Stanford Health Policy is a joint effort of the Freeman Spogli Institute for International Studies and the Stanford School of Medicine
FSI researchers consider international development from a variety of angles. They analyze ideas such as how public action and good governance are cornerstones of economic prosperity in Mexico and how investments in high school education will improve China’s economy.
They are looking at novel technological interventions to improve rural livelihoods, like the development implications of solar power-generated crop growing in Northern Benin.
FSI academics also assess which political processes yield better access to public services, particularly in developing countries. With a focus on health care, researchers have studied the political incentives to embrace UNICEF’s child survival efforts and how a well-run anti-alcohol policy in Russia affected mortality rates.
FSI’s work on international development also includes training the next generation of leaders through pre- and post-doctoral fellowships as well as the Draper Hills Summer Fellows Program.
The effort to discover and develop new pharmaceuticals is a risky and costly enterprise. For diseases that affect few patients, the barriers to development maybe especially great, since the drugs' small markets may make it difficult for firms to recoup their initial research and development investments. The Federal Government has sought to reduce these barriers through incentives first adopted in the Orphan Drug Act of 1983 (Public Law 97-414). The transfer of technology from Federal laboratories such as the National Institutes of Health to the pharmaceutical industry can also reduce the cost and risk of drug development for firms. Although such incentives may result in important new therapies, their price to patients and insurers may still be high.
As part of our assessment, Government Policies and Pharmaceutical Research and
Development, requested by the House Committee on Energy and Commerce and its
Subcommittee on Health and the Environment and the Subcommittee on Antitrust,
Monopolies, and Business Rights of the Senate Committee on the Judiciary, OTA
commissioned researchers at Stanford University to examine the development and provision of alglucerase, an important new treatment for Gaucher disease. Gaucher disease is a rare inherited disorder in which the body lacks an enzyme necessary to break down fats. This background paper describes the development of alglucerase, illustrates the role that both the Federal Government and private sector can have in making new therapies available for orphan diseases, and lays out some of the tradeoffs that can exist between developing new medical technologies and controlling health care costs.
Abstract
Although economic research has not yet produced accurate estimates of the total cost of prenatal substance exposure, there is growing evidence that this exposure may result in large short-term expenditures for newborn medical intensive care and probably even larger long-term medical, social, and educational expenditures. The annual short-term economic costs due to maternal smoking are estimated to be from $332 million to $652 million (in 1986 dollars). Long-term costs due to maternal smoking are estimated at $351 million to $852 million (in 1986 dollars) per year. In comparison, the short-term economic costs for perinatal cocaine exposure are estimated at $33 million to $650 million (in 1989 dollars). The cost estimates for cocaine vary widely because accurate estimates of the number of infants born exposed to this drug each year are not available.
Programs aimed at reducing the number of women who use drugs during pregnancy, and thus reducing the overall rate of low birth weight and the need for neonatal intensive care, may be extremely cost-effective. Because of the high cost of neonatal intensive care, even moderately effective programs that address maternal substance abuse may be cost-effective and may rapidly yield savings. Substantial long-term costs may also be saved by avoiding the need for subsequent medical care and for social and special education services that may be consequences of prenatal substance exposure.
One of the most striking pieces of medical news in the 1980s revealed the connection between high blood cholesterol and a person's likelihood of developing coronary artery disease. In 1985, the National Heart, Lung, and Blood Institute of the National Institutes of Health began the National Cholesterol Education Program, whose goal was to develop a national policy for reducing serum cholesterol. However, the panel that convened to formulate recommendations for screening and treatment was instructed not to consider cost in its deliberations. As Alan Garber and Judy Wagner point out in this article, failure to include costs in the development of guidelines such as these can have "far-reaching, unanticipated effects." This point is especially relevant to the new Agency for Health care Policy and Research (AHCPR) , which was formed as part of the 1989 budget reconciliation law. One of AHCPR's express mandates is to develop condition-specific treatment guidelines for nationwide use. "If the AHCPR guidelines show the same disregard for costs" that the cholesterol guidelines showed, the authors state, "they cannot be expected to guide health dollars to their most effective use."