One of the things I like about modeling direct/indirect patient financial benefits is that it should allow a high-confidence lower bound for ODH’s effectiveness. Let’s unrealistically and uncharitably assume that all of ODH’s patients would have counterfactually sought care at a more distant facility, and would have received as-timely and as-good care. In that case, the net benefit to patients includes avoided travel costs + loss-of-time costs + other-care costs (the other care is supposed to be free, but often isn’t in practice for various reasons), less fees paid to ODH.
In that pessimistic scenario, we should also include estimated (but difficult to calculate!) benefits to those served by the public health care system, because ODH’s existence diverted tens of thousands of patients a year from that underresourced and underfunded system. (Unless ODH scaled to multiple times its size, I doubt its existence would funge overall public health-care spending in Uganda. It’s just too small to affect a nationwide budget given how political processes generally work.)
A somewhat more realistic, but still probably awfully conservative, model would credit ODH (say) 25% of the DALYs in Nick’s model and 75% of the income effects in the model described above. Because the DALY source includes both treated and untreated cases, such a mixed model would assume more than 75% of patients would be counterfactually treated.
Doing a really quick BOTEC, that would yield 3.425 DALYs plus the [75% of net economic effects from the financial-only model, less $87.50[1]] for a donor/grantor spend of $137.50. If we assume $3 savings per patient in the financial-only model (based on Nick’s travel estimate of $3 + time value of money and other-care costs equal to the ODH fee), that yields us a patient savings of 112.5 patients (75% of average volume) * $3, or $337.50. Subtracting the $87.50 yields $250. If you think those savings are equal in value to GiveDirectly cash transfers, you could model that at 1.81X GiveDirectly + getting the DALYs (and benefits to non-ODH patients from relieving the burden on nearby government health centers) for “free.” (I note that this is primarily intended to demonstrate the idea of a mixed-benefits model only, not to make assertion about a reasonable lower-bound estimate for ODH.)
I’m probably doing this wrong, but GiveWell’s moral weights seem to suggest a DALY is morally “worth” about doubling the consumption of a person for two years. Given the median income in Uganda is $804, averting a DALY would be roughly equal to increasing consumption by $1600, which would make averting 3.425 DALYs roughly as effective as increasing consumption by $5480. I don’t mean to assert that ODH is 41.67X GiveDirectly on this conservative model ($5480 from DALYs + $250 from economic savings / $137.50 donor spend), but this quick analysis does suggest that the bulk of the value in the mixed-model described above comes from the “free” components and not the hypothesized 1.81X GiveDirectly economic effect.
One of the things I like about modeling direct/indirect patient financial benefits is that it should allow a high-confidence lower bound for ODH’s effectiveness. Let’s unrealistically and uncharitably assume that all of ODH’s patients would have counterfactually sought care at a more distant facility, and would have received as-timely and as-good care. In that case, the net benefit to patients includes avoided travel costs + loss-of-time costs + other-care costs (the other care is supposed to be free, but often isn’t in practice for various reasons), less fees paid to ODH.
In that pessimistic scenario, we should also include estimated (but difficult to calculate!) benefits to those served by the public health care system, because ODH’s existence diverted tens of thousands of patients a year from that underresourced and underfunded system. (Unless ODH scaled to multiple times its size, I doubt its existence would funge overall public health-care spending in Uganda. It’s just too small to affect a nationwide budget given how political processes generally work.)
A somewhat more realistic, but still probably awfully conservative, model would credit ODH (say) 25% of the DALYs in Nick’s model and 75% of the income effects in the model described above. Because the DALY source includes both treated and untreated cases, such a mixed model would assume more than 75% of patients would be counterfactually treated.
Doing a really quick BOTEC, that would yield 3.425 DALYs plus the [75% of net economic effects from the financial-only model, less $87.50[1]] for a donor/grantor spend of $137.50. If we assume $3 savings per patient in the financial-only model (based on Nick’s travel estimate of $3 + time value of money and other-care costs equal to the ODH fee), that yields us a patient savings of 112.5 patients (75% of average volume) * $3, or $337.50. Subtracting the $87.50 yields $250. If you think those savings are equal in value to GiveDirectly cash transfers, you could model that at 1.81X GiveDirectly + getting the DALYs (and benefits to non-ODH patients from relieving the burden on nearby government health centers) for “free.” (I note that this is primarily intended to demonstrate the idea of a mixed-benefits model only, not to make assertion about a reasonable lower-bound estimate for ODH.)
I’m probably doing this wrong, but GiveWell’s moral weights seem to suggest a DALY is morally “worth” about doubling the consumption of a person for two years. Given the median income in Uganda is $804, averting a DALY would be roughly equal to increasing consumption by $1600, which would make averting 3.425 DALYs roughly as effective as increasing consumption by $5480. I don’t mean to assert that ODH is 41.67X GiveDirectly on this conservative model ($5480 from DALYs + $250 from economic savings / $137.50 donor spend), but this quick analysis does suggest that the bulk of the value in the mixed-model described above comes from the “free” components and not the hypothesized 1.81X GiveDirectly economic effect.
If 25% of visits are counterfactual, then 25% of patient expenses would never have occured.