2014 is already shaping up to be another exciting year for the global movement for universal health coverage (UHC). I was just with World Bank Group President Jim Kim in Myanmar, where we are putting our previously announced global targets for universal health coverage into action.
universal health coverage
On Jan. 29, 2014, World Bank Group President Jim Yong Kim spoke about Thailand’s effort to achieve universal health coverage at the Prince Mahidol Award Conference in Bangkok. In just one year, the country’s universal health coverage scheme added 18 million uninsured citizens to the rolls of the insured. Kim also addressed Thailand’s success in reducing new HIV infections by more than 90% from 1990 to 2013, which saved $18 billion. Read Kim’s full remarks.
Nobody likes to be stung. Doctors regard it as unethical. Publishers say it betrays the trust of their profession. But the fact is, as three recent studies have demonstrated, sting operations can be extremely effective at exposing questionable professional practices, and answering questions that other methods can't credibly answer.
Sting #1: Are open-access journals any good?
Much of the world has gotten fed up with the old academic publishing business. Companies like the Anglo-Dutch giant Elsevier and the German giant Springer earn high profit margins from their academic journals (Elsevier earns 36% profit, according to The Economist), through a mix of ‘free’ inputs from academics (the article itself and the peer-review process) and high (and rapidly rising) subscription charges that impede access by academics working in universities whose libraries can’t afford the subscriptions. Of course, many of these universities paid for the authors’ time in the first place, and/or that of the peer-reviewers; tax-payers also contributed, by direct subsidizing universities and/or by the research grants that supported the research assistants, labs, etc. Unsurprisingly, libraries, universities, academics and tax-payers aren’t happy.
The author with colleagues after touring a health facility in Turkey, June 2013. Also available in Turkish
Two days after joining the World Bank, I traveled to Turkey to attend the government’s ministerial meeting on universal health coverage (UHC), which corresponded with The Lancet publication of an independent 10-year assessment of Turkey’s Health Transformation Program (HTP).
I've been blogging a bit about Universal Health Coverage (UHC) recently. In my "old wine in a new bottle" post, I argued that UHC is ultimately about ensuring that rich and poor alike get the care they need, and that nobody suffers undue financial hardship from getting the care they need. In my "Mrs Gauri" post, I used my colleague Varun Gauri's mother as a guinea pig to see whether the general public feels that UHC is a morally powerful concept and whether it could be expressed in a way that the general public would find accessible.
My sense from Ms Gauri's comment on the post, is that the answer to both questions could well be Yes. So far so good.
Some bad news—resources are finite
But before we place orders for colorful placards and huge banners with my suggested slogans "Everyone should get the care they need!" and "End impoverishment due to health spending!", we should break some bad news to Ms Gauri and the rest of the general public: resources are finite, and especially in poor countries the available resources won't allow us to get to UHC anytime soon.
In a recent blogpost I asked whether Universal Health Coverage (UHC) is old wine in a new bottle, and if so whether that’s so bad.
I argued that UHC is ultimately about making sure that “everyone – whether rich or poor – gets the care they need without suffering undue financial hardship as a result.” I suggested UHC embraces three important concepts:
• equity: linking care to need, not to ability pay;
• financial protection: making sure that people's use of needed care doesn't leave their family in poverty; and
• quality of care: making sure providers make the right diagnosis, and prescribe a treatment that's appropriate and affordable.
I had been warned—I found it hard to believe—that WHO ministerial meetings can be rather dull affairs of little consequence. Ministers typically take it in turn to read their prepared speeches; their fellow ministers appear to be listening attentively through their headsets but some, it seems, have been known to zap through the simultaneous translation channels in search of lighter entertainment. Speeches aren’t played over the loudspeakers for fear of waking jetlagged ministers from their afternoon naps. WHO is a very considerate organization: it likes to make sure that while on its premises visitors reach “a state of complete physical, mental and social well-being.”
Well I’m happy to report that last week’s ministerial meeting on Universal Health Coverage (UHC)—held in Geneva on February 18-19, jointly organized by WHO and the World Bank, and attended by delegates from all over the world (see map)—didn’t fit the stereotype.
It's easy to see how the concept of universal health coverage (UHC) became so elusive.
At the start, the idea must have seemed straightforward enough. Lots of countries "covered" only part of their population, and several were making efforts to expand coverage to "uncovered" populations. China, for example, started out on this process in 2003, trying to expand coverage to the rural population that lost coverage when the old rural cooperative medical scheme collapsed following the de-collectivization of agriculture in 1978.
In the developing world, a hospitalization is one of the things that families – especially poor ones – fear most. This came through in country after country in the World Bank’s Voices of the Poor exercise. Here are just some examples:
A man from Ghana is quoted as saying: “Take the death of this small boy this morning, for example. The boy died of measles. We all know he could have been cured at the hospital. But the parents had no money and so the boy died a slow and painful death, not of measles, but out of poverty.”
The researchers write that in Lahore, Pakistan, “a father explained that it had taken him eight years to repay debts acquired after he, his wife, and two of their children had been hospitalized.”