Investment banking and global surgery

The language of global surgery, public health, and finance includes jargon that can be quite dissimilar. Nevertheless, cost-effectiveness analysis and other public health approaches can be helpful in defining value in global surgery. Similarly, financial concepts such as time value of money, discounting, capitalization, and discounted cash flow are also valuable in such discussions. In order to determine the economic impact for surgery, it is necessary to determine what the present and future values are for specific surgical interventions. To do this, disability-adjusted life years (DALYs) are used to calculate the impact of various disease states, wherein a DALY is equal to the years of life lost due to premature death plus years lost due to disability. Surgical interventions are measured in terms of how many DALYs they will avert. DALYs can then be translated into dollars using one of two distinct economic approaches. Translating DALYs to dollars can be helpful in determining the value and cost-effectiveness of global surgery, such as the recently described high return on investment in caesarean delivery to treat obstructed labor. Another possible useful fiscal approach in global surgery is time-driven activity-based costing (TDABC), which can help identify the hidden costs and hidden profits in various activities. Using financial modeling to allow for dynamic understanding of the relationship between margin, volume, capacity, and staff substitutions, TDABC has been helpful in operational planning and strategic use of mid-level providers in clinics domestically. This approach is likely applicable and beneficial in resource-limited settings found in global surgery.