Health Equity: 03/03/10

Wednesday, March 3, 2010

[EQ] The Joint Learning Workshop on Universal Health Coverage

The Joint Learning Workshop on Universal Health Coverage

Workshop planned in consultation with:
Delegation leads from each participating country, and with technical and/or financial support from a number of partners, including the ACCESS Health Initiative, Atlantic Philanthropies, the Bill & Melinda Gates Foundation, GTZ, the International Labour Organization, the Providing for Health (P4H) Initiative, the Results for Development Institute, the Rockefeller Foundation, and the World Bank.

Website www.jointlearningworkshop.org

The Joint Learning Workshop on Universal Health Coverage, held in Gurgaon, India on February 3-5, 2010, convened 120 representatives from six countries – Ghana, India, Indonesia, Philippines, Thailand and Vietnam – and several international organizations to share experiences in carrying out health coverage reform domestically, as well as to learn from the experiences and challenges of reform processes in other countries

Joint Learning Workshop brings together six countries to discuss universal health coverage reform

Over the past decade, a number of national or state-level reforms have been implemented by governments that are committed to expanding health coverage through "demand-side" (third-party) financing models, to reach the poorest and informal sectors of their populations. These reforms are ambitious in their goals, but challenging to implement successfully. Many organizations and initiatives currently provide helpful policy assistance for and generate valuable information on these new and innovative reforms. To complement these existing activities, there is increasing demand for cross-learning and joint problem-solving among countries pursuing similar reforms. Cross-learning activities are specifically desired by implementing practitioners who feel they can work with peer countries to identify strategies and tactics to overcome the many challenges to successful implementation.

To meet this demand for cross-learning, a group of initiating countries, in collaboration with several development partners, is developing a plan to establish a multi-country cross-learning platform for countries implementing demand-side financing reforms. This effort would result in a network of country-level implementers, ongoing activities designed for cross-country learning and problem-solving, a repository of existing and new tools that could be used by implementers, better documentation and dissemination of existing reform efforts and a practical research agenda around core implementation questions.

As a first step toward the development of an ongoing, multi-country cross-learning platform, representatives from six countries
– Ghana, India, Indonesia, Philippines, Thailand and Vietnam – and their development partners convened a joint learning workshop in Delhi, India on February 3 – 5, 2010.

· The first day opened with three country-led panel discussions reviewing health coverage schemes of representative delegations, specifically covering the following themes: scope of coverage, financing, and institutional structure.

· The second day allowed participants to focus on particular technical issues related to quality, provider management, coverage and technology. These technical sessions allowed representatives to tackle the topics expressed as most relevant on a very granular level, through joint learning and problem solving among country delegations.

· On the third day, members convened to report back from the four technical breakout sessions and discuss potential opportunities for future joint learning activities.

One day prior to the start of the workshop, participants also had the opportunity to participate in site visits to learn more about the RSBY smart card, an innovative electronic enrollment and record keeping mechanism widely implemented within the 23 Indian states currently served by the RSBY scheme.

The workshop served as the pilot initiative in a series of joint learning activities. Beyond sharing ideas and experiences, participants also laid the foundations for the creation of Joint Learning Network. Specific follow-up activities are expected to take place later in the year. [From Brian Latko Results for Development Institute]

Technical tracks

While the first day was designed to give participants a general overview of each country's health insurance reform efforts and discuss broadly the typical design issues and choices facing health insurance schemes, the technical track sessions allowed participants to hone in on one of four key implementation issues in a smaller group setting. The sessions were intended to serve as a platform for joint learning and problem‐solving across country delegations.

Technology technical track

Moderator: Gina Lagomarsino (Results for Development Institute)
Presenters: Dr. Sun Hau Chen (Taiwan) – Information Management Division, Bureau of National Health Insurance, Government of Taiwan; Dr. Kannika Pruksachat (Thailand) – Social Security Office, Government of Thailand

This session explored the various ways that countries can utilize information technology to improve the functioning of national health insurance systems. Presenters shared the success stories of Taiwan and Thailand in implementing sophisticated smart card or identity card technologies, and the ways in which these technologies contributed to health system reform in these countries. Participants identified and discussed a number of common issues around information technologies, including their technological needs, how new technologies can enable systems reform, and the challenges that they face in developing and adopting new technology. While many "lessons learned" emerged from the day-long discussion, the country delegates recognized that further collaboration and learning across countries is necessary.

Coverage technical track

Moderator: Dr. Peter Berman – The World Bank
Presenters: Dr. MariaLuisa Escobar (Colombia) – The World Bank (Formerly with the Government of Colombia); Mr. Anil Swarup (India/RSBY) – Ministry of Labor and Employment, Government of India; Mr. Prasad Rao Pasam (India/Aarogyasri) – General Manager of Human Resources, Star Health; Dr. Eduardo Banzon (the Philippines) – The World Bank

Participants in this technical track discussed effective strategies for increasing awareness and coverage levels among the populations targeted by their countries' health insurance schemes. Topics covered included mechanisms for identifying and targeting members of the formal and informal sectors, and challenges associated with expanding coverage.

Provider management technical track

Moderators: Dr. Somil Nagpal – The World Bank (Formerly with Indian Insurance Regulatory and Development Authority); Dr. Jack Langenbrunner – The World Bank
Presenter: Dr. Jadej Thammatacharee (Thailand) – National Health Security Office, Government of Thailand

Participants in this technical track discussed their schemes' approaches to provider contracting and payment, as well as the associated tradeoffs and challenges. They were able to learn from the experiences of Thailand and other schemes which have employed innovative approaches to provider payment and jointly

Quality technical track

Moderator: Dr. Jerry La Forgia – The World Bank
Presenters: Dr. Robert Janett (US/Massachusetts) – Senior Medical Director of Network Health, Cambridge Health Alliance; Dr. Paulo Borem (Brazil) – Commercial Director, UNIMED, Belo Horizonte

Participants in this technical track focused on the various options available for health insurers and purchasers for incentivizing quality of care improvements in a demand side health financing environment. Major issues discussed included how to handle underuse, overuse and misuse of services, lack of data on quality and subsequent challenges in monitoring, accreditation mechanisms and congestion of facilities, among others.

* * *
This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues. [DD/ KMC Area]

"Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members".
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[EQ] Beyond Facts - Understanding Quality of Life

Beyond Facts - Understanding Quality of Life

Eduardo Lora, Coordinator

Inter-American Development Bank, Co-published by David Rockefeller Center for Latin American Studies

Harvard University

Available online [286p.] at: http://idbdocs.iadb.org/wsdocs/getdocument.aspx?docnum=1775002

“……Everybody seeks a better quality of life, although few people are able to define with precision the objective of their quest. If the key to a good quality of life were simply to have a good income, governments could concentrate their efforts on economic growth and ignore what people need for personal development and what society needs to achieve the public good. Reality, however, is quite different. In any democratic society, governments and the political systems that include them are judged not only by the quality of macroeconomic results, but also by their capacity to interpret and respond to the demands of the electorate on the most varied of fronts, ranging from national security to access to justice, and from the delivery of public utility services to the operation of hospitals and schools. A few basic economic and social statistics and a good dose of intuition to interpret public opinion and the actions of politicians are generally the main sources of information available to government leaders in making judgments and decisions….”

“…….Along with offering policy recommendations for each issue analyzed, this study also draws attention to the effects that perceptions can have on political processes and on public decision making. The beliefs and the perception and interpretation biases of both the electorate and politicians and government leaders exert considerable influence on the supply and demand of public policies. Information possessed by various actors in the political process can affect (in ways that are not always consistent) the perceptions of issues among the different players, which in turn affect the policy discussion, formulation, and implementation process. On those bases, strategies are proposed herein to reduce the information gap and the influence of perception biases so that the public debate may involve better options for producing policies that contribute to improving the quality of life….”

Content

PART I SETTING THE STAGE

Chapter 1 Quality of Life Viewed through Another Lens.

Chapter 2 The Personality of Quality of Life Perceptions.

Chapter 3 The Conflictive Relationship between Income and Satisfaction.

Chapter 4 Satisfaction beyond Income. . . . . . . . . .

PART II FACTS AND PERCEPTIONS IN ACTION

Chapter 5 Getting a Pulse on Health Quality.

Chapter 6 Learning about Education Quality and Perceptions . .

Chapter 7 Rethinking Conventional Wisdom on Job Quality.

Chapter 8 Urban Quality of Life: More Than Bricks and Mortar .

PART III THE CURTAIN CALL

Chapter 9 The People’s Choice? The Role of Opinions in the Policymaking Process

References.

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.
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    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.

[EQ] Evidence-based Health Economics: what is it and where does it come from?

Complex Problems or Simple Solutions?
Enhancing Evidence-based Economics to Reflect Reality

Chantale Lessard, Canadian Institutes of Health Research (CIHR) Fellow - Department of Health Administration - School of Public Health, Faculty of Medicine University of Montreal - Montreal, Quebec, Canada

Stephen Birch, Professor Department of Clinical Epidemiology and Biostatistics McMaster University Hamilton, Ontario, Canada & School of Community Based Medicine University of Manchester, Manchester, United Kingdom
CHEPA working paper series Paper 09-05 - July 8, 2009
The Centre for Health Economics and policy Analysis (CHEPA)

The final version of this working paper will be published as a chapter in: Donaldson, Shemilt, Mugford, Vale & Marsh (eds) (2010) Evidence-Based Decisions and Economics: Health care, social welfare, education and criminal justice. Blackwell Publishing, Oxford.

Available online [24p.] at: http://www.chepa.org/Libraries/PDFs/WP_09_05.sflb.ashx

‘……As demands for new health care technologies1 increase in environments of cost-containment, choices must be made about which interventions to fund. Similar problems arise in other sectors as decision-makers struggle to determine the most productive ways of deploying the resources available to them. The evidence-based approach has drawn on economics aimed at providing analytical frameworks to inform decision-making about effectiveness and efficiency of resource use. These frameworks increasingly form the basis for resource allocation decisions.

For example, jurisdictions have adopted formal requirements and guidelines for economic evaluation in health care (1-4). Donaldson and colleagues (5) recognise the need for the application of evidence-based principles in the practice of economic evaluation. However, the importance of adopting evidence-based approaches in health economics is not confined to the economic evaluation of new technologies.

Health economics encompasses a much broader range of influences and constraints on the production of health, illness and recovery in populations (6). Moreover, under an evidence-based approach, the methods and processes used, as well as the principles and assumptions on which they are based, must themselves be compatible with the concepts of economics (5).

The evidence-based approach to decision-making draws its foundations from clinical epidemiology. The focus of attention is establishing ‘evidence’ of effectiveness, i.e., providing information on whether a technology works or not (7). This has lead to the development and use of research methods which devalue the complexity of social reality and exclude the consideration of context (8). As a result, the research answers questions about whether the intervention ‘works’ on average in the sample of the population selected for study….”

    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.