Joseph S. Coyne, DrPH, PhD, Health Policy and Administration Program, Washington State University, Spokane.
Peter Hilsenrath, Department of Health Management and Policy, School of Public Health, University of North Texas Health Science Center, Fort Worth.
Comparative studies have been part of health services research literature for decades. The benefits of these analyses include documenting how the more successful practices can be adapted in another country. Such has been the case in France, where many US health care delivery practices have been adopted in market reforms.
The World Health Organization (WHO) studied the health systems of 191 countries for its World Health Report 2000. The study is provocative and has stimulated significant analysis of the structure and performance of health systems. We examine the variables and methodology used by the WHO to measure efficiency and performance of health systems.
Resource allocation and health financing
Vicente Navarro, MD, PhD, DrPH
Director of the Public Policy Program jointly sponsored by the School of Public Health of The Johns Hopkins University
The major criticisms that can be made of the WHO report are conceptual and methodological in nature and can be made for each of the components (effectiveness, responsiveness, and fairness) of the single indicator of performance used in the report. Regarding effectiveness of health care, for example, the WHO report assumes erroneously that health care is the primary force responsible for the decline of mortality and morbidity in both developed and developing countries. That assumption is evident in statements such as "[If] Sweden enjoys better health than Uganda—life expectancy is almost exactly twice as long—it is in large part because it spends exactly 35 times as much in its health systems." Not surprisingly, the report concludes that what is needed to eradicate disease in less-developed countries is a greater investment in health care: "with investment in health care of $12 per person, one third of the disease burden in the world in 1990 would have been averted." Such statements reveal a medicalization of the concept of health that is worrisome and surprising, coming as it does from the major international health agency of the United Nations.
Hospital care is unaffordable and inaccessible for many HIV patients in sub-Saharan Africa. Home-based care (HBC) provides a practical alternative, but demand is growing rapidly. Can existing services expand to meet this need? What role should governments and non-governmental organisations (NGOs) play? Researchers from the UK Nuffield Institute for Health investigate HBC services in Zambia.
Mark Pearson, 2001. HSRC Health Systems Research Center, Institute for Health Sector Development (IHSD), DFID's Health Population Department, London, UK
The way in which a country finances its health care can have a major bearing on the access to health services enjoyed by its poor. National health policies generally set out a strategic goal of ensuring equal access to essential health services for all, on the basis of need and irrespective of ability to pay or some variation on this theme. Health financing impacts on this goal in two ways: on the supply side by ensuring that essential services are adequately financed and delivered, and on the demand side by reducing financial barriers to access and by making sure that funds are raised and services delivered in ways which are affordable to all. In a typical low income country, where only $3 - $5 of public funds per head is available for the health sector, such an ambitious goal is probably unrealistic no matter how well resources are allocated and used. In practice, there will often be significant inefficiency and inequity in both allocation and use of resources. This clearly raises the question as to whether, and how, financing policies could be made more pro-poor.
An effective referral system is a key element of health services based on primary healthcare (PHC). If referral steps are bypassed, treatment costs are greater than necessary. Higher level hospitals become overloaded while lower level facilities are underused. Why do referral systems fail and how can they be improved?
What are the implications for reproductive health of health reforms in low and middle-income countries? The last decade has seen a change in approach from supply-side health sector reforms to an emphasis on demand-driven and anti-poverty interventions. But has this increased access to reproductive healthcare and have services improved as a result?
Juan Antonio Casas, Division of Health Systems and Services Development, Director PAHO/WHO
Presentation at International Summit on the Private Health Sector December 2-5, 2001, Miami, Florida, USA
Provides an overview of the nature of international trade in health service. It also outlines some of the main barriers constraining trade in health services. More information about the Summit: <href a=http://www.internationalhealthsummit.com/index.html>http://www.internationalhealthsummit.com/index.html</a>
Under-resourced government health systems in sub-Saharan Africa often provide poor quality services. How can policy-makers improve healthcare standards without unsustainable increases in expenditure? The Tanzania Family Health Project implemented a range of interventions involving staff, facilities and services in the Mbeya region. Within two years, substantial progress has been made.
Chris Simms, Mike Rowson and Siobhan Peattie (Save the Children UK and Medact), 34pp
This report, informed by consultations with 50 donor representatives involved in health reform in Africa, welcomes the global initiative to tackle HIV/AIDS, TB and malaria. The report warns that lessons learned over the past 30 years should be heeded before huge sums are committed.
Inge Kaul & Michael Faust. Bulletin of the World Health Organization Volume 79, Number 9, September 2001
We examined recent special health initiatives to control HIV/AIDS, malaria, and tuberculosis, and make four policy recommendations for improving the sustainability of such initiatives. First, international cooperation on health should be seen as an issue of global public goods that concerns both poor and rich countries. Second, national health and other sector budgets should be tapped to ensure that global health concerns are fully and reliably funded; industrialized countries should lead the way. Third, a global research council should be established to foster more efficient health-related knowledge management. Fourth, managers for specific disease issues should be appointed, to facilitate policy partnerships. Policy changes in these areas have already begun and can provide a basis for further reform.