<br>From: <b class="gmail_sendername">Ruggiero, Mrs. Ana Lucia (WDC)</b> <span dir="ltr"><<a href="mailto:ruglucia@paho.org">ruglucia@paho.org</a>></span><br><div class="gmail_quote">crossposted from: <a href="mailto:EQUIDAD@listserv.paho.org">EQUIDAD@listserv.paho.org</a><br>
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<p class="MsoNormal" style="margin-left:.5in"><span><b><font size="3" color="maroon" face="Arial"><span style="font-size:12.0pt;font-family:Arial;color:maroon;font-weight:bold">WHO The world health report <br>
- Health systems financing: the path to universal coverage<br>
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<p class="MsoNormal" style="margin-left:.5in"><span><font size="2" color="navy" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:navy"> </span></font></span></p>

<p class="MsoNormal" style="margin-left:.5in"><span><b><font size="2" color="navy" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:navy;font-weight:bold">World Health Organization WHO, November 22, 2010<br>

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<p class="MsoNormal" style="margin-left:.5in"><span><font size="2" color="navy" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:navy">Website:   <a href="http://bit.ly/dotQNz" target="_blank"><font color="navy"><span style="color:navy">http://bit.ly/dotQNz</span></font></a> <br>

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<p class="MsoNormal" style="margin-left:.5in"><span><font size="2" color="navy" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:navy"> </span></font></span></p>

<p style="margin-left:.5in;line-height:10.05pt"><font size="2" color="navy" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:navy">“…..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.</span></font></p>

<p style="margin-left:.5in"><font size="2" color="navy" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:navy"><br>
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.</span></font></p>

<p style="margin-left:.5in"><font size="2" color="navy" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:navy"><br>
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.</span></font></p>

<p style="margin-left:.5in"><font size="2" color="navy" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:navy"><br>
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.<br>
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<p class="MsoNormal" style="margin-left:.5in"><font size="2" color="navy" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:navy">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<br>
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.<br>
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<p class="MsoNormal" style="margin-left:.5in"><font size="2" color="navy" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:navy">No one in need of health
care, whether curative or preventive, should risk financial ruin as a result.</span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font size="2" color="navy" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:navy">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.<br>
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</span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font size="2" color="navy" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:navy">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.<br>
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</span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font size="2" color="navy" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:navy">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…..” </span></font><i><font size="1" color="navy" face="Arial"><span style="font-size:8.0pt;font-family:Arial;color:navy;font-style:italic">[Dr Margaret Chan, Director-General, World Health
Organization]</span></font></i></p>

<p class="MsoNormal" style="margin-left:.5in"><i><font size="1" color="navy" face="Arial"><span style="font-size:8.0pt;font-family:Arial;color:navy;font-style:italic"><br>
</span></font></i><b><font size="2" color="navy" face="Arial"><span style="font-size:11.0pt;font-family:Arial;color:navy;font-weight:bold">Content</span></font></b></p>

<p class="MsoNormal" style="margin-left:.5in"><font size="2" color="navy" face="Arial"><span style="font-size:10.0pt;font-family:Arial;color:navy"> </span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font size="1" color="navy" face="Arial"><span style="font-size:9.0pt;font-family:Arial;color:navy">Message from the
Director-General</span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font size="1" color="navy" face="Arial"><span style="font-size:9.0pt;font-family:Arial;color:navy">Executive summary</span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font size="1" color="navy" face="Arial"><span style="font-size:9.0pt;font-family:Arial;color:navy">Why universal coverage?</span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font size="1" color="navy" face="Arial"><span style="font-size:9.0pt;font-family:Arial;color:navy">Where are we now?</span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font size="1" color="navy" face="Arial"><span style="font-size:9.0pt;font-family:Arial;color:navy">How do we fix this?</span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font size="1" color="navy" face="Arial"><span style="font-size:9.0pt;font-family:Arial;color:navy">Raising sufficient
resources for health</span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font size="1" color="navy" face="Arial"><span style="font-size:9.0pt;font-family:Arial;color:navy">Removing financial risks
and barriers to access</span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font size="1" color="navy" face="Arial"><span style="font-size:9.0pt;font-family:Arial;color:navy">Promoting efficiency and
eliminating waste</span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font size="1" color="navy" face="Arial"><span style="font-size:9.0pt;font-family:Arial;color:navy">Inequalities in coverage</span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font size="1" color="navy" face="Arial"><span style="font-size:9.0pt;font-family:Arial;color:navy">An agenda for action</span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font size="1" color="navy" face="Arial"><span style="font-size:9.0pt;font-family:Arial;color:navy">Facilitating and
supporting change</span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font size="1" color="navy" face="Arial"><span style="font-size:9.0pt;font-family:Arial;color:navy">Practical steps for
external partners</span></font></p>

<p class="MsoNormal" style="margin-left:.5in"><font size="1" color="navy" face="Arial"><span style="font-size:9.0pt;font-family:Arial;color:navy">A message of hope<br>
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