Is Private Health Care the Answer to the Health Problems of the World's Poor?

Background to the debate: The global burden of disease falls disproportionately upon the world's low-income countries, which are often struggling with weak health systems. Both the public and private sector deliver health care in these countries, but the appropriate role for each of these sectors in health system strengthening remains controversial. This debate examines whether the private sector should step up its involvement in the health systems of low-income countries

Private health insurance: implications for developing countries.

Private health insurance is playing an increasing role in both high- and low-income countries, yet is poorly understood by researchers and policy-makers. This paper shows that the distinction between private and public health insurance is often exaggerated since well regulated private insurance markets share many features with public insurance systems. It notes that private health insurance preceded many modern social insurance systems in western Europe, allowing these countries to develop the mechanisms, institutions and capacities that subsequently made it possible to provide universal access to health care. We also review international experiences with private insurance, demonstrating that its role is not restricted to any particular region or level of national income. The seven countries that finance more than 20% of their health care via private health insurance are Brazil, Chile, Namibia, South Africa, the United States, Uruguay and Zimbabwe. In each case, private health insurance provides primary financial protection for workers and their families while public health-care funds are targeted to programmes covering poor and vulnerable populations. We make recommendations for policy in developing countries, arguing that private health insurance cannot be ignored. Instead, it can be harnessed to serve the public interest if governments implement effective regulations and focus public funds on programmes for those who are poor and vulnerable. It can also be used as a transitional form of health insurance to develop experience with insurance institutions while the public sector increases its own capacity to manage and finance health-care coverage

Global Health Forecasting Working Group Background Paper Mapping and Realigning Incentives in the Global Health Supply Chain

Poor allocation of risks among the constituents of a supply chain results in a misalignment of incentives, leading to over-reactions, unnecessary interventions, second guessing, mistrust, and distorted information – ultimately degrading its ability to match supply and demand. This study assesses the current allocation of operational risks and their impact on the incentives of different players in the global health supply chain, focusing on the case of fixed-dose artemisinin-based combination therapy for malaria as an illustrative example. Currently, there is a highly non-optimal allocation of risks in this supply chain, where constituents that have the best knowledge about demand uncertainty, or the highest ability to resolve part of this uncertainty, or have the highest potential to benefit from this uncertainty reduction, do not necessarily carry its corresponding risks. This and other improper risk allocations lead to misaligned incentives for accurate forecasting, sharing demand/supply information in this supply chain. Similarly, an asymmetric risk structure for the quality regulators does not provide them the right incentive to quickly approve more drugs by higher resource commitment. The authors recommend establishing a global health infomediary to overcome the uncertainty due to the opacity of data from the various supply chain nodes. Funding agencies should also adopt a risk-sharing approach based on rolling partially-flexible purchase commitments, which would lead to an economically optimal sharing of risks and would eliminate some of the incentive misalignments, as well as a broader use of framework contracts. Finally, manufacturers should explore the potential for a joint demand driven supply-hub to respond more rapidly to order and reduce the overall reliance on demand forecasts. This paper informed the deliberations of the Center for Global Development’s Global Health Forecasting Working Group and is cited extensively in their final report, A Risky Business: Saving Money an

Moving towards true integration

Considerable action will be needed to get maximum benefits from the lessons learnt about integrated health car

Getting more for their dollar: a comparison of the NHS with California's Kaiser Permanente

OBJECTIVE: To compare the costs and performance of the NHS with those of an integrated system for financing and delivery health services (Kaiser Permanente) in California. METHODS: The adjusted costs of the two systems and their performance were compared with respect to inputs, use, access to services, responsiveness, and limited quality indicators. RESULTS: The per capita costs of the two systems, adjusted for differences in benefits, special activities, population characteristics, and the cost environment, were similar to within 10%. Some aspects of performance differed. In particular, Kaiser members experience more comprehensive and convenient primary care services and much more rapid access to specialist services and hospital admissions. Age adjusted rates of use of acute hospital services in Kaiser were one third of those in the NHS. CONCLUSIONS: The widely held beliefs that the NHS is efficient and that poor performance in certain areas is largely explained by underinvestment are not supported by this analysis. Kaiser achieved better performance at roughly the same cost as the NHS because of integration throughout the system, efficient management of hospital use, the benefits of competition, and greater investment in information technology

Establishing a regulatory value chain model: An innovative approach to strengthening medicines regulatory systems in resource-constrained settings

ABSTRACT Medicines Regulatory Authorities (MRAs) are an essential part of national health systems and are charged with protecting and promoting public health through regulation of medicines. However, MRAs in resource-constrained settings often struggle to provide effective oversight of market entry and use of health commodities. This paper proposes a regulatory value chain model (RVCM) that policymakers and regulators can use as a conceptual framework to guide investments aimed at strengthening regulatory systems. The RVCM incorporates nine core functions of MRAs into five modules: (i) clear guidelines and requirements; (ii) control of clinical trials; (iii) market authorization of medical products; (iv) pre-market quality control; and (v) post-market activities. Application of the RVCM allows national stakeholders to identify and prioritize investments according to where they can add the most value to the regulatory process. Depending on the economy, capacity, and needs of a country, some functions can be elevated to a regional or supranational level, while others can be maintained at the national level. In contrast to a “one size fits all” approach to regulation in which each country manages the full regulatory process at the national level, the RVCM encourages leveraging the expertise and capabilities of other MRAs where shared processes strengthen regulation. This value chain approach provides a framework for policymakers to maximize investment impact while striving to reach the goal of safe, affordable, and rapidly accessible medicines for all