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BURGESS BOOKS
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Multi-Dimension Impact Accounting
Accounting for ALL the Capitals ... for Society, Nature and the Economy
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Section VIII
Health Sector
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Why is this book being written? What does the writer hope to achieve? What sort of impact will a changed paradigm for development produce?
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MULTI DIMENSION IMPACT ACCOUNTING (MDIA)
The TrueValueMetrics Book – Section VIII
MULTI DIMENSION
IMPACT ACCOUNTING
(MDIA)
The TrueValueMetrics Book
Section VIII
The Socio-Economic Dynamic
of Different Sectors
TVM-Book-Section-8-131025a.odt Page 1
Copyright (c) 2013 Peter Burgess
MULTI DIMENSION IMPACT ACCOUNTING (MDIA)
The TrueValueMetrics Book –
Section VIII
The Socio-Economic Dynamic
of the Health Sector
Health is a big element of good quality of life
Good health is at the center of a good quality of life. When a person's health is compromised in
any way, quality of life deteriorates.
The expectation of good health changes with age, but at any age, quality of life is lower when
health is poor compared to when health is good.
Economics ... a truly dismal science
For most rich countries ... expectation of life has increased substantially over the past hundred
years ... which is good. For those who are not in the rich countries ... and without big fortunes ...
the healthcare system is problematic. Expectation of life in poor communities around the world
is something like half what it is in rich countries ... with rates of infant mortality ... complications
of pregnancy ... and prevalence of all sorts of preventable disease that are simply awful.
The bad news is that real world market economics does not result in good outcomes in healthcare
... market economics and healthcare are incompatible systems and produce dysfunctional
outcomes. The tools for analysis used by economists are insufficient ... inadequate ... to manage
resources in healthcare. Techniques that work for scientific research do not work well for
managing resources. Good management accounting, however, has techniques that can get clarity
about matters and what does not.
Each of the interventions needed for sustainable success in malaria control builds on a different
foundation of science, and must be planned for and implemented in different ways. All
interventions have two things in common: (1) they have costs; and, (2) they contribute more or
less to impact. They are planned differently and have different cost and impact behavior. The best
... most cost effective ... outcome is not always apparent because the science is complex as is
society.
A better system of metrics
There is no good reason for not having the data about cost of healthcare, what it paid for, and the
impact for each and every community.
Guideline
It is understandable that there is some doubt about how things will turn out in the
future ... but there is absolutely no excuse for not knowing how things have
worked out in the past.
Revise this to reflect Multi Dimension Impact Accounting (MDIA) methodology
The data centric aspect of IMM addresses the need for the metrics that are essential to the
management of scarce resources ... the essence is economy. The conceptual framework for IMM
TVM-Book-Section-8-131025a.odt Page 2
Copyright (c) 2013 Peter Burgess
MULTI DIMENSION IMPACT ACCOUNTING (MDIA)
The TrueValueMetrics Book – Section VIII
data derived from the Community Analytics (CA) Methodology is more aligned with science and
accountancy than with the techniques of the social sciences and statistics.
CA builds on ideas from science and engineering, economic and accountancy. The understanding
of cost is simple relative to much of science and engineering ... but not well done. It is possible
to calculate what costs should be using technical considerations and simple arithmetic ... and it is
possible to know what actual costs are using equally simple cost accounting. The fact that such
data are not compiled and available is a failure of management pure and simple ... usually
because management knows that such data will highlight poor performance and create
embarrassment, if nothing more serious. Cost efficiency is the idea that actual costs may be
compared to a theoretical standard of what costs should be ... a common practice in corporate
organizations.
It is possible to calculate cost effectiveness using similar concepts. The idea is simply to relate
the resources used ... costs ... with the value realized, or the impact on the community. The
quantification of value is not easy ... and very much a subjective exercise ... but it is not
impossible. CA has developed an approach where a standard value is assigned to all matters of
importance in a community ... and progress may be measured using changes in this value.
Cost effectiveness in malaria control
Because the various possible malaria control interventions work in different ways, the problem
of resistance is minimized ... but it is also true that these interventions also provide a multiplier
effect. In simplistic terms it makes sense to combine environmental controls, source control,
dwelling repellency (IRS), personal protection (bednets) and medical therapy to reduce not only
the medical impact, but also the transmission. There are very complex linkages between the
different elements with no reliable information on how these various interventions can be
optimized ... but it is nevertheless apparent that a combination of interventions is significantly
better than a single intervention.
Cost effectiveness for community health
The case for integration of health programs is strong. The following data from WHO in 2000
shows the relative importance of diarrhea, acute respiratory disease and malaria for under 5 child
mortality. While malaria mortality is high, so also is mortality from diarrhea and acute
respiratory disease. From a purely medical perspective none of these diseases should be life
threatening for young children. If there is no accessible health infrastructure there is going to be
mortality that would otherwise be preventable. The data show that HIV-AIDS and TB are the
diseases associated with high mortality for older children and adults.
TVM-Book-Section-8-131025a.odt Page 3
Copyright (c) 2013 Peter Burgess
MULTI DIMENSION IMPACT ACCOUNTING (MDIA)
The TrueValueMetrics Book – Section VIII
These data suggest that the most cost effective successful health performance at the community
level will be one where there is a broader clinical capacity rather than one that has only a single
disease focus. Infrastructure is most cost effective when the system has the capacity to address
all the main diseases, and not just a single one.
Integrated multi-disease efficiency
A system that has the capability to reduce mortality caused by diarrhea, acute respiratory
infections and malaria is going to have a level of cost effectiveness way better than one that only
treats malaria ... or only treats an other single disease. Some data from studies conducted in
Zambia suggest that where interventions to reduce the prevalence of malaria have worked, infant
mortality from other causes remained high. This indication is another element that has motivated
a strong focus on community health performance and the spatial dimensions of the IMM
approach.
Smart healthcare strategy
But while the issue of resources for malaria is important ... the way all resources in the health
sector are used may well be even more important. Resources that are of use to improve malaria
performance may, at the same time, improve the situation for other diseases ... and together the
burden of disease in the community then becomes very much reduced. In smart health ... the
most amount of good health is achieved at the least cost. With smart health data, decisions are
measured based on the impact there is on health outcomes and cost effectiveness.
With community health
infrastructure
No community health
infrastructure
No community health
infrastructure
The better way Good luck outcome Bad luck outcome
TVM-Book-Section-8-131025a.odt Page 4
Copyright (c) 2013 Peter Burgess
MULTI DIMENSION IMPACT ACCOUNTING (MDIA)
The TrueValueMetrics Book – Section VIII
A person feels ill A person feels ill A person feels ill
Easy visit to the clinic Waits in hope illness will go away Waits in hope illness will go away
Quick accurate diagnosis Illness gets worse Illness gets worse
Treatment specified Have to find transport Have to find transport
Pays for clinic Pay for transport Pay for transport
Drugs purchased ... pay for drugs Get to clinic Get to clinic
Treatment started Wait in line Wait in line
Person goes home Maybe have to wait to next day ...
stay overnight or redo the journey.
Maybe have to wait to next day ...
stay overnight or redo the journey.
Person gets better See health worker ... get diagnosis See health worker ... get diagnosis
Treatment specified Needs hospitalization
Clinic paid for Clinic paid for
Buy drugs ... pay for drugs Pay for hospital
Treatment starts Treatment starts
Patient goes home Buy drugs ... pay for drugs
Treatment too late
Patient dies
It really does not matter what disease a patient has ... they need access to medical care. Medical
care is more effective when the diagnosis is timely, the diagnosis is correct and treatment is given
soon after the onset of the symptoms.
This requires a functioning health infrastructure that is easily accessible to the local population.
The community health infrastructure may well be the most important determinant of the health of
the people in the community. If timeliness is important ... then a community health care presence
is very valuable. But community health is improved with local infrastructure because the process
is lower cost as well as the outcomes being better. The table shows how this works:
One of the most valuable metrics for health sector planning in developing countries would be to
know the cost and the impact of the community clinic ... or even just the community health
worker ... having cost and impact well documented. Some understanding of how disease
progresses and treatment progresses suggests that early intervention at the community level is a
very good way to go ... but not much data about this seems to exist.
TVM-Book-Section-8-131025a.odt Page 5
Copyright (c) 2013 Peter Burgess
MULTI DIMENSION IMPACT ACCOUNTING (MDIA)
The TrueValueMetrics Book – Section VIII
The Socio-Economic Dynamic
of the Education Sector
Education is valuable
TVM-Book-Section-8-131025a.odt Page 6
Copyright (c) 2013 Peter Burgess
MULTI DIMENSION IMPACT ACCOUNTING (MDIA)
The TrueValueMetrics Book – Section VIII
The Socio-Economic Dynamic
of the Employment Sector
Education is valuable
TVM-Book-Section-8-131025a.odt Page 7
Copyright (c) 2013 Peter Burgess
MULTI DIMENSION IMPACT ACCOUNTING (MDIA)
The TrueValueMetrics Book – Section VIII
Heading 1 … 40pt
Heading 2 … 28pt
Heading 3 … 18pt
Heading 4 … 16pt
Heading 5 … 15pt
Heading 6 … 14pt
Heading 7 … 13pt
Heading 8 … 12 pt
Heading 9 … 11pt
Heading 10 … 10.5pt
TVM-Book-Section-8-131025a.odt Page 8
Copyright (c) 2013 Peter Burgess
MULTI DIMENSION IMPACT ACCOUNTING (MDIA)
The TrueValueMetrics Book – Section VIII
CONTACT
Founder / CEO … TrueValueMetrics
Peter Burgess
Mailing Address:
204 Seaham Court
Bushkill PA 18324 USA
Internet/communications footprint
Telephone: mobile: 212 744 6469 landline 570 431 4385
Twitter: @truevaluemetric @peterbnyc
Blogs: http://truevaluemetrics.blogspot.com http://communityanalyticsca.blogspot.com
Email: peterbnyc@gmail.com
Skype: peterburgessnyc
LinkedIn for Peter Burgess: www.linkedin.com/in/peterburgess1/
Print on Demand Books:
Search Peter Burgess at www.lulu.com
TVM-Book-Section-8-131025a.odt Page 9
Copyright (c) 2013 Peter Burgess
MULTI DIMENSION IMPACT ACCOUNTING (MDIA)
The TrueValueMetrics Book – Section VIII
Table of Contents
The Socio-Economic Dynamic of the Health Sector...................................................................2
Health is a big element of good quality of life.......................................................................2
Economics ... a truly dismal science.............................................................................2
A better system of metrics.............................................................................................2
Guideline...............................................................................................2
Cost effectiveness in malaria control ...........................................................................3
Cost effectiveness for community health.......................................................................3
Integrated multi-disease efficiency...............................................................................4
Smart healthcare strategy......................................................................................................4
The Socio-Economic Dynamic of the Education Sector.............................................................6
Education is valuable.............................................................................................................6
The Socio-Economic Dynamic of the Employment Sector..........................................................7
Education is valuable.............................................................................................................7
Heading 1 … 40pt............................................................................................................................8
Heading 2 … 28pt.......................................................................................................................8
Heading 3 … 18pt..................................................................................................................8
Heading 4 … 16pt..............................................................................................................8
Heading 5 … 15pt.........................................................................................................8
Heading 6 … 14pt....................................................................................................8
Heading 7 … 13pt...............................................................................................8
Heading 8 … 12 pt..........................................................................................8
Heading 9 … 11pt......................................................................................8
Heading 10 … 10.5pt............................................................................8
CONTACT...................................................................................................................................9
TVM-Book-Section-8-131025a.odt Page 10
Copyright (c) 2013 Peter Burgess
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