1

HEALTH ECONOMICS

INTRODUCTION
Good health is a determinant of economic growth and a component of
the well-being of the population. There is unlimited healthcare 'wants'
with rapid growth in health expenditure. There are insufficient health
sector resources. We need to choose between 'wants' and 'afford'
within our given limited resources. The opportunity cost and how best
we can allocate the limited resources is possible when we understand
health economics.
Health economics has developed into discipline itself due to size and
differential characteristic of health care sector in economy It is
becoming a subject of increasing significance particularly in the
developing countries primarily because of an economic climate where
resources are extremely scare and decisions on priorities are crucial
but difficult, a growing appreciation among health professionals and
policy-makers that health economics and economists can help them
formulate policies and make decisions; the increasing maturity of the
sub-disciplines of health economics; and the growing of interest
among economists and others in applying their economic skills to
health issues .
Health
Health is a state of complete physical, mental and social well-being
and not merely the absence of disease or infirmity,
Economics
'Economies in the study of wealth." (Adam Smith.)
Health Economics is a branch of economics that studies the
production and consumption of health and health care ..It focuses on
issues such as efficiency, effectiveness, values and behaviour. Health
economies is concerned with the problems of allocating health care
resources under conditions of scarcity and uncertainty
 2

 Health economies generally deals with the purpose of and

planning of budgeting which is required to be done in the health
care delivery system for providing care.
Definition
 Health economics is concerned with the use of resources affect the health
care industry. (Jacobs 2002)
 Health economics is the discipline that determines the price and the quantity
of limited financial and non-financial resources devoted to the care of the
sick and promotion of health. –Gupta & Mahajan
 'Health economics is a branch of economics, concerned with issues
related to efficiency, effectiveness, value and behaviour in the
production and consumption of health and health care.( Lee &
Mille)
Purpose of health economics
 To study the pattern of allocation of budget effectiveness and efficiency.
 To study health expenditure v/s health status.
 Evaluation of health status.
 Improve collaboration between different administrations
 To extract minimum benefits from health industry with least
cost combination.
Importance of health economics
 Health and economic development.
 Planning finance aspect of health system.
 Health manpower planning and demand analysis.
 Examines the situation where the resources available to us are
limited, the alternative uses for these resources are unlimited.
 Promote efficiency and equality in health care sector by
providing analytical techniques to decision makers.
 Organization of health care investment.
Economic concepts in Health care
The 3 basic concepts of supply, demand and cost are
increasingly related in economics.
 3

The supply of health care refers to the amount of resources currently

available for delivering health services. Resources include health care facilities,
manpower and financing. Supply levels are constantly changing because of
technological discoveries, costs for consumers, consumer demands and effect of
government regulations.
The demand of health care refers to the amount and type of health care the
consumer requires and is willing to purchase.
The Cost of health care refers to the amount a provider pays to produce
health related goods and service as well as the amount a consumer pays to
purchase these goods and services. Factors influencing the cost of health care
are numerous, ranging from consumer demands to advancements in medical
technology to the nation’s economy.

PRINCIPLES OF HEALTHECONOMICS.
 Scarcity and Choice
1. Limited Resources: Healthcare resources are limited, and
demand for healthcare services often exceeds supply.
2. Opportunity Cost: Every decision to allocate resources to one
healthcare service means forgoing another service.
 Efficiency
1. Maximizing Health Outcomes: Healthcare resources should
be allocated to maximize health outcomes.

2. Minimizing Costs: Healthcare services should be delivered at

the lowest possible cost.
 Equity
1. Fair Distribution of Resources: Healthcare resources should
be distributed fairly and justly.

2. Equal Access to Healthcare: Everyone should have equal

access to healthcare services, regardless of income, social status,
or geographic location.
 4

 Effectiveness
1. Evidence-Based Decision-Making: Healthcare decisions
should be based on the best available evidence.
2. Cost-Effectiveness Analysis: Healthcare interventions should
be evaluated based on their cost- effectiveness.
 Consumer Theory
1. Rational Choice: Consumers make rational choices about
healthcare services based on their preferences and budget
constraints.
2. Demand and Supply: The demand for healthcare services is
influenced by factors such as price, income, and education.
 Market Failure
1. Information Asymmetry: Healthcare markets often generate
externalities, such as the spread of infectious diseases.
2. Externalities: Healthcare markets often generate externalities,
such as the spread of infectious diseases.
Areas of health economics
 Health problem
 Cost of health care.
 Demand of health care.
 Supply analysis in health care.
 Health care services market.
 Health plans and outlays.
 Financing for health care industry.
 Optimum utilization of resources.
1.. Health problems
The study of health economics also concentrates on health as an
important economic indicator of economic development. It deals with
the correlation between health industry and economic development
2.Cost of health care
Cost of health care include all those serves or facilities to promote
humans well being.
3. Demand of health care.
 5

Demand refers to desire accompanied by willingness to pay and

ability to pay for a product or service in a market. The demand will
may be elastic or inelastic. e.g. The demand for medicine has in
elastic demand as it is necessary product which saves life.
4.Supply analysis in health care
Supply refers to anything material or nonmaterial which is offered for
sale at a particular level of price and at a given period of time. Supply
depends on many factors such as price, cost of production, govt
policy, demand etc.
5. Health care services market
Market is extended forms local to international and covers almost all the goods
and services which are consumed directly indirectly. The scope of health
economics explains how the market for health services work.
6.Health plans and out lay
One of the primary motives of every country is to give primary importance to
health services to make citizen healthy both physical and mentally
7. Financing for health care industry.
Financing means creation and investment of funds in creating various health
care amenities. Health economics studies the various sources of finance
available for health industry.
8. Optimum utilization of resources
The optimum allocation of resources is an important element of health
economics. The resources in health industry include all these men and material
used to promote health.
Factors influencing health care cost
 Health care use
 Lack of preventive care
 Lifestyle and health behaviours
 Societal beliefs
 Technological advances -Telehealth
 Aging of society
 Pharmaceuticals
 Shift to for -profit health care
 6

 Health care fraud and abuse

The elements of health economics

• Micro economics
• Macro economics
 Microeconomics
That is how individual choose, minimize cost for maximise profit or
utilizes with in a given health care systems with in a set of rules and
prices. Supply and demand influences each other in turn affect prices.
 Macro economics
It is the study of aggregate national income and expenditure,
aggregate demand and consumption aggregate investment level in
both private and government sectors.
Economic evaluation.
"Economic evaluation is the comparative analyses of alternative
causes of action in terms of both their costs and consequences in order
to assist policy decisions." (Drummond M. F)
Tools for evaluation of economic analysis
1. Cost minimization analysis (CMA)
2. Cost effectiveness analysis (CEA)
3. Cost utility analysis (CUA)
4. Cost benefit analysis (CBA)
1.Cost minimization analysis.
This approach compares the costs of alternative forms of treatment or
management that produce equitant health outcomes. The aim of this
analysis is decide the least costly way of achieving some outcome.
2. Cost effectiveness analysis
 7

it is a ratio of the difference in costs to the difference in effectiveness

of the interventions under considerations. When different health care
interventions are not expected to produce the same outcomes, both the
costs and consequences of the options needed to be assessed.
● Cost-effectiveness analysis
○ Cost (versus) effectiveness (health outcomes)
■ Natural unit of health outcome
● cases, deaths averted, etc
3. Cost utility analysis.
A special form of cost effectiveness analysis. It measures the effect of
an intervention on health units that measures both quantity and quality
of life.
○ Cost (versus) utility (health-related quality of life measures)
■ DALYs - disability-adjusted life-years
■ QALYs - quality-adjusted life-years
4. Cost benefit analysis
The costs and benefits are the both valued in cash terms. It provides a
broader comparison between alternative programmes. This allows to
assess whether program is economically sound or worthwhile.
○ Cost (versus) benefits (health outcomes)
■ Monetary valuation of health benefits/outcomes
Cost containment
It is the process of of controlling the expenses to operate an
organization or to perform a project with in pre-planned budgetary
constraints.
strategies
 Reducing need for services.
o Primary and secondary prevention
 8

o Health promotion and education

o Patient safety and reduced medical care
 modifying Consumer demands
o High deductible plans.
o Progressive cost sharing and sharing the cost by patient
and insurer.
 Modifying providers behaviours
o Pay for performance for or reimbursement based on the quality
of structure, process and outcome standards of care
 Instrumental measures.
o electronic health record
o clinical effectiveness and cost effectiveness research
Resources of health economics
1. Health Economics Journals: Journals such as Health Economics,
Pharmaco Economics, and Value in Health.
2. Health Economics Software: Software such as TreeAge, Excel, and
R.
3. Health Economics Courses: Online courses and training programs
offered by organizations such as the World Health Organization
(WHO) and the International Society for Pharmacoeconomics and
Outcomes Research (ISPOR)
Family budgeting in health and illness
A family spends its money effectively to safeguard their health
welfare. The family can practice health economics in the following
ways.
➤ obtain health insurance.
➤ Follow healthy life style.
➤ Seek consultation from health care provider when ill.
➤ Routine immunization.
 9

Factors influencing economic problem

The extent of family disruption depends on the
 seriousness of the illness.
 The family's level of functioning before the illness
 Socio economic considerations
 The extent to which other family members can absorb the role
of the person who is it.
Steps for good economics at home
Make a budget.
Record expense.
Plan on saving money.
Set savings goal.
Decide on priorities.
Different savings and investment strategies for different goals.
Make saving money easier with automatic transfer.
Watch your savings.
ROLES OF THE PUBLIC HEALTH NURSE IN THE
ECONOMICS OF HEALTH CARE
1. Educator
2. Counsellor
3.Advocate
4.Researcher
5.Care provider
HEALTH SURVEILLANCE
The dictionary meaning of surveillance is supervision or close
watch especially on suspected person.
DEFINITION
 It is a process of collection of reliable information about the
status (or occurrence and spread) of a specific disease in given
 10

population and the factors related thereto, for the monitoring and
reporting on trends in specific health problems for prevention
and contend of that health problem/disease.
 In other words, it is the exercise of close scrutiny over the
distribution of the disease with severance to time, place, and
person and the factors related for the effective control. This
helps to know the incidence and prevalence rates. Population
under surveillance may be a city or region or nation.
History of Surveillance
Beginning in the late 1600s and 1700s, death reports were first used
as a measure of the health of populations, a use that continues today
also. In the 1800s, Shattuck used morbidity and mortality reports to
relate health a living condition following the earlier work of
Chadwick who demonstrated the relationship between poverty and
disease. Farr combined data analysis and interpretation and
disseminated to policy makers.
In the late 1800s and early 1900s, physicians were to report selected
communicable diseases (such as small pox, tuberculosis, cholera,
plague, and yellow fever) to local h authorities in the United States
and Europe, and the term surveillance was evolved to describe a
population approach to monitor health and disease by Langmuir in
1963. 1961 In the 1960s, networks of "sentinel" general practitioners
were established in the United Kingdom and the Netherland and
surveillance was used to target smallpox vaccination campaigns,
leading to global eradication and to control malaria in India.
Meanwhile, WHO broadened its concept of surveillance to include
full range of public health problems (beyond communicable diseases.)
During 1980s the introduction of microcomputers allowed more
effective decentralisation of data analysis and electronic linkage of
participants in surveillance networks thus revolutionised the
surveillance practice.
During 1990s and early 2000s the automation of surveillance was
accelerated by the use of internet. Meanwhile, the increasing threat of
 11

bioterrorism provided an impetus for the growth of the systems and

led to the growth in “syndromic surveillance” and aimed at early
detection of epidemics.
OBJECTIVES OF SURVEILLANCE
 To monitor the incidence or prevalence of specific health
problem
 To document the effect of disease in in defined populations
 To characterise affected people and those at greatest risk
 To inform and evaluate public health programmes
 To anticipate future trends for assisting health planners
 To hypotheses or identify participants for more detailed
epidemiologic investigations.
 To identify the high-risk areas thereby helps to plan for the
program interventions
 To monitor the quality of services and to evaluate the services.
Uses of Surveillance
 To highlight the magnitude of the problem in terms of morbidity
and mortality rates
 To plan for the program intervention
 To monitor the quality of the services
 To identify the high-risk areas for additional action
 To identify the outbreaks early for preventive measures
 To estimate the needs for drugs
 To achieve the goals of elimination or eradication
 To document the impact of services.
SURVEILLANCE PROCESS
The components of this process are as follows:
 Collection of data
 Compilation of data
 Analysis of data
 Interpretation of the data
 reporting of this information
 12

 Action or intervention
 Feedback
Epidemiological surveillance
The surveillance systems are typically operated by public health
agencies the term” public health surveillance “is often used.
It can be done at individual and family level, national and
international level:
 Individual or family surveillance: It includes surveillance of an
infected person in a family as long as the individual is source of
infection to others, e.g. typhoid case and carriers.
 Community or local population surveillance: it includes active
and passive surveillance of the whole Community for early
detection and prevention and control of a disease. E.g. Malaria
 National surveillance: it includes surveillance at the National
level, e.g. surveillance of smallpox after its eradication.
 International surveillance: it includes surveillance of some of the
diseases which are listed by WHO.e.q. malaria, influenza, filaria,
polio, etc. and are to be reported to WHO which then provides
information to the countries in the world to take timely actions.
Elements of a Surveillance System
Surveillance systems encompass not only data collection but also
analysis and dissemination. This "cycle" of information flow may
depend on manual or technologically advanced methods, including
the internet. The protection of confidentiality is essential and requires
protecting the physical security of data as well as policies against
inappropriate release. The best incentive to maintaining participation
in surveillance system is demonstration of usefulness of the
information collected. The ethical conduct of public health
surveillance requires an appreciation of both the benefits and risks of
obtaining population health information.
 13

Approaches to Surveillance (Data Collecting Procedures)

This means methods to conduct surveillance
Following are the methods:
1.Active and passive surveillance: An active approach means that the
organization conducting surveillance initiates. procedures to obtain
report. (For example, in malaria, active surveillance means cases
detected by the health worker by visiting the houses). A passive
approach means the organization does not contact potential reporters
and leaves the initiatives for reporting to others (For example, in
malaria, cases are detected by the static agencies, such as nursing
homes, hospitals, etc.).
2.Reporting of notifiable diseases: Under public health laws, certain
diseases are deemed "notifiable," meaning that physicians or
laboratories must report cases to public health officials. Traditionally,
this includes infectious diseases. Recently cancer is also included.
Some diseases have to be reported immediately or within 24 hours to
allow an effective public health response.
3.Laboratory-based surveillance: This is highly effective for some
diseases, e.g., the serum levels of a toxin or the antibiotic
sensitivity/resistance of a bacterial pathogen.
The disadvantage is that the laboratory records alone may not
provide all the information and that the patients having laboratory
tests may not be representative of all persons with the disease.

4.Volunteer providers. This approach to surveillance is required

whenever the capabilities of routine approaches exceed. Such
situation occurs when more detailed or timely information is required.
5. Registers: This provides comprehensive population-based data for
specific health events, such as births defects, cancer, etc. Registries
collect relatively detailed information and may identify patients for
long-term follow-up.
 14

6. Surveys: Population surveys done periodically (or ongoing) provide

a method for monitoring behaviours associated with disease, attributes
that affect disease risk, attitudes that influence health behaviours, use
of health services, etc. This approach is preferred in those countries,
where vital registration systems are underdeveloped.
7. Information systems: These are large data bases collected for
general rather than disease-specific purpose, which can be applied to
surveillance. For example, records from hospital discharges are
computerized to monitor the use and costs of hospital services. Data
on discharge diagnoses, however, are a convenient source of
information on morbidity.
8.Sentinel events: The occurrence of a rare disease known to be
associated with a specific exposure can alert health officials to
situations where others may have been exposed to a potential hazard.
Such occurrences have been termed "sentinel events," because they
are harbingers of broader public health problems. Surveillance for
sentinel events can be used to identify situations where public health
investigation or intervention is required.
9.Record linkages: Records from different sources may be linked to
extend their usefulness for surveillance by providing information that
one source alone may lack. For example, in order to monitor birth
weight, infant mortality rates (IMRs), it is necessary to link
information from corresponding birth and death certificates for
individual infants. The former provides information on birth weight
and other infant and maternal characteristics (e.g., gestational age at
delivery, number of antenatal visits, mother's age and marital status,
hospital where birth occurred, etc.) and latter provides information on
age at death (e.g., neonatal versus post-neonatal) and causes of death.
By combining information based on individual level linked birth and
death records, a variety of maternal, infant, and hospital attributes can
be used to make inferences about the effectiveness of maternal and
infant health programs or to identify potential gaps in services. Thus,
record linkage may be used to expand the scope of surveillance data.
 15

10.Combinations of surveillance methods: For many conditions a

single data source or surveillance method may be insufficient to meet
information needs. Under such circumstances, combinations of
multiple sources may be used to provide complimentary perspectives.

SENTINEL SURVEILLANCE
It is the monitoring of rate of occurrence of specific conditions to
assess the stability or change in health levels of a population. It also
describes the study of disease rates in a specific cohort or population
sub group to estimate trends of the disease in a larger population
(Last. Dictionary of Epidemiology).
purpose of sentinel surveillance
 to obtain high quality data about a particular disease, usually
missed cases
 to estimate the disease prevalence.
 involves testing people across the community, including those
who are apparently well, in order to find out unseen
transmission.
The data is collected in a well-designed system, to signal trend of the
disease, identify outbreaks and monitor disease burden in the
community, providing rapid, economical alternative to other
surveillance methods Sentinel surveillance is conducted in selected
locations.
Sentinel surveillance requires more time and resources but often can
produce more detailed data on diseases because the healthcare
workers agree to participate to collect data and receive incentives. It
may be the best type of surveillance if more intensive investigations
are done. It is excellent for detecting large public health problems but
insensitive (not useful) for rare diseases, because these diseases may
emerge anywhere in the population.
 16

Usually a general hospital or an infectious disease hospital is the

reporting site of sentinel system.
The following criteria should be considered in selecting a sentinel
health centre.
 It should be willing to participate
 It should serve relatively large population
 It should have high probability of observing the target disease
 It should have sufficient specialized medical staff to diagnose,
treat and report cases of the disease under surveillance.
 It should have high quality diagnostic laboratory.
 It should be committed to resource the program.
Analysis and Interpretation of Surveillance Data
The analysis of surveillance data is generally descriptive, using
standard epidemiologic techniques. However, following
considerations may arise during analysis and interpretation of data:
Attribution of date. A decision must often be made whether to
examine trends by the date events occurred or the date they
were reported. Date of diagnosis provides a better measure of
disease occurrence. Using the date of report is easier but subject
to irregularities in reporting. There may be long delay between
diagnosis and report. So, it may be necessary to adjust recent
counts for reporting delays, based on previous reporting
experience.

Attribution of place It is often necessary whether analysis will

be based on events or exposures occurred, where people live or
where health care is provided, which may all differ. For
example, people cross geographic boundaries to receive medical
care, the places where care is provided may differ from where
people reside. Place of care is more important in surveillance
system to monitor the quality of health care. Where the place of
residence is important to track the need for preventive services
among people who live in different areas.
 17

Use of geographic information system (GIS) GIS computer

software can facilitate the study of spatial association between
health services and health outcomes.
Presentation of Surveillance Data
The mode of presentation of data should be geared to the intended
audience in the form of tables, graphs, or maps to convey the key
points.
Types of Surveillance
There are nutritional surveillance, epidemiological surveillance in
malaria, acute flaccid paralysis, surveillance in poliomyelitis,
demographic surveillance, serological surveillance etc.
Attributes of Surveillance
These are used to evaluate the existing systems or to conceptualize
proposed systems. These attributes are as follows: →
 Sensitivity. To what extent does the system identify all targeted
events?
 Timeliness: How promptly does information flow from
collection to dissemination?
 Predictive value: To what extent are reported cases really exist?
 Representativeness: To what extent do events detected through
the surveillance represent persons with the condition of interest
in the target population?
 Data quality. How accurate and complete are descriptive data in
case reports, surveys, or information systems?
 Simplicity: Are surveillance procedures and processes simple or
complicated?
 Flexibility: Can the system readily adapt to new circumstances
or changing information needs?
 Acceptability: To what extent the participants in a surveillance
system accept the system enthusiastically?
 18

Certain attributes are likely to be mutual reinforcing. For example,

simplicity is likely to enhance acceptability. Others 5 in are likely to
be competing.
Ultimately the test of a surveillance system depends on its for success
or failure in contributing to the prevention and control of disease,
injury, disability, or death.
Improvement in the Surveillance System
An increase in the reported number of cases or deaths is not always a
negative sign or reflection of inadequate program interventions. An
increase in the reported incidence occurring in the first few years as a
result of improvement in the surveillance system is a "positive sign."
This increase will be due to:
 Increase in the number of reporting
 Improvement in the completeness of reporting
 Increased awareness among the people
 Active surveillance through paramedical personnel.
Challenges and Limitations of Health Surveillance
1. Data Quality: Ensuring the accuracy, completeness, and
timeliness of health data.

2. Data Sharing: Ensuring the secure and authorized sharing of

health data.

3. Funding: Securing sufficient funding to support health

surveillance activities.

4. Workforce: Ensuring a skilled and trained workforce to

conduct health surveillance activities.
Real-World Examples of Health Surveillance
 19

1. Global Polio Eradication Initiative: A global surveillance

system to track polio cases and monitor progress towards
eradication.

2. CDC's Flu View: A web-based surveillance system to track

influenza activity in the United States.

3. World Health Organization's (WHO) International Health

Regulations (IHR): A global surveillance system to detect and
respond to public health emergencies.
HEALTH INFORMATICS
Health informatics plays very important role in identification and
prevention of globally occurring current diseases in the world. Health
information is an integral part of the national health system.

DEFINITION
 A mechanism for the collection processing, analysis and
transmission of information required for organizing and
operating health services, and also for research and training.
 Health informatics is the intersection of healthcare, information
technology, and data analysis. It involves the design,
development, and implementation of health information systems
to improve healthcare delivery, quality, and safety.

Subfields
1. Clinical Informatics: Focuses on the application of informatics
principles to clinical practice.
2. Public Health Informatics: Focuses on the application of
informatics principles to public health practice.
3. Health Information Management: Focuses on the management of
health data and information systems.
 20

4. Medical Imaging Informatics: Focuses on the application of

informatics principles to medical imaging.
5. Bioinformatics: Focuses on the application of informatics
principles to biomedical research.
OBJECTIVES
The primary objective of a health information system is
 To provide reliable, relevant, up to date, adequate, timely and
reasonably complete information for health managers at all
levels .
 To Share technical and scientific information by all health
personnel participating in the health services of the country.
 To assist planners in studying their current functioning and
trends in demand and work load.
 To provide at periodic intervals the data that will show the
general performance of the health services.

DIFFERENCE BETWEEN DATA AND INFORMATION

Data consist of discrete observations of events that carry little

meaning when considered alone. Data as collected from operating
health care systems are inadequate for planning. Data need to be
transformed into information by reducing, summarizing, adjusting
them for variations, such as age, sex composition of population so that
comparisons over time and place are possible.

Requirements to be satisfied by Health Information System

According to WHO expert committee identified the following

requirements to be satisfied by the health information systems:

 The system should be population based.

 21

 The system should avoid unnecessary agglomeration of data.

 The system should be problem oriented.

 The system should employ functional and operational terms, e.g.

episodes of illness, treatment regimens and laboratory tests

 The system should express information briefly and

imaginatively, e.g. tables, charts, percentages, etc.

 The system should make provision for the feedback of data.

Components of a Health Information System

The comprehensive health information system requires information

and indicates on the following aspects:

 Demography and vital events.

 Environmental health statistics.

 Health status-mortality, morbidity, disability and quality of life.

 Health resources-facilities, beds, manpower, etc.

 Utilization and non-utilization of health services attendance,

admissions, waiting lists.
 22

 Indices of outcome of medical care.

 Financial statistics (cost expenditure) related to the particular

objective.

Uses of Health Information

Important uses of health information that may be applied are:

 To measure the health status of the people and to quantify their

health problems and medical and healthcare needs.

 For local, national and international comparisons of health

status. For such comparisons the data need to be subjected to
rigorous standardization and quality control.
 For planning, administration and effective management of health services
and programs. For assessing whether health services due accomplishing
their objectives in terms of their effectiveness and efficiency.

 For assessing the attitudes and degree of satisfaction of the beneficiaries

with the health system.

 For research into particular problems of health and disease.

Sources of Health Information

1.Census: Census is an important source of health information. It is

taken in most of the countries of the world at regular intervals, usually of
10 years. A census is defined as the total process of collecting, compiling
and publishing demographic, economic and social data pertaining at a
specified time or times to all persons in the country or delimited territory.
The first regular census in India was taken in 1881, and thereafter it took
 23

place at every 10-year intervals. The supreme officer who directs, guides
and operates the census is the Census Commissioner for India.

2.Registration of vital events

Registration of births and deaths keeps a continuous check on
demographic changes. If registration of vital events is complete and
accurate, it serves reliable source of health information. The central birth
and deaths registration act 1969 promulgated by Government of India.
The act came to force on 1 April 1970. The act provides for compulsory
registration of births and deaths throughout the country and compilation
of vital statistics in the states. The time event for registering the birth is
14 days and that for the deaths is 7 days. In case of default fine can be
imposed.
- Some countries have attempted to employ first line health workers Village
Health Guides record births or deaths in the community.
- "Lay reporting of health information" approach has been developed in several
countries for Transmission of information by health workers.
3.Sample registration system (SRS):
Since civil registration is deficient in India, a sample registration system
was initiated in the mid-1960s to provide reliable estimates of birth and
death rates at the national and state levels. The sample registration record
system consisting of continuous enumeration of births and deaths an
independent survey every 6 months in addition to serving as an
independent check on the computing rates.
4. Notification of Diseases
The primary purpose of notification is to effect prevention
and control of the disease. Notification is also a valuable
source of morbidity data i.e. the incidence and distribution of
certain specified diseases which are modifiable. Lists of
modifiable diseases vary from country to country and also
within the same country between the states and 6 between
urban and rural areas. At the international level the diseases
like cholera, plague, yellow fever, relapsing fever, polio,
influenza, malaria, and rabies are modifiable to W.H.O. The
limitations of notification are: (a) it covers only a small part
 24

of the total sickness in the community (b) it suffers from

under-reporting (c) many cases especially atypical and sub
clinical cases escape notification due to non-recognition e.g.
rubella, non-paralytic polio etc. In spite of the above
limitations, notification provides valuable information about
fluctuations in disease frequency and provides early warning
about new occurrences or outbreaks of disease.
5.Hospital Records
In India where registration of vital events is defective and
notification of infectious diseases is extremely inadequate,
hospital data constitute a basic and primary source of
information about diseases prevalent in the community.

The main drawbacks of hospital data are:

 They provide information on only those patients who seek
medical care. Mild cases may not attend hospital; sub clinical
cases are always missed.
 The admission policy may differ from hospital to hospital;
therefore, hospital statistics may be highly selective.
 Population served by a hospital cannot be defined There are no
precise boundaries to the catchment area of the hospital. In spite
of above limitations, a lot of useful information about health
care activities can be derived from hospital records. A study of
hospital data provides information on the following aspects
 Geographic sources of patients
 Age and sex distribution of different diseases and duration of
hospital stay
 Distribution of diagnosis
 Association between different diseases
 The period between disease and hospital admission
 The distribution of patients according to different social and
biological characteristics
 The cost of hospital care such information is of great value in
planning of health care services.
 25

6.Disease Registers
A register requires that a permanent record established, that the cases be
followed up, and the basic statistical tabulations be prepared both on
frequency and on survival. Morbidity registers exist only for certain
diseases such as stroke, myocardial infarction, cancer, blindness, and
congenital defects. Tuberculosis and leprosy are also registered in many
countries where they are common. These registers are of valuable
information as to the duration of illness, case fatality and survival. These
registers provide follow-up of patients and provide a continuous account
at the frequency of disease in the community. The useful information can
be obtained from registers on the natural course of disease, especially
chronic diseases. If the reporting system is effective the register can
provide useful data on morbidity from the particular diseases, treatment
given and disease specific mortality.
7.Record Linkage
The term record linkage is used to describe the process of bringing
together records relating to one individual (or to one family), the records
originating in different times or places. The term medical record linkage
implies the assembly and maintenance for each individual in a
population, of a file of the more important records relating to his health.
The events commonly recorded are birth, marriage, death, hospital
admission and discharge. Other useful data might also be included such
as sickness absence from work, prophylactic procedures, use of social
services etc. the main problem with the record linkage is the volume of
data that can accumulate. Therefore, in practice. record linkage has been
applied only on a limited scale e.g. twin studies, measurement of
morbidity, chronic disease epidemiology and family and genetic studies.
8. Epidemiological surveillance:
In many countries where particular diseases are endemic special
control eradication programmes have been instituted. For example,
National Disease Control Programmes against malaria, tuberculosis,
leprosy etc. the surveillance programmes are set up to report on the
occurrences of new cases and on efforts to control the diseases eq.
immunization is provided. . These programmes have yielded
considerable morbidity and mortality data for the specific
diseases.
 26

9. Other Health Service Records

These are hospital Out Patient Department, primary health centres and
sub centres, polyclinics, private practitioners, mother and child health
centres, school health records, diabetic and hypertensive clinics etc.
For e.g. records in Maternal and Child Health centres provide
information about birth weight, height, arm circumference,
immunization, disease specific mortality and morbidity. The
drawback is that it relates only to a certain segment of the general
population and the data generated by these records is mostly kept for
administrative purposes rather than for monitoring.
10. Environmental Health Data
Health statistics provide data on various aspects of air, water and
noise pollution; harmful food additives; industrial toxicants;
inadequate waste disposal and other aspects of combination of
population explosion with increased production and consumption of
material goods. Environmental data is helpful in the identification and
quantification of factors causative of disease.
11. Health and Manpower Statistics
This information relates to the number of physicians (by age, sex,
specialty and place of work), dentists, nurses, medical technicians etc.
there records are maintained by The State Medical/Dental/Nursing
Councils and the Directorates of Medical Education. The census also
provides information about occupation. The Institute Of Applied
Manpower Research attempts estimates of manpower, taking into
account different sources of data, mortality and out turn of qualified
persons from different institutions. The Planning Commission also
gives estimates of active doctors for different states
12. Population Surveys
 The term health surveys is used for surveys relating to any
aspect of health- morbidity, mortality, nutritional status etc.
when the mean variable to be studied is disease suffered by the
 27

people, the survey is referred diagnosis of problems of health

and disease.
 Surveys for investigations of factors affecting health and disease
e.g. environment, occupation, income, circumstances associated
with the onset of illness etc.
 Surveys relating to administration of health services e.g. use of
health services,
 expenditure on health, evaluation of population health needs and
unmet needs, evaluation of medical care. Population surveys can
be conducted in almost any setting. These may be cross-
sectional or longitudinal; descriptive and analytical or both.
CLASSIFICATION OF HEALTH SURVEYS
a. Health Examination Surveys
It provides more valid information. This survey is carried out by
teams consist of doctors, technicians and interviewers. It is expensive
and cannot be carried out on the extensive scale. It also considers the
provision of treatment to people found suffering from certain
diseases.
b. The health interview
It measures subjective phenomena such as morbidity, disability,
impairment, economic loss due to illness, expenditure on disease,
beliefs and attitudes.
c. Health records survey
It involves collection of data from health service records. It is the
cheapest method of collecting data. The disadvantages of this method
are that the estimates available from records are not population based;
reliability is open to question and lack of uniform procedures in
recording the data.
d. Questionnaire
 28

It is simpler and cheaper and they may be sent. A certain level of skill
and education is expected from respondents. There is usually high rate
of non-response. It is more time consuming also.
13. Other Routine Statistics Related to Health
Demographic: In addition to routine census data, statistics on other
demographic phenomena as population density, movement and
education level.
Economic: consumption of consumer goods like tobacco, dietary fats,
sales of drugs, employment and non-employment data.
Social security schemes: medical insurance schemes make it possible
to study the occurrence of illnesses in the insured population.
14. Non-Quantifiable Information
Health planners require this information e.g. information on health
policies, health legislation, public attitudes, programme costs,
procedures and technology. There should be proper storage,
processing and dissemination of information.
Applications
1. Electronic Health Records (EHRs): Digital versions of patient
medical charts.
2. Telemedicine: Remote healthcare delivery using digital
technologies.
3. Clinical Decision Support Systems (CDSSS) Computer-based
systems that provide healthcare professionals with clinical decision
making support.
4. Health Information Exchange (HIE): Secure electronic sharing of
health-related information among healthcare providers.
5. Predictive Analytics: Use of statistical models and machine
learning algorithms to analyze health data and predict patient
outcomes.
 29

ROLE OF NURSE IN HEALTH INFORMATICS

ROLES
 Patient safety
 Operational efficiencies
 Communication
 Documentation
CHALLENGES IN HEALTH INFORMATICS

 MEETING DATA MANAGEMENT TRENDS

 INCREASED CYBERSECURITY
 EXPANSION OF TELEHEALTH
 APPLICATION OF ARTIFICIAL
INTELLIGENCE, MACHINE LEARNING AND
PREDICTIVE ANALYTICS
 ADVANCES IN ELECTRONIC HEALTH
RECORDS CAPABILITIES
RESEARCH ABSTRACT

1. The Social media-based surveillance systems for healthcare using

machine learning: A systematic review by Aakansha Gupta and Rahul
Katarya published on Journal of Biomedical Informatics volume 108,
August 2020,103500.

Abstract
Real-time surveillance in the field of health informatics has emerged as a
growing domain of interest among worldwide researchers. Evolution in
this field has helped in the introduction of various initiatives related to
public health informatics. Surveillance systems in the area of health
informatics utilizing social media information have been developed for
early prediction of disease outbreaks and to monitor diseases. In the past
few years, the availability of social media data, particularly Twitter data,
enabled real-time syndromic surveillance that provides immediate
analysis and instant feedback those who are charged with follow-ups and
investigation of potential outbreaks. In this paper, we review the recent
 30

work, trends, and machine learning (ML) text classification approaches

used by surveillance systems seeking social media data in the healthcare
domain. We also highlight the limitations and challenges followed by
possible future directions that can be taken further in this domain. To
study the landscape of research in health informatics performing
surveillance of the various health-related data posted on social media or
web-based platforms, we present a bibliometric analysis of the 1240
publications indexed in multiple scientific databases (IEEE, ACM Digital
Library, ScienceDirect, PubMed) from the year 2010–2018. The papers
were further reviewed based on the various machine learning algorithms
used for analysing health-related text posted on social media platforms.
2. Public Health Informatics in Global Health
Surveillance: A Review by Puteri Nureylia Amir, Mohd
Fazeli Sazali, Loganathan Salvaraji, Nafsah Dulajis, Syed
Sharizman Syed Abdul Rahim, Richard Avoi Borneo
Epidemiology JournalVol. 2 No. 2 (2021) Published: 2021-
12-29.
Abstract

Surveillance is the backbone for effective public health practice.

Traditionally, surveillance system relies on the collection of
information regarding health-related events through healthcare
facilities, disease notification system from the physician, syndromic
notification networks, selected sentinel healthcare facilities, or by
event-based data. However, there are several limitations in using
conventional surveillance. With the advancement of technology and
computer science, overcoming those limitations and complementing
the traditional method has been recommended. Three leading
emerging technologies are applied in public health surveillance: the
internet of things, artificial intelligence, and blockchain. Application
of informatics in public health surveillance could raise several issues
including accessibility and affordability of innovations; public health
informatics’ experts, law, and regulation to protect patients’
information; social and ethical considerations, norms, and standards
of implementing new technologies; data ownership; privacy and
sharing of information; biosecurity; biosafety; and cyber security.
 31

CONCLUSION

According to economic principles, the existence of a desirable product

, the demand for the product , and the availability of financial funding
influencing the use of the product. Health care is the product , and the
demand for this product increases when the need expands and the
funding is available.

Health manpower statistics Information in health manpower is by no

means least in importance. Such informative relates to the number of
physicians (age. sex, specialty and place of work), dentists,
pharmacists, veterinarians, lab technicians, etc. Their records are
maintained by the State Medical Dental or Nursing Councils and the
directorate of medical education health information system Population
statistics collected from the above same. But they do not get the
information about health and disease in the community. Surveys for
evaluating of health status of a population, community diagnosis of
health problems, surveys for investigation of factors affecting health
and disease. Surveys relating to administration of health services, e.g.
use of health services, expenditure on health and evaluation of
population health needs and unmet needs, evaluation of medical care,
etc.
BIBLIOGRAPHY
1.Basheer S P, Khan S Y. A concise text book of advanced nursing
practice .3rd ed. Bangalore: EMMESS Medical Publishers ;2022.
2.G G Reddamma. Advanced concepts of nursing practice.1st ed. New
Delhi: Jaypee Brothers Medical Publishers;2021.
3.Aakansha Gupta and Rahul Katarya published on Journal of
Biomedical Informatics volume 108, August 2020,103500.
4. Puteri Nureylia Amir, Mohd Fazeli Sazali, Loganathan Salvaraji,
Nafsah Dulajis, Syed Sharizman Syed Abdul Rahim, Richard Avoi
Borneo Epidemiology Journal Vol. 2 No. 2 (2021) Published: 2021.
 32

5. Suryakantha A H, Community Medicine with recent advances.7th

ed New Delhi:.Jaypee brothers mecical publishers;2023.
6.Nies M. A ,Mcewen M. Community public health nursing. 7th ed.
Elsevier publication:.Canada;2015 .
7.IOSR Journal of Nursing and Health Science (IOSR-JNHS) e-ISSN:
2320–1959.p- ISSN: 2320–1940 Volume 12, Issue 3 Ser.2 (May. –
June. 2023), PP 33-37 www.iosrjournals.org DOI: 10.9790/1959-
1203023337 . .
8.Vati.J. Principles and practice of nursing management and
administration .1st ed. New Delhi: Jaypee’s medical publishers;2013.