Abstract
African American men are at greater risk of developing malignant prostate tumors than Hispanics or white men are. This risk factor necessitates the need for public health interventions to improve the health outcomes of this population. The M-PACT project is a public health initiative that aims to enhance prostate cancer screening by blacks through public education. It is based on the public need for interventions meant to increase healthcare service utilization. This paper evaluates the economic principles underlying community health needs assessment of the initiative and the health economics relevant to the utilization of the service.
The Need for the Public Health Initiative
Ethnicity or race is a major risk factor in prostate cancer. The risk of prostate cancer is 60% more in black males than in their white counterparts (Saunders, 2012). Blacks are also two times more likely to succumb to prostate cancer than white men are (Saunders, 2012). Given the cancer health disparities, there is a clear need for a public health initiative to create awareness and improve the outcomes of the at-risk group.
A community health needs assessment (CHNA) centers on the identification and evaluation of the determinants of health to support the prioritization and planning for the unmet needs (Cookson, Drummond & Weatherly, 2009). In Maryland, the University of Maryland’s M-PACT initiative has a goal of enhancing prostate cancer awareness in the black population (Saunders, 2012). One of the underpinning principles of this initiative is a focus on the needs of the disadvantaged groups. The economic evaluation focuses on the project’s needs that are not satisfied by the current resource allocations. It helps identify the opportunity cost of the initiative, i.e., an alternative action with the best possible outcomes for the target population.
Another principle is that an evaluation should generate optimal results per unit cost for the identified need. The aim is to attain the best possible health outcomes without exceeding the budget. It entails a cost-benefit analysis of an initiative to determine its cost-effectiveness in addressing the unmet needs (Cookson, Drummond & Weatherly, 2009). All the relevant costs and outcomes of the intervention are reflected in the analysis. It must also capture the potential tradeoffs in reducing the health inequalities.
Macroeconomic vs. Microeconomic Program
The M-PACT initiative seeks to support informed decisions on prostate cancer screening to promote population health. The economic gains of an intervention are usually based on microeconomic evaluations. Microeconomics focuses on utility maximization and decisions at the individual level while macroeconomics describes the “sum total of economic activities, such as growth, inflation, and unemployment” (Getzen, 2013, p. 41). Building on this description, we can see that M-PACT is a microeconomic program. The initiative is a preventative, i.e., it aims to reduce the risk of prostate cancer among blacks through early screening. One of the health benefits of early screening is a reduction in economic expenditure of treating cancer. The significant cost savings and improved health outcomes fit well within the framework of a microeconomic program.
Public vs. Private Good
A public good, unlike a private product, is beneficial to all individuals in a community. It is a “non-rival and non-excludable” product or service (Carande-Kulis, Getzen &Thacker, 2007, p. 229). The concept of non-excludability means that service is beneficial to the whole community. On the other hand, the non-rival consumption implies that the cost of supplying the product is minimal. This characteristic implies that a public good is available to all people.
The M-PACT project is a public good because it benefits the entire African American community in Maryland. Its value cannot be expressed in monetary terms because it involves volunteer services from community health advisors and parishioners. Another characteristic of a public good is that its value is cumulative, which makes it difficult to give it a price (Fiszbein & Schady, 2009). The expected outcome of the initiative is to eliminate prostate cancer disparities in a period of four years.
The M-PACT initiative also has externalities, i.e., it indirectly benefits the community besides the black men. Sensitizing men on the importance of early screening is a preventative measure. Thus, the community benefits from cost savings associated with early detection and treatment of cancer. From an economic perspective, the initiative is a good example of a public product targeting the black males given their high prostate cancer risk. It is offered freely to the consumers, including the underinsured and the uninsured. It utilizes the available community resources, i.e., health ministry leaders, to screen and treat prostate cancer cases.
A public good cannot be substituted, and therefore there is no opportunity to consume alternative services. The M-PACT initiative is not a commercial program that is subject to market forces. It is shaped by community values and public interest. The project was launched to provide relevant knowledge to the black males in order to promote early testing. Public interest comes in because of the high prevalence rate of prostate cancer in this demographic.
Public health interventions targeting particular groups or segments of the population tend to involve multiple outcomes. The benefits of a public intervention include promoting the health outcomes of the people, improving the determinants of health, and reducing health disparities (Ensor, 2004). The M-PACT aims to improve the utilization of prostate cancer screening to reduce the health inequalities between white and black men.
Financing Source
Community-based faith organizations and public health donors fund the M-PACT initiative. The churches supply the community resources and health advisors who participate in health education. The community health advisors hold public meetings and workshops to educate and empower African American men to make informed choices (Saunders, 2012). The participants can be the insured, the underinsured, and the uninsured. Therefore, the project receives reimbursements from the Medicare and Medicaid programs for screening and treatment services. Grants received from donor institutions, including the American Cancer Society, constitute another source of funding for this project. The tax-exempt donations are used to fund the project’s activities.
Effect on Supply and Demand of Public Health Services
Addressing the supply side effects of public health would require the implementation of strategies that enhance healthcare accessibility to the black population in Maryland. The M-PACT initiative makes health education and prostate cancer screening readily accessible to black men. The demand side effect entails creating the demand for the product among the consumers. Ensor and Cooper (2004) observe that most initiatives are launched to address the supply constraints without considering the level demand for the services. Both public and private providers seek to fill the supply gaps in cancer awareness. However, since the M-PACT focuses on health education, it may shift the demand for public health services, including early cancer screening. The project will be able to address the issue of low utilization of healthcare services.
The uptake of prostate cancer screening services is low among the black population. Thus, the demand for these services is not high. The M-PACT serves as a tool for promoting the uptake of the under-utilized services by empowering the black men to make informed decisions. It also gives consumers a choice of a community-based provider. The defining characteristic of M-PACT is that it is provider-led. A host of faith-based organizations provides care modeled around the principles of spirituality of the black population. It involves men as community health advisors and women as partners.
Therefore, the initiative is a provider-led demand side factor. According to Drummond, Sculpher, Torrance, O’Brien, and Stoddart (2005), demand side factors demonstrate a direct relationship between grants received, the beneficiary, and the goal of the donation. The grants received by M-PACT are channeled towards cancer screening and treatment. Therefore, the initiative increases the utilization of the under-utilized services through health education. Drummond et al. (2005) writes that a demand side factor has a pre-defined target group that requires the services. The M-PACT targets black men in Maryland who require the screening for the presence of prostate cancer.
The financial transfers to this initiative will also shift the demand for cancer screening. M-PACT receives funds from the government (Medicare reimbursements) and private donors. It provides merit goods, i.e., services whose demand is suboptimal (Ensor, 2004). A demand side initiative focuses on training the human resource to build community capacity to drive its agenda (Ensor, 2004). M-PACT trains community health advisors (CHAs) who hold workshops and informal meetings to educate black men on issues of prostate cancer. The CHAs include prostate cancer survivors, opinion leaders, and doctors. It also trains black women to support men in making informed decisions.
References
Carande-Kulis, V.G., Getzen, T.E. &Thacker, S.B. (2007). Public Goods and Externalities: A Research Agenda for Public Health Economics. Journal of Public Health Management Practice, 13(2): 227–232.
Cookson, R., Drummond, M. & Weatherly, H. (2009). Explicit Incorporation of Equity Considerations into Economic Evaluation of Public Health Interventions. Health Economics, Policy and Law, 4(2), 231–245
Drummond, M.F., Sculpher, M.J., Torrance, G.W., O’Brien, B.J. & Stoddart, G.L. (2005). Methods for the Economic Evaluation of Health Care Programmes. New York: Oxford University Press.
Ensor, T. (2004). Consumer-Led Demand Side Financing for Health and Education: An International Review. Oxford Policy Management, 19(3), 267-285.
Fiszbein, A. & Schady, N. (2009). Conditional Cash Transfers: Reducing Present and Future Poverty. New York: Oxford University Press.
Getzen, T.E. (2013). Health Economics and Financing. Hoboken, NJ: John Wiley and Sons.
Saunders, D.L. (2012). Men’s Prostate Cancer Awareness Church Training (M-PACT) Project: Intervention Development and Formative Research. College Park, MD: University of Maryland.