Accounting for institutional change in health economic evaluation: A program to tackle HIV/AIDS and gender violence in Southern Africa
Accounting for institutional change in health economic evaluation: A program to tackle HIV/AIDS and gender violence in Southern Africa
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DOI：
10.1016/j.socscimed.2007.11.010
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发表时间：
2008-02-01
影响因子：
5.4
通讯作者：
Kim, Julia
中科院分区：
文献类型：
--
作者：
Jan, Stephen;Pronyk, Paul;Kim, Julia
在卫生经济学文献中，对制度主义观点的应用越来越感兴趣。本文探讨了社会价值的制度主义概念及其在经济评估中的应用，特别是针对南部非洲艾滋病毒/艾滋病和性别暴力的计划（IMAGE）。制度是规范个人、团体和组织之间行为的规则。它们的社会价值源于它们能够减少人类互动的不确定性，从而降低交易成本，重要的是，使各种活动能够启动和可持续（工具价值）。此外，制度往往是围绕某些道德立场形成的，因此，将未来的决策与这些立场（内在价值）联系起来。将这种社会价值观念纳入传统的福利衡量标准是有问题的，因为体制发展不一定与个人效用相一致。机构化方法允许将这些额外领域纳入经济评估，IMAGE是一项干预措施，通过小额供资、健康教育和社区发展减少性别暴力和艾滋病毒，并涉及对机构建设活动的大量初始投资，特别是通过对方案工作人员和社区成员的培训活动。采用制度主义方法评估IMAGE的关键是理解可被视为制度建设的行动的性质，并确定：（1）通过在反映干预所获得的经济效益的范围内适当摊销交易成本，确定后续活动的工具价值;以及（2）通过先验概念模型提供信息的成本-后果方法，确定社区任何转型的内在价值。本案例研究强调了卫生部门的干预措施如何影响体制变革，以及如何在基于理论的经济评估框架内捕捉这些变化。(C)2007爱思唯尔有限公司保留所有权利。
There has been growing interest in the application of institutionalist perspectives in the health economics literature. This paper investigates the institutionalist notion of social value and its use in economic evaluation with particular reference to a program to address HIV/AIDS and gender violence in Southern Africa (IMAGE). Institutions are the rules that govern the conduct between individuals, groups and organisations. Their social value stems from their capacity to reduce the uncertainty in human interactions thereby both reducing transaction costs and, importantly, enabling the initiation and sustainability of various activities (instrumental value). Furthermore, institutions tend to be formed around certain ethical positions and as a consequence, act in binding future decision making to these positions (intrinsic value). Incorporating such notions of social value within a conventional welfare-based measure of benefit is problematic as institutional development is not necessarily consistent with individual utility. An institutionalist approach allows for these additional domains to be factored into economic evaluation.IMAGE is an intervention to reduce gender violence and HIV through microfinance, health education and community development, and involves significant initial investment in institution-building activities, notably through training activities with pro-gram staff and community members. The key to employing an institutionalist approach to the evaluation of IMAGE is in understanding the nature of those actions that can be seen as institution-building and determining: (1) the instrumental value of follow-up activities by appropriate amortisation of transaction costs over an horizon that reflects the economies gained from the intervention; and (2) the intrinsic value of any transformation in the community through a cost-consequences approach informed by an a priori conceptual model. This case study highlights how health sector interventions can effect institutional changes and how these are captured within a theory-based economic evaluation framework. (C) 2007 Elsevier Ltd. All rights reserved.