PHM-Exch> WHO The world health report - Health systems financing: the path to universal coverage

[Claudio Schuftan]

From: Ruggiero, Mrs. Ana Lucia (WDC) <ruglucia at paho.org>
crossposted from: EQUIDAD at listserv.paho.org


 *WHO The world health report
- Health systems financing: the path to universal coverage

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*World Health Organization WHO, November 22, 2010

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Website:   http://bit.ly/dotQNz



“…..The objective was to transform the evidence, gathered from studies in a
diversity of settings, into a menu of options for raising sufficient
resources and removing financial barriers to access, especially for the
poor. As indicated by the subtitle, the emphasis is firmly placed on moving
towards universal coverage, a goal currently at the centre of debates about
health service provision.


The need for guidance in this area has become all the more pressing at a
time characterized by both economic downturn and rising health-care costs,
as populations age, chronic diseases increase, and new and more expensive
treatments become available. As this report rightly notes, growing public
demand for access to high-quality, affordable care further increases the
political pressure to make wise policy choices.


At a time when money is tight, my advice to countries is this: before
looking for places to cut spending on health care, look first for
opportunities to improve efficiency. All health systems, everywhere, could
make better use of resources, whether through better procurement practices,
broader use of generic products, better incentives for providers, or
streamlined financing and administrative procedures.


This report estimates that from 20% to 40% of all health spending is
currently wasted through inefficiency, and points to 10 specific areas where
better policies and practices could increase the impact of expenditures,
sometimes dramatically. Investing these resources more wisely can help
countries move much closer to universal coverage without increasing
spending.

 Concerning the path to universal coverage, the report identifies continued
reliance on direct payments, including user fees, as by far the greatest
obstacle to progress. Abundant evidence shows that raising funds through
required prepayment is the most efficient and equitable base for increasing
population coverage
such mechanisms mean that the rich subsidize the poor, and the healthy
subsidize the sick. Experience shows this approach works best when
prepayment comes from a large number of people, with subsequent pooling of
funds to cover everyone’s health-care costs.

 No one in need of health care, whether curative or preventive, should risk
financial ruin as a result.

As the evidence shows, countries do need stable and sufficient funds for
health, but national wealth is not a prerequisite for moving closer to
universal coverage. Countries with similar levels of health expenditure
achieve strikingly different health outcomes from their investments. Policy
decisions help explain much of this difference.

 At the same time, no single mix of policy options will work well in every
setting. As the report cautions, any effective strategy for health financing
needs to be home-grown. Health systems are complex adaptive systems, and
their different components can interact in unexpected ways. By covering
failures and setbacks as well as successes, the report helps countries
anticipate unwelcome surprises and avoid them. Trade-offs are inevitable,
and decisions will need to strike the right balance between the proportion
of the population covered, the range of services included, and the costs to
be covered.

 Yet despite these and other warnings, the overarching message is one of
optimism. All countries, at all stages of development, can take immediate
steps to move towards universal coverage and to maintain their achievements.
Countries that adopt the right policies can achieve vastly improved service
coverage and protection against financial risk for any given level of
expenditure. It is my sincere wish that the practical experiences and advice
set out in this report will guide policy-makers in the right direction.
Striving for universal coverage is an admirable goal, and a feasible one –
everywhere…..” *[Dr Margaret Chan, Director-General, World Health
Organization]*

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**Content*



Message from the Director-General

Executive summary

Why universal coverage?

Where are we now?

How do we fix this?

Raising sufficient resources for health

Removing financial risks and barriers to access

Promoting efficiency and eliminating waste

Inequalities in coverage

An agenda for action

Facilitating and supporting change

Practical steps for external partners

A message of hope
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