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This study examines the cost-effectiveness of reintegrating ex-combatants from armed groups in Colombia. After an ethnographic exploration of the challenges of reintegration that ex-combatants face, I evaluate the cost-effectiveness of the reintegration program operated by the Agency for Reincorporation and Normalization (Agencia para la Reincorporación y la Normalización, ARN), the government agency that handles the reintegration of ex-combatants from all armed groups in Colombia. I analyze the agency's approaches (past, current, and proposed) toward reintegrating ex-combatants from various armed groups, comparing the financial costs against outcomes. The ARN has been successful at achieving two of its primary goals: minimizing recidivism and maximizing employment of ex-combatants. Only 10% of ARN program participants rejoin criminal groups and 93% find employment across both the formal and informal sectors (informal employment is widespread in Colombia and Latin America). The ARN has been unsuccessful at providing adequate security for ex-combatants. Approximately 6% of ex-combatants enrolled in the ARN program have been murdered since 2001: approximately 3,000 program participants have been assassinated. Next, I evaluate the cost-effectiveness of both the ARN's overall program and its outcome across different regions and demographics of the participant population. Finally, I suggest ways that other countries facing the challenge of reintegrating populations of ex-combatants can learn from the Colombian experience, as well as ways that Colombia can improve its own reintegration cost-effectiveness.

This chapter considers the analysis of a cost-effectiveness dataset from an econometrics perspective. We link cost-effectiveness analysis to the net benefit regression framework and explore insights and opportunities from econometrics and their practical implications. As an empirical illustration, we compare various econometric techniques using a cost-effectiveness dataset from a published study. The chapter concludes with a discussion about implications for applied practitioners and future research directions.

Purpose – To examine the cost-effectiveness of UK government policy with respect to the mitigation of carbon emissions from the transport sector.

Methodology/approach – Existing policy as set out by the Department for Transport in Low Carbon Transport: A Greener Future is examined. This document elaborates a Low Carbon Transport Strategy intended to achieve annual emissions savings of 17.7 MtCO2 by 2020. A wide range of policy areas where further action could be taken to reduce carbon emissions are examined and their cost-effectiveness considered.

Findings – Measures that influence behaviour including smarter choices, eco-driving across modes, freight best practice and modest price increases are highly cost-effective. More cost-effective routes to saving 17.7 MtCO2 are identified, as are further cost-effective savings.

Originality/value – It appears that government targets could be delivered and indeed exceeded at lower cost than the Low Carbon Transport Strategy. However, policy development is influenced by a wide range of factors which help to explain why cost-effective measures are not always fully exploited.

Purpose – Although the US has lagged behind international developments in health technology assessment (HTA), renewed interest in HTA in the US has been fueled by the appropriation of $1.1 billion comparative effectiveness research (CER) in 2009 and the debate over health care reform.

Approach – To inform CER practices in the US, we present case studies of HTA from England/Wales and Germany: contrasting methods; relevance to the US; and impact on innovation.

Findings – The National Institute of Health and Clinical Excellence (NICE) was established in 1999 to inform trusts within the National Health Service of England and Wales. It uses cost-effectiveness analysis to guide the allocation resource across preventative and curative interventions. In Germany, the Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG) was established in 2004 to inform reimbursement and pricing policies for the statutory sickness funds set by the Gemeinsamer Bundesausschuss (G-BA). IQWiG evaluates competing technologies within specific therapeutic areas, placing more weight on clinical evidence and the relative efficiency of competing therapies.

Practical implications – Although having deep political and cultural antecedents, differences between NICE and IQWiG can be explained by perspective: the former guiding resource allocation across an entire system (macro-evaluation), the latter focusing on efficiency within the bounds of a particular therapeutic area (micro-evaluation). Given the decentralized nature of the US health care system, and the relative powers of different medical specialties, the IQWiG model presents a more suitable case study to guided CER efforts in the US.

In this chapter we discuss the cost-effectiveness analysis (CEA) of public health interventions where there are combined, and potentially conflicting, objectives of increasing total population health and reducing unfair health inequalities in the population. Our focus is on identifying appropriate health inequality measures in this context to quantify the impacts of interventions on unfair health inequality and, where necessary, analyse equity-efficiency trade-offs between improving total population health and reducing unfair health inequality. We recognise that this requires a number of important social value judgements to be made, and so prefer measures that facilitate transparency about these social value judgements. We briefly summarise the literature on health inequality and health-related social welfare functions, and conclude that while valuable it is not entirely suitable for our purpose. We borrow instead from the wider literature on economic inequality, highlighting how this translates to a health setting, and identify appropriate measures for CEA. We conclude with a stylised example illustrating how we would apply a battery of dominance rules and social welfare indices to evaluate the health distributions associated with two hypothetical health interventions.

In this chapter, we address the question of what health economic models represent. Are they realistic? And, does model realism matter? Or, is model usefulness in terms of informing pricing, reimbursement, and prescribing decisions all policymakers care about? The usefulness of models is circumscribed given that: (1) market failure is inherent in healthcare and (2) models oversimplify the preference structure underlying choices. We suggest, however, that models which employ the ceteris paribus clause can be useful in order to isolate factors that play a role in healthcare decision-making and ultimately characterize agents’ multiattribute utility functions through discrete choice experiments. As a result, policymakers gain important knowledge about decision criteria in the healthcare system.

This chapter demonstrates (1) divergence between spending based upon a budget ratcheting model and a benchmark spending model, (2) that this divergence affects organizational performance, and (3) that internal benchmarking enables unit-to-unit performance comparisons, despite claims of organizational or unit uniqueness. We contrast two spending models to examine whether the divergence, or cost estimation gap, affects operating performance across inpatient (n=4,536) and outpatient departments (n=8,438) in 23 U.S. Army hospitals. Using a fixed-effects panel data methodology for fiscal years 2004–2006, we find that unit managers’ spending in this setting is more closely approximated by budget ratcheting. Using multiple performance metrics measured via a DuPont-like decomposition, we find that, within a specified range, operating performance generally improves as resources become constrained. Outside that range, however, we find nonlinear performance effects that approximate a quadratic loss function. Our benchmark model enables clinical department comparisons while controlling for facility, clinical specialty, and case mix severity. The resulting departmental comparability facilitates identification and communication of best practices across the entire Army hospital system. These results should be of interest to corporate executives, government officials, and agency managers who have responsibility for establishing funding mechanisms that include performance-based components.

The Norwegian health care system is semi-decentralized. Primary care and long-term care (LTC) are the responsibilities of the municipalities. Specialist care is the responsibility of the central government and is organised through four Regional Health Authorities (RHA). Resource use, health outcomes and severity are the three main pillars for priority setting, regularly applied in reimbursement decisions for pharmaceuticals.

The sustainability of health care is challenged in Norway. The main factors are a growing elderly population with high need of complex, coordinated services, an increasing demand for newly approved drugs and advanced technology and a potential shortage of health care personnel.

We present recent trials and policy reforms in Norway aimed at improving care pathways combined with cost containment. Reforms in the pharmaceutical market, both with regard to market access and reimbursement (cost-effectiveness), and regulation of prices, have resulted in cost containment. The primary care sector awaits reform initiatives to recruit and retain physicians as general practitioners. No reform in the hospital sector has had cost containment as a main focus. The sector is characterized with low productivity growth, and expenditures that have increased more than the GDP growth. Waiting times are long, and coordination between sub-sectors of health care has been poor, although the Coordination reform of 2012 has alleviated some of the challenges related to intersectoral coordination. Still, the divided responsibility for health care between the central government and the municipalities creates tensions between national ambitions and local decisions in the financing and provision of health services.