Tim France, Gorik Ooms and Bernard Rivers (21 April 2002).
Nearly one year ago, the majority of the world's nations resolved at `UNGASS', a major UN conference on AIDS, to increase annual expenditure on the AIDS epidemic to $7-10 billion by 2005, with much of this money to be raised and disbursed by a new global fund. When the fund was eventually set up, its mandate was extended, and it was named the Global Fund to Fight AIDS, Tuberculosis and Malaria. AIDS, an unprecedented and accelerating emergency, is already having a devastating impact in Africa, with similar impacts unfolding on other continents. Every day, 8,000 die, and 13,000 more become infected. Experts agree that reasonable expenditures on prevention and treatment of AIDS, tuberculosis and malaria can be of dramatic benefit not only to human health, but also to economic development. Thus far, efforts have been made to raise the money needed by the Global Fund through ad hoc voluntary donations. These efforts have failed. Governments have pledged a mere $1.8 billion. Contributions from the private sector have been even more disappointing, with not a single meaningful pledge since the Bill & Melinda Gates Foundation offered $100 million ten months ago. It's time for a new approach.
Resource allocation and health financing
Adam Oliver, LSE Health and Social Care, London School of Economics and Political Science ISBN [07530 1932 9] Discussion Paper 2, February 2002. Health care resources are scarce, and there are competing moral claims on how the available resources ought to be distributed. Many of the claims focus upon the distribution of health outcomes, and thus assume that different health outcomes arising from disparate health care programmes can in some sense be compared. If cardinal values for health states could be elicited, they would help us to distribute resources more accurately towards our chosen health care objectives (whatever they might be).
Trudy Harpham, Emma Grant, South Bank University, London, UK and Elizabeth Thomas, Medical Research Council, Johannesburg, South Africa. Health Policy and Planning; 17(1): 106-111 Oxford University Press 2002. With growing recognition of the social determinants of health, social capital is an increasingly important concept in international health research. Although there is relatively little experience of measuring social capital, particularly in developing countries, there are now a number of studies that allow the identification of some key issues that need to be considered when measuring social capital.
Paolo Belli, Research Fellow, Department of Population and International Health Harvard School of Public Health - August 2001, Professor at Pavia University, Pavia Italy, and Lecturer at Bocconi University. This paper introduces a conceptual framework to investigate into the equity consequences of resource allocation, strategic purchasing and payment system reforms in health. It also presents a selective survey of the evidence available on the distribution of health, on utilization of public health services across socio-economic groups, and on the equity impact of RAP reforms in a number of developing countries.
Musgrove P, Zeramdini R. A summary description of health financing in WHO Member States(CMH Working Paper Series, Paper No. WG3: 3.
Analysed in this paper are national health accounts estimates for 191 WHO Member States for 1997, using simple comparisons and linear regressions to describe spending on health and how it is financed. The data cover all sources—out-of-pocket spending, social insurance contributions, financing from government general revenues and voluntary and employment-related private insurance — classified according to their completeness and reliability.
Health care report cards - public disclosure of patient health outcomes at the level of the individual physician and/or hospital - may address important informational asymmetries in markets for health care, but they may also give doctors and hospitals incentives to decline to treat more difficult, severely ill patients. Whether report cards are good for patients and for society depends on whether their financial and health benefits outweigh their costs in terms of the quantity, quality, and appropriateness of medical treatment that they induce. Using national data on Medicare patients at risk for cardiac surgery, we find that cardiac surgery report cards in New York and Pennsylvania led both to selection behavior by providers and to improved matching of patients with hospitals. On net, this led to higher levels of resource use and to worse health outcomes, particularly for sicker patients. We conclude that, at least in the short run, these report cards decreased patient and social welfare.
Policy makers have long been concerned with improving the performance of their health systems, with reforms targeting all system functions - financing, provision, stewardship and resource generation. An increasing number of studies have assessed the impact of reforms in different settings, but these studies have used varying frameworks and methods to assess and measure the effect of changes in policies and strategies. This makes it difficult to separate out the true variations in impact from variations stemming from the different methods that were used.
WHO, UNICEF, UNAIDS, World Bank, UNESCO, and UNFPA, 2/1/02.
In December 2001, the Commission on Macroeconomics and Health presented the results of its two-year work to the World Health Organization in a publication titled Macroeconomics and Health: Investing in Health for Economic Development. The Commissioners present a new global blueprint for health that is both compassionate and cost-effective. Millions of deaths occur each year in the developing world due to conditions which can be prevented or treated. The Commissioner's outline a plan of action to save millions of these lives every year at a small cost relative to the vast improvements in health and increased prosperity. The Report shows that just a few conditions are responsible for a high proportion of the avoidable deaths in poor countries - and that well-targeted measures, using existing technologies, could save around 8 million lives per year and generate economic benefits of more than $360 billion per year, by 20152020. The aggregate cost of scaling up essential health interventions in low-income countries would be around $66 billion per year, with the costs roughly divided between high-income donor countries and low-income countries. Thus, the economic benefits would vastly outstrip the cost. Scaling Up the Response to Infectious Diseases: A way Out of Poverty takes up the Commission's challenge. It outlines how increased investment in health can be well spent, stressing how interventions, health system strengthening and behaviour change together can help achieve the goals we are setting ourselves. This report takes forward the Commission's action agenda. It will help decision makers see how we can turn increased investment in health into concrete results.
Ellen Verheul, Wemos, the Netherlands <ellen.verheul@wemos.nl>
Mike Rowson, Medact, UK <mikerowson@medact.org>
Only 11% of the global health budget is spent in the low- and middle- income countries, where 84% of the global population lives. 1,1 billion people do not have access to clean water. 2,4 billion people lack access to sanitation. One third of deaths in developing countries are due to preventable and/or treatable conditions.
The purpose of this report is to consider the legitimacy of the assumption that communities or societies with more unequal income distributions have poorer health outcomes. The report presents a critical review of the existing international literature on the relationship between income, income inequality and health, in terms of conceptual approaches, research methods and the policy implications drawn from it. The report also offers some guidance for judging between policy priorities based on the relative importance of income inequality versus other potential causal factors in determining population levels of health. An overview of the potential relationship between income, income inequality and health is set out, followed by a discussion of the methodological and technical issues required to explore these links.