Wednesday, September 19, 2012

Lancet: How to achieve universal health coverage

Warning: this study in the prestigious medical journal The Lancet is not for followers of faith-based science, or supporters of CATO, Heritage Foundation or the Family Research Council. This is for Americans who, living in the richest country on Earth, believe that universal health coverage (forget about the means for a moment) is both our common goal and moral obligation.

Here's the Summary:

Countries have reached universal health coverage by different paths and with varying health systems. Nonetheless, the trajectory toward universal health coverage regularly has three common features. The first is a political process driven by a variety of social forces to create public programmes or regulations that expand access to care, improve equity, and pool financial risks. The second is a growth in incomes and a concomitant rise in health spending, which buys more health services for more people. The third is an increase in the share of health spending that is pooled rather than paid out-of-pocket by households. This pooled share is sometimes mobilised as taxes and channelled through governments that provide or subsidise care—in other cases it is mobilised in the form of contributions to mandatory insurance schemes. The predominance of pooled spending is a necessary condition (but not sufficient) for achieving universal health coverage. This paper describes common patterns in countries that have successfully provided universal access to health care and considers how economic growth, demographics, technology, politics, and health spending have intersected to bring about this major development in public health.

Note that America meets the second criterion already, and Obamacare meets the other two.  

And here's the key take-away: 

Countries that want to achieve universal health coverage need to adopt public policies that reduce reliance on out-of-pocket spending and improve the institutions that manage pooled funding to address the equity, efficiency, and sustainability of health expenditures.

Finally, let's recognize that although government must always play a strong role, constant tinkering with the system is a hallmark of universal health coverage. Countries with universal coverage don't declare victory and call it a day:

A large government role is always an essential element in the expansion of access to care and provision of financial protection. However, the process of negotiation and compromise over health reforms leads governments to assume different roles and leads health systems institutions to take on different forms. Even in countries that have effectively universalised access to most health care, the process of debate and contestation does not end. Instead, debates continue in response to changes in economics, politics, and medical technology, as well as inequities in access that persist even in the most effective systems.

Thus, when right-wing media cite public "discontent" with universal coverage systems in countries like Britain and Canada, we must note that their public is never in favor of scrapping their system in favor of "free-market medicine," but rather reforming their existing system.  Indeed, as cited byThe Wall Street Journal, in a survey of the 10 major economies in 2008, Americans reported the lowest level of satisfaction with their health coverage.  

By Dr. William D Savedoff, et al
September 8, 2012 | The Lancet

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