Health Equity: 04/06/10

Tuesday, April 6, 2010

[EQ] Colombia: Approaching Universal Coverage

Colombia: Approaching Universal Coverage

Book Review:
Philip Musgrove, Health Affairs deputy editor, in Bethesda, Maryland.
Health Affairs, Supplement 2010; 29(4): 739-740. - doi: 10.1377/hlthaff.2010.0225

Website: http://content.healthaffairs.org/cgi/content/full/29/4/739?rss=1

From Few to Many: Ten Years of Health Insurance Expansion inColombia
Edited by Amanda L. Glassman, María-Luisa Escobar,Antonio Giuffrida, and Ursula Giedeón, with colleaguesWashington(DC):
Inter-American Development Bank and Brookings Institution,2009. 188 pp.

“…..During the past two decades, several middle-income countrieshave achieved universal health insurance coverage or made substantialprogress toward that goal. The Colombian reform that began withLaw 100 in 1993 is the most radical and interesting of theseexperiences. Instead of gradually adding beneficiaries to existing,small-scale insurance, as in Korea and Taiwan; creating a newscheme for the uninsured poor, as in China, Mexico, and Thailand;or making private insurance match public coverage, as in Chile,Colombia introduced a managed competition model in which for-profitand nonprofit providers and insurers insure and deliver care.

The intent was to move from the inefficiencies and inequityof budgeted funding of public providers—in effect, supply-sidefinancing—to a form of demand-side financing in whichmoney follows the patient, using both existing and newly createdinsurance organizations. The reform created a "contributory"program for those who could afford a reasonable premium anda subsidized program with half the premium and reduced benefitsfor those unable to pay. These changes were to occur simultaneouslywith a major decentralization of responsibilities to departmentand municipal governments for health care financing and delivery.^….”

From Few to Many -Ten Years of Health Insurance Expansion in Colombia

Edited by Glassman, Amanda L.; Escobar, María-Luisa; Giuffrida, Antonio; Giedion, Ursula
Dec, 2009 | ISBN: 9781597820738
Inter-American Development Bank - Co-published by The Brookings Institution

Available online at: http://idbdocs.iadb.org/wsdocs/getdocument.aspx?docnum=35026183

“ a comprehensive look at Colombia's 1993 health system reforms. It describes the implementation of universal health insurance, including a subsidized system for the poor, and examines the impact of this and other reforms during a time when Colombia experienced crushing recession and internal conflict that displaced half a million people

Prior to the reforms, a quarter of the Colombian population had health insurance. Subsidies failed to reach the poor, who were vulnerable to catastrophic financial consequences of illness. Yet by 2008, 85 percent of the population benefited from health insurance.

“…describes the challenges and benefits of implementing social health reforms in a developing country, exploring health care financing, institutional reform, the effects of political will on health care, and more. The reforms have provided important lessons not only for continued reform in Colombia, but also for other nations facing similar challenges….”

http://www.iadb.org/topics/topic.cfm?lang=es&id=heal – link to full text book in Spanish (see under Publicaciones)

* * *
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”.
------------------------------------------------------------------------------------
PAHO/WHO Website
Equity List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html
Twitter http://twitter.com/eqpaho

    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] Building Cities: neighborhood upgrading and urban quality of life

Building cities: neighborhood upgrading and urban quality of life

Eduardo Rojas, editor
Inter-American Development Bank, 2010.

Available online PDF [271p.] at: http://idbdocs.iadb.org/wsdocs/getdocument.aspx?docnum=35132311

“…..In an effort to improve the quality of life for inhabitants of informal settlements and their surrounding neighbourhoods, governments and international development aid agencies have expressed a growing interest in settlement upgrading programmes. The Millennium Development Goal to significantly improve the lives of at least 100 million slum dwellers by 2020 offers an added incentive to take action. As investment levels have increased, so too have the number and diversity of programmes targeting the problems confronted by the populations living in informal settlements.

The persistence of some of the problems and the emergence of new challenges—the result of the deepening of recent trends and new social and economic situations—have led designers and implementers to create a wide range of innovative programmes. The analysis and exchange of information on the principles, design methodologies, and implementation and evaluation methods for new interventions assist in this process.

Lessons drawn from past experiences can serve as a trustworthy guide to confronting emerging problems. Among these new challenges are the persistent difficulties encountered by the inhabitants of informal settlements to join in the formal economy of the cities, the increase in violence and other antisocial behaviours in the informal settlements, and the physical decay and social deterioration occurring in neighbourhoods where there is a concentration of government-built housing—the result of the physical, economic, and social marginalisation of their inhabitants…..

Content:
Introduction .

CHAPTER 1. Building Citizenship for a Better Quality of Life

CHAPTER 2. Income and Security: Prerequisites for Citizenship .

CHAPTER 3. Land: A Scarce Resource

CHAPTER 4. Preventing New Informality

CHAPTER 5. Neighbourhood Upgrading Programmes: Lessons from Latin America and the Caribbean

CHAPTER 6. Community Participation: More than Good Intentions .

CHAPTER 7. The Foundations of Sustainability

    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] Estimating the costs of medicalization

Estimating the costs of medicalization

Peter Conrad a, Thomas Mackie a and Ateev Mehrotra b

a Department of Sociology, Brandeis University, Waltham, United States

b Rand Corporation, Pittsburgh, PA, United States

Social Science & Medicine doi:10.1016/j.socscimed.2010.02.019

Website:

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6VBF-4YK2F7H-6&_user=1403540&_coverDate=03%2F10%2F2010&_rdoc=1&_fmt=high&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000052610&_version=1&_urlVersion=0&_userid=1403540&md5=5d7c646baf2ce2f72411db19aa90f058

“…..Medicalization is the process by which non-medical problems become defined and treated as medical problems, usually as illnesses or disorders.

There has been growing concern with the possibility that medicalization is driving increased health care costs. In this paper we estimate the medical spending in the U.S. of identified medicalized conditions at approximately $77 billion in 2005, 3.9% of total domestic expenditures on health care.

This estimate is based on the direct costs associated with twelve medicalized conditions. Although due to data limitations this estimate does not include all medicalized conditions, it can inform future debates about health care spending and medicalization…."

Journal homepage: www.elsevier.com/locate/socscimed

    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] Securing Good Care for More People - Options for Reform

Securing Good Care for More People - Options for Reform

Richard Humphries is a Senior Fellow at The King’s Fund

Julien Forder is Professor of the Economics of Social Policy and Deputy Director of PSSRU at the University of Kent

José-Luis Fernández is Deputy Director and Principal Research Fellow at PSSRU at the London School of Economics.

The King’s Fund 2010 – March 2010

http://www.kingsfund.org.uk/document.rm?id=8610

“….Fundamental reform to achieve a more sustainable funding system is both essential and possible, through four steps:

– adopting a staged approach to funding reform

– a fundamental spending review to achieve a new settlement for older people

– ensuring that the reform of funding is accompanied by reform of delivery.

– driving comprehensive reform by establishing a strategic, long-term framework for change, which will require an all-party road map for reform….”

Content:

Executive summary

1 Introduction

2 Trends and developments

Introduction

Policy developments

Need and unmet need

Demographic and social change

A colder financial climate

New ideas on funding options

Lessons from other countries

Prevention and early intervention

Improved modelling tools

3 The funding options assessed

The King’s Fund partnership model

Free personal care model

The Green Paper options compared

Working-age adults

4 Reforming Attendance Allowance

5 Conclusions and ways forward

The case for change

Towards long-term reform – four steps

Appendix A Technical notes and tables
References

    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] Effective Ways to Realise Policy Reforms in Health Systems

Effective Ways to Realise Policy Reforms in Health Systems

Jeremy Hurst

Health Working Papers - OECD Health Working papers No. 51

Available online [33p.] at: http://www.olis.oecd.org/olis/2010doc.nsf/ENGDATCORPLOOK/NT00000F96/$FILE/JT03280896.PDF

“………Sometimes it is argued that the content of a reform is less important in determining whether or not it receives public and legislative approval than the timing of the proposal; the way in which the reform is presented; the discussions with stakeholders; and a multitude of other factors.

The OECD has a crosscutting project on these issues, entitled Making Reform Happen. A number of OECD directorates are considering the factors lying behind successful implementation of reforms in their different policy areas, including tax, environment, agriculture, trade, competition, education, health, pensions, product markets and labour markets.

This paper is a contribution to the wider OECD project. It is based on evidence from the countries which have seen their health systems reviewed by the OECD in recent years, and on a selected review of the literature. It considers four issues in particular, these being the ones used across all the different reform areas covered by the Making Reform Happen project:

• The existence of appropriate institutions to support reforms from decision to implementation.

• The impact on, and reactions of, those affected by the reforms.

• Reform agendas, timing and interactions across different policy areas.

• The role of evidence and international organisations to sustain reforms.

It concludes that a number of stages of reform need to be implemented before a reform can be said to be successful; failure in one of them will generally lead to failure of the reform. Issues particular to the health sector include:

• The role of the professional monopolists who provide health services.

• The role of information and evidence.

• The role of international comparisons of health system performance.

• A clear diagnosis and a compelling design for a reform.

• Taking advantage of political ‘windows of opportunity’.

• Communication and engagement between the proponents of reforms and other key stakeholders –especially those holding veto powers.

• Use of incentives, to align the interests of stakeholders with the intentions of the reform.

• Securing sufficient resources to ‘oil the wheels of change’.

However, in some cases there may be tradeoffs between: maximising the success and sustainability of health system reforms; maximising the speed at which they are carried out; and minimising the resources that have to be invested in their implementation.

There may be a role for the OECD in continuing to look at what works and what does not work in health policy – and what are the determinants of success in health system reforms…..”

Content:

Introduction

The need for reforms to improve the performance of health systems

The design and implementation of health system reforms

Factors which can help or hinder health system reform

The availability of information, evidence and analysis

Political leadership and political possibilities

The use of incentives and disincentives

The availability of resources

Case studies

Finland

Korea

Mexico

Switzerland

Turkey

Discussion

Information, evidence and analysis

Political leadership and political possibilities

Incentives

Resource availability

Conclusions

    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.