Dr. Anthony F. Markus

February 11, 2018 | Author: Anonymous | Category: Business, Economics, Macroeconomics
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ANTHONY F. MARKUS Consultant, Maxillofacial Surgeon Head of Department Maxillofacial Surgeon, Poole Hospital and Royal Bournemouth Hospital Director, Dorset Centre for Cleft Lip and Palate E-mail: [email protected]

Honorary Consultant Maxillofacial Surgeon, Worthing Hospital Honorary Consultant Maxillofacial Surgeon, Royal Naval Hospital, Haslar Honorary Consultant Maxillofacial Surgeon, Guy’s Hospital, London Visiting Fellow, Bournemouth University Member, Clinical Standards Advisory Group, UK Department of Health Member of Council, British Association of Oral and Maxillofacial Surgeons Chairman, British Association of Oral and Maxillofacial Surgeons Cleft Group President, Oral Surgery Club of Great Britain Fellow, Royal Society of Medicine Fellow, Royal Society of Public Health Member, British Association of Oral and Maxillofacial Surgeons Member, Societé Française de Stomotologie et Chirurgie Maxillo-Faciaux Member, International Association of Oral and Maxillofacial Surgeons Member, European Association of Craniomaxillofacial Surgeons Member, American Cleft Palate - Craniofacial Association De Puy Surgical Prize, British Association of Oral and Maxillofacial Surgery Author of several papers on cleft lip and palate

Craniofacial Anomalies - The Burden of Care, Meeting the Treatment Need in a Global Context A. F. Markus, Poole, UK Craniofacial deformities (CFA), a term that encompasses a large number of conditions of which the most common is cleft lip and palate, affect a significant proportion of the global community. Clefts are themselves frequently associated with other severe abnormalities ranging from learning difficulties of varying severity, to heart and limb abnormalities. More severe craniofacial abnormalities occur, for example, Crouzon’s and Apert’s syndrome in which there is failure of normal cranial and facial growth due to synostosis of the bones that make up the cranial vault and cranial base. There is considerable geographic and racial variation, with the rates being highest amongst North American Indians followed by the Japanese and the lowest amongst Caucasians. Worldwide 15,000 children are born each hour and this represents a child born with a cleft every two and a half minutes. The costs incurred from CFA in terms of morbidity, health care, emotional disturbance, social exclusion and restricted employment opportunities, are considerable for affected individuals, their families and society as a whole. Assessment of the true financial costs of all aspects of management is essential in an environment of increasingly restricted budgets. Surgery is expensive and it is important that the best techniques are employed by the best surgeons, surgeons who have developed their skills on the back of the best educational training opportunities. It must be the principal aim of the cleft surgeon to restore the deformed and displaced regional anatomy to as close to normality as possible. Only in this way can one reasonably expect restoration of function and so enable optimal growth and development. Primary surgical methods encompassing these ideals should, theoretically, reduce the frequently observed sequelae of both the cleft deformity itself and surgery and so, in turn, the need for secondary surgery. In reality, given even the most favourable circumstances, secondary surgery will be required. There has been little work as yet on the health economics of CFA. Health status and the utility of care and associated quality of life may be estimated using techniques of time trade-off and conjoint analysis. Economic prioritisation models use decision analysis and simulation to assess the resource costs and patient benefits of current treatment patterns and therefore the “costs

– effectiveness gap” or in other words potential gain from diverse surgical procedures for CFA. There is no major widely accepted registry which enables critical appraisal of different kinds of CFA interventions. REACH (Rural, Effective and Comprehensive Community Healthcare) is a management system that has been implemented in Andhra Pradesh, Southern India, on a localised basis with the aim of addressing some of these issues. An awareness of the existing problems is essential if research is to be appropriately directed and funded, if the correct level of human resource is to be identified and made available, if health care professionals and organisations are to be brought together with the affected individuals and communities, and if the necessary information, by for example, modern IT facilities, is to be accessible and have an impact on education and, therefore, prevention of disease. In this way, treatment need can be identified and addressed. Globalisation is primarily an economic phenomenon - the rapid economic integration between countries by removing obstacles to the global movement of capital and the production of goods and services. Its ideological parent is neoliberalism and it is oiled by new technology, especially IT. Its supporters have pointed to the creation of unprecedented wealth globally, the creation of hundreds of thousands of jobs; mainly in selected Asian countries where poverty levels have sharply reduced. Its critics point to the ever-widening gap between the rich and poor countries and between rich and poor people, even in the north. And indeed the statistics are daunting. The share of the poorest fifth of the world's population in global income has dropped from 2.3% to 1.4% over the past 10 years. The proportion taken by the richest fifth, on the other hand, has risen from 70% to 85%. In Sub-Saharan Africa, 20 countries have lower incomes per head in real terms than they did two decades ago. Globalisation, with significant percentage increases in GDP of many developing countries should make possible achievement of the ideals as defined in “Global strategies to reduce the health-care burden of craniofacial anomalies: Report of WHO meetings on International Collaborative Research on craniofacial anomalies”. Yet, whilst research as the basis for long term improvements in the management of CFA is absolutely essential, in the immediate future efforts to reduce healthcare burden and treatment need must continue,

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