** measure, not effectiveness - **Assertion 2 (Immunization coverage rate measures efficiency)** - FALSE - Immunization coverage measures the proportion of target population vaccinated, indicating achievement of a public health objective - This is an **effectiveness** measure, not efficiency - **Assertion 3 (Cost per patient treated measures efficiency)** - TRUE ✓ - This directly measures how well resources (money, staff, supplies) are utilized per unit output - This is an **efficiency** measure - **Assertion 4 (Reduction in mortality measures effectiveness)** - TRUE ✓ - This directly reflects achievement of predetermined health objectives (saving lives) - This is an **effectiveness** measure **Therefore, only assertions 3 and 4 are correct.** *Incorrect: 2 and 3 only* - While assertion 3 is correct (efficiency), assertion 2 is incorrect because immunization coverage rate measures effectiveness, not efficiency *Incorrect: 1 and 2* - Assertion 1 is incorrect because bed occupancy measures efficiency, not effectiveness - Assertion 2 is incorrect because immunization coverage measures effectiveness, not efficiency *Incorrect: 2, 3 and 4* - Assertion 2 is incorrect because immunization coverage rate measures effectiveness, not efficiency - While assertions 3 and 4 are correct, including assertion 2 makes this option wrong

Health Economics Indian Medical PG Question 5: Disability-adjusted life years (DALYs) measure the burden of disease by accounting for both:

• A. None of the options
• B. Morbidity and disability
• C. Mortality and disability (Correct Answer)
• D. Morbidity and mortality

Health Economics Explanation: ***Mortality and disability*** - **DALYs** quantify the overall burden of disease by combining years of life lost due to **premature mortality** and years lived with disability. - This metric provides a comprehensive measure of disease impact, reflecting both the fatal and non-fatal consequences of illness. *Morbidity and disability* - While both **morbidity** (illness) and **disability** contribute to disease burden, DALYs specifically quantify the years lived with disability, not just the general state of morbidity. - **Morbidity** is a broader term encompassing any illness or disease, which doesn't fully capture the "years lost" component of DALYs. *None of the options* - This option is incorrect because **DALYs** are explicitly defined by the combination of mortality and disability. - The definition of **DALYs** is standard in public health and epidemiology. *Morbidity and mortality* - Although both **morbidity** and **mortality** are crucial aspects of population health, DALYs use **disability** (specifically "years lived with disability" or YLDs) in conjunction with **mortality** ("years of life lost" or YLLs). - Simply using "morbidity" is less precise than "disability" when defining the components of DALYs.

Health Economics Indian Medical PG Question 6: Which of the following statements is TRUE regarding Disability-Adjusted Life Year (DALY)?

• A. Years lost due to disability (YLD) are not considered in DALY.
• B. DALY only measures mortality and does not include morbidity.
• C. DALY does not account for both YLD and YLL.
• D. DALY includes both Years of Life Lost (YLL) and Years Lived with Disability (YLD). (Correct Answer)

Health Economics Explanation: ***DALY includes both Years of Life Lost (YLL) and Years Lived with Disability (YLD).*** - This statement is **correct**. The fundamental formula is **DALY = YLL + YLD**. - **YLL (Years of Life Lost)** quantifies the burden of premature mortality by measuring years of potential life lost due to early death. - **YLD (Years Lived with Disability)** quantifies the burden of morbidity by measuring time lived in states of less than full health. - **DALY** is a comprehensive health metric designed to capture the total burden of disease by integrating both mortality and morbidity components. - This unified metric allows comparison of disease burden across different conditions and populations. *Years of Life Lost (YLL) is not included in DALY calculations.* - This is **incorrect**. YLL is a core component of DALY calculations, representing the mortality burden. *Years lost due to disability (YLD) are not considered in DALY.* - This is **incorrect**. YLD is an essential component of DALY, representing the morbidity burden. *DALY only measures mortality and does not include morbidity.* - This is **incorrect**. DALY explicitly measures both mortality (through YLL) and morbidity (through YLD), making it a comprehensive burden of disease measure.

Health Economics Indian Medical PG Question 7: In a population of 5000, there are 19 % eligible couples. To achieve a couple protection rate (CPR) of 60 %, how many of these should be covered for family planning services?

• A. 550
• B. 530
• C. 590
• D. 570 (Correct Answer)

Health Economics Explanation: ***570*** - First, calculate the total number of **eligible couples**: 19% of 5000 = (19/100) * 5000 = **950 couples**. - To achieve a **Couple Protection Rate (CPR) of 60%**, calculate 60% of the eligible couples: 60% of 950 = (60/100) * 950 = **570 couples**. *550* - This option indicates a protection rate of approximately **57.9%** (550/950 * 100), which is less than the target of 60%. - It does not meet the specified target for **Couple Protection Rate**. *530* - This option would result in a protection rate of approximately **55.8%** (530/950 * 100), which is significantly lower than the desired 60%. - This value is an underestimation of the number of couples needed to achieve the target CPR. *590* - This option indicates a protection rate of approximately **62.1%** (590/950 * 100), which exceeds the target of 60%. - While protecting more couples is generally good, the question asks for how many *should* be covered to achieve *60%* specifically, making 570 the exact answer.

Health Economics Indian Medical PG Question 8: The most comprehensive indicator of cost-effectiveness analysis is

• A. Number of heart attacks avoided
• B. Cost per life year gained
• C. Number of life years gained
• D. QALYs gained (Correct Answer)

Health Economics Explanation: ***QALYs gained*** - **Quality-Adjusted Life Years (QALYs)** is the most comprehensive measure in cost-effectiveness analysis as it accounts for both the quantity and quality of life - Combines years of life added with a utility score reflecting health-related quality of life during those years - Provides a holistic view that captures both mortality and morbidity benefits of interventions *Number of heart attacks avoided* - Specific to a single clinical outcome and does not account for other health benefits or adverse effects - While important for cardiovascular interventions, it is too narrow to serve as a comprehensive cost-effectiveness indicator - Does not capture broader impact on overall health, quality of life, or longevity *Cost per life year gained* - Focuses on the quantity (length) of life gained but does not consider the quality of those gained years - An intervention might add years of life that are of poor quality, which this measure cannot differentiate - Less comprehensive than QALYs as it misses the health status dimension *Number of life years gained* - Only considers the extension of life without incorporating health status or quality of life during additional years - Provides an incomplete picture as it treats all life years equally regardless of health state - A longer life with significant disability would be valued the same as healthy years

Health Economics Indian Medical PG Question 9: Which of the following is false about the selection of essential drugs?

• A. Cost to benefit has to be considered
• B. Fixed drug combination is preferred over single drugs (Correct Answer)
• C. An adequate safety profile needs to be established
• D. Disease prevalence is considered

Health Economics Explanation: ***Fixed drug combination is preferred over single drugs*** - The statement that **fixed-drug combinations (FDCs)** are preferred over single drugs for essential drug selection is false. Generally, **single drugs are preferred** to allow for individual dose adjustments and minimize potential adverse effects from unnecessary components. - FDCs are only considered essential when they offer specific advantages, such as **improved adherence** (e.g., in tuberculosis treatment) or a **synergistic effect** not achievable with individual drugs. *Cost to benefit has to be considered* - This statement is true; the **cost-effectiveness** and **cost-benefit ratio** are crucial factors in selecting essential drugs. - Essential drugs aim to provide the most public health benefit at an **affordable cost**, ensuring access for a broad population. *An adequate safety profile needs to be established* - This statement is true; essential drugs must have a **well-established safety profile** with acceptable risks. - The benefits of the drug must significantly outweigh its potential harms, with minimal serious **adverse reactions**. *Disease prevalence is considered* - This statement is true; essential drugs are selected based on their ability to address the **most prevalent diseases** and health needs of a population. - Prioritizing drugs for common conditions ensures that public health resources are effectively allocated to where they are most needed.

Health Economics Indian Medical PG Question 10: What is the most cost-effective screening strategy for STIs in resource-limited settings according to WHO guidelines?

• A. Risk-based screening
• B. Periodic mass treatment
• C. Syndromic management (Correct Answer)
• D. Universal screening

Health Economics Explanation: ***Syndromic management*** - This approach involves diagnosing and treating STIs based on the **clinical symptoms** presented by the patient, without the need for expensive laboratory tests. - It is highly cost-effective in resource-limited settings as it reduces the need for costly diagnostics while ensuring prompt treatment to prevent complications and onward transmission. *Risk-based screening* - While helpful, identifying high-risk individuals and conducting targeted screening still requires some level of diagnostic testing, which can be **expensive** or **unavailable** in resource-limited settings. - It may miss STIs in individuals who do not fit predefined risk categories but are still infected. *Periodic mass treatment* - This strategy involves treating a large population group for STIs regardless of their symptom status, which can lead to **antimicrobial resistance** and is not specifically recommended by WHO for routine STI control. - It is generally **inefficient** and potentially wasteful of resources, as many individuals treated may not be infected. *Universal screening* - This approach involves comprehensive diagnostic testing for all individuals, which is highly effective but **prohibitively expensive** and logistically challenging for resource-limited settings. - It requires significant infrastructure for laboratory testing and follow-up, which is often lacking where resources are scarce.

Health Economics Flashcard 1 of 10

Question: The _____ analysis provides information on how much input is needed to produce a unit amount of output.

Answer: input-output

Health Economics Flashcard 2 of 10

Question: 1cbab20eae4f4cfd898e3c83f0d0788a-ao-1

Answer: malthusian growth model

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Health Economics Flashcard 3 of 10

Question: 1cbab20eae4f4cfd898e3c83f0d0788a-ao-4

Answer: malthusian growth model

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Health Economics Flashcard 4 of 10

Question: _____ assesses value for money for health interventions

Answer: QALY

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Health Economics Flashcard 5 of 10

Question: target of health expenditure to _____% of GDP by year 2025

Answer: 2.5

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Health Economics Flashcard 6 of 10

Question: standard of living depends upon _____

Answer: income

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Health Economics Flashcard 7 of 10

Question: 1. Identify → _____

Answer: Rashtriya Swasthya Bima Yojana

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Health Economics Flashcard 8 of 10

Question: 1cbab20eae4f4cfd898e3c83f0d0788a-ao-2

Answer: malthusian growth model

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Health Economics Flashcard 9 of 10

Question: 1cbab20eae4f4cfd898e3c83f0d0788a-ao-3

Answer: malthusian growth model

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Health Economics Flashcard 10 of 10

Question: conceopt of poverty line was introduced in india by _____ committee and _____ committee

Answer: tendulkar

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