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.
East Asia and Pacific
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.
This past week, I attended a couple of interesting seminars at the World Bank’s Human Development Forum on how some mineral-rich countries have been able to translate their newfound riches into sustained economic growth, improved living conditions, and better nutrition, health and education levels for their populations.
New estimates released today by the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), the United Nations Population Fund (UNFPA), and the World Bank show that the number of women dying due to complications in pregnancy and childbirth has almost halved in 20 years—from more than 540,000 in 1990 to less than 290,000 in 2010.
This is good news, but it doesn’t tell the whole story. While substantial progress has been achieved at the global level, many countries, particularly in sub-Saharan Africa, will still fail to reach the Millennium Development Goal (MDG 5) target of reducing maternal mortality by 75% from 1990 to 2015.
Health systems are under pressure in Asia. Epidemiological and demographic transitions are taking place much faster than in Europe and America, in the span of a single generation. With the transition comes the non-communicable disease (NCD) epidemic that requires more sophisticated and expensive interventions provided by hospitals, inpatient or outpatient. Rapid economic development in Asia has lifted millions out of poverty and raised peoples’ expectations for services. Between China, India, Thailand, Philippines, Indonesia and Vietnam, expansion of health insurance coverage during the last decade has reached an additional one billion people, making services more affordable and thus increasing demand. Advancing medical technology eagerly awaited by specialist doctors sitting on top of health professional hierarchies further expands possibilities for treatment. The middle class votes with their feet and takes their health problems to medical tourism meccas like those in Bangkok and Singapore, voiding their own countries of additional income to health care providers. Policymakers are scrambling to expand hospital capacity, boost the pay of health professionals, and encourage investment to meet the demand.
But governments do not wait. They are exploring hospital autonomy, decentralization, user fees and private sector participation. These policies often pose risks that need to be mitigated by policies and institutional arrangements. For example, health care providers sometimes order unnecessary procedures to earn additional revenue, thanks to the powerful incentive of the fee-for-service payment mechanism and information asymmetry between the patient and health care provider. This can mean financial ruin for both the patient and new, relatively weak health insurance agencies.
Despite these challenges, hospitals aren’t high on the international health development agenda, save a few initiatives to improve quality and provider payment reform.