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Preventing childhood obesity
Children's health has made tremendous strides over the past century. In general, life expectancy has increased by more than thirty years since 1900 and much of this improvement is due to the reduction of infant and early
childhood mortality. Given this trajectory toward a healthier childhood, we
begin the 21st-century with a shocking development-an epidemic of obesity
in children and youth. The increased number of obese children
throughout the U.S. during the past 25 years has led policymakers to rank
it as one of the most critical public health threats of the 21st-century.
Preventing Childhood Obesity provides a broad-based examination of the
nature, extent, and consequences of obesity in U.S. children and youth,
including the social, environmental, medical, and dietary factors responsible
for its increased prevalence. The book also offers a prevention-oriented
action plan that identifies the most promising array of short-term and
longer-term interventions, as well as recommendations for the roles and
responsibilities of numerous stakeholders in various sectors of society to
reduce its future occurrence. Preventing Childhood Obesity explores the
underlying causes of this serious health problem and the actions needed to
initiate, support, and sustain the societal and lifestyle changes that can
reverse the trend among our children and youth.
eBook
Effect on maternal and child health services in Rwanda of payment to primary health-care providers for performance: an impact evaluation
Evidence about the best methods with which to accelerate progress towards achieving the Millennium Development Goals is urgently needed. We assessed the effect of performance-based payment of health-care providers (payment for performance; P4P) on use and quality of child and maternal care services in health-care facilities in Rwanda.
166 facilities were randomly assigned at the district level either to begin P4P funding between June, 2006, and October, 2006 (intervention group; n=80), or to continue with the traditional input-based funding until 23 months after study baseline (control group; n=86). Randomisation was done by coin toss. We surveyed facilities and 2158 households at baseline and after 23 months. The main outcome measures were prenatal care visits and institutional deliveries, quality of prenatal care, and child preventive care visits and immunisation. We isolated the incentive effect from the resource effect by increasing comparison facilities' input-based budgets by the average P4P payments made to the treatment facilities. We estimated a multivariate regression specification of the difference-in-difference model in which an individual's outcome is regressed against a dummy variable, indicating whether the facility received P4P that year, a facility-fixed effect, a year indicator, and a series of individual and household characteristics.
Our model estimated that facilities in the intervention group had a 23% increase in the number of institutional deliveries and increases in the number of preventive care visits by children aged 23 months or younger (56%) and aged between 24 months and 59 months (132%). No improvements were seen in the number of women completing four prenatal care visits or of children receiving full immunisation schedules. We also estimate an increase of 0·157 standard deviations (95% CI 0·026–0·289) in prenatal quality as measured by compliance with Rwandan prenatal care clinical practice guidelines.
The P4P scheme in Rwanda had the greatest effect on those services that had the highest payment rates and needed the least effort from the service provider. P4P financial performance incentives can improve both the use and quality of maternal and child health services, and could be a useful intervention to accelerate progress towards Millennium Development Goals for maternal and child health.
World Bank's Bank-Netherlands Partnership Program and Spanish Impact Evaluation Fund, the British Economic and Social Research Council, Government of Rwanda, and Global Development Network.
Journal Article
Cost–effectiveness of results-based financing, Zambia: a cluster randomized trial
To evaluate the cost-effectiveness of results-based financing and input-based financing to increase use and quality of maternal and child health services in rural areas of Zambia.
In a cluster-randomized trial from April 2012 to June 2014, 30 districts were allocated to three groups: results-based financing (increased funding tied to performance on pre-agreed indicators), input-based financing (increased funding not tied to performance) or control (no additional funding), serving populations of 1.33, 1.26 and 1.40 million people, respectively. We assessed incremental financial costs for programme implementation and verification, consumables and supervision. We evaluated coverage and quality effectiveness of maternal and child health services before and after the trial, using data from household and facility surveys, and converted these to quality-adjusted life years (QALYs) gained.
Coverage and quality of care increased significantly more in results-based financing than control districts: difference in differences for coverage were 12.8% for institutional deliveries, 8.2% postnatal care, 19.5% injectable contraceptives, 3.0% intermittent preventive treatment in pregnancy and 6.1% to 29.4% vaccinations. In input-based financing districts, coverage increased significantly more versus the control for institutional deliveries (17.5%) and postnatal care (13.2%). Compared with control districts, 641 more lives were saved (lower-upper bounds: 580-700) in results-based financing districts and 362 lives (lower-upper bounds: 293-430) in input-based financing districts. The corresponding incremental cost-effectiveness ratios were 809 United States dollars (US$) and US$ 413 per QALY gained, respectively.
Compared with the control, both results-based financing and input-based financing were cost-effective in Zambia.
Journal Article
Economic returns on investing in early childhood development in Vietnam: a cost-benefit analysis
Background
Economic evidence on the long-term benefits of investing in early childhood development is limited. This study aimed to estimate the potential long-term economic benefits of an early childhood development intervention ‘Learning Clubs’ in Vietnam.
Methods
We conducted a cost-benefit analysis to estimate the costs and benefits of the intervention compared to the standard of care from a limited societal perspective. The intervention cost and child cognitive development outcome were derived from the published ‘Learning Clubs’ trial-based cost-effectiveness analysis. Benefits were monetised based on the gains in wages associated with improved cognitive development over a lifetime at the population level, using a life-table model. The benefit-cost ratio was estimated as the benefits in wages divided by the intervention cost with a 3% discount rate, assuming nationwide scale up to a hypothetical national birth cohort. Sensitivity, scenario, and threshold analyses were conducted to examine the uncertainty around the model.
Results
The benefit-cost ratio was 5.52, indicating that the expected benefit for each US$1 invested would be US$5.52. The intervention would generate economic benefits of US$1,566 per child over their lifetime. Upon nationwide scale-up, the total benefit would amount to US$2.28 billion per national annual birth cohort. Probabilistic sensitivity analyses estimated the benefit-cost ratio to be 5.90 (95%CI 2.66 to 11.12). The findings were relatively robust as the benefit-cost ratios remained above 1 in all sensitivity and scenario analyses.
Conclusions
Our findings support greater investments in early childhood development. The Excel-based model is available for further use and adaption to other settings.
Journal Article
Children With Medical Complexity And Medicaid: Spending And Cost Savings
A small but growing population of children with medical complexity, many of whom are covered by Medicaid, accounts for a high proportion of pediatric health care spending. We first describe the expenditures for children with medical complexity insured by Medicaid across the care continuum. We report the increasingly large amount of spending on hospital care for these children, relative to the small amount of primary care and home care spending. We then present a business case that estimates how cost savings might be achieved for children with medical complexity from potential reductions in hospital and emergency department use and shows how the savings could underwrite investments in outpatient and community care. We conclude by discussing the importance of these findings in the context of Medicaid's quality of care and health care reform.
Journal Article