PHM-Exch> Report on the Berlin Conference on health systems financing

[Claudio Schuftan]

From: Thomas Gebauer <gebauer at medico.de>



*Short Report on the Ministerial Conference "Health Systems Financing - Key
to Universal Coverage" held in Berlin, Nov. 22-23, 2010. *



The conference was convened by two German Ministries on the occasion of the
presentation of the “World Health Report 2010”. It turned out to be a most
interesting gathering of almost 30 Ministers of Health from all over the
world plus government officials, politicians, some researches and a few
NGOs.



Everyone agreed on the aim to achieve universal coverage. The model that was
presented by WHO concerning this doesn’t speak about  just going for “some
coverage” or essential packages, but demands from all countries to do their
utmost to set up pooled funds that cover three dimensions: expanding the
number of people covered, expanding the scope of services and reducing cost
sharing (direct payment such as user fees).



Dr Margaret Chan had demanded to get rid of user fees, because "user
fees punish the poor". Everywhere there are people too poor to contribute
financially to health care, therefore they need to be subsidised from pooled
funds, generally tax-based health systems. “Out of pocket” payments have to
be reduced by promoting prepayment und pooling systems (tax-based or
mandatory social heath insurance). All agreed that there is no "silver
bullet" that serves as a solution for all countries. There is no global
scheme that has to be "adopted" by all countries, but the need is to “adapt”
a way to move forward in the three dimensions (population covered, the scope
of services expanded and cost sharing reduced) at national level. This opens
space for national adaptations and provides civil society organizations with
the chance to continuously challenge their governments, e.g. to expand the
scope of services.



With exception of only few participants nobody mentioned private companies
as relevant actors. Achieving universal coverage requires the strengthening
of health systems. Ensuring affordable access to health is ultimately a
public responsibility and not related to private assurance companies.



To ultimately realize the right to health, governments have to create the
needed fiscal space. In this regard, the “World Health Report” mentions as
possible new sources of revenue: a special levy on large and profitable
companies, a currency transaction levy, a financial transaction tax, and the
so-called sin-taxes (alcohol, tobacco). No reference is made to for profit
PP Partnerships.



In the context of global responsibility, the “Report” stated that donor
countries should do more to meet their international commitments by
providing a more predictable and long-term aid-flow.



It should not be surprising that a ministerial conference tends to produce
documents with nice and bubbly words. Most of the presenters mixed up
risk-sharing with solidarity-actions, and when it came to actions (with
exception of the Brazilian Minster of Health), almost al preferred to be
vague in their statements.



Nevertheless, there is an interesting shift in the international debate on
global health. 32 years after its coinage, the concept of” Health for all”
is back on the agenda.





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Thomas Gebauer
medico international

www.medico.de
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