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CGD Policy Blogs

 

Experimentation for Better Health: Lessons from the US for Global Health

In recent weeks, the public health world and political pundits alike have been abuzz about results from the “Oregon Experiment,” a study published in the New England Journal of Medicine that finds no statistical link between expanded Medicaid coverage and health outcomes such as high cholesterol or hypertension. Limitations of the study aside, the Oregon Experiment is a good example of the importance of rigorously testing all US health programs, rather than just assuming ‘more care = better health’.  The Innovation Center at the United States Centers for Medicaid and Medicare Services, created under the umbrella of the Affordable Care Act, represents a new and encouraging approach to address this problem, an approach that we think has important lessons for global health.

What Will Universal Health Coverage Actually Cover?

This week the World Health Organization held a major international meeting on universal health coverage (UHC), with Director General Margaret Chan reaffirming her regard for universal coverage “as the single most powerful concept that public health has to offer.” While the term “universal” signals that the entire population will be “covered,” an unanswered question is: covered with what? Another way to put the question: What health benefits or interventions would represent coverage, taking into account UHC’s implicit goals of improved health, equity and financial protection?

What’s in a Pilot? A View from South Africa’s National Health Insurance (NHI)

This is a joint post with Rachel Silverman.

Last week, I attended a conference on South Africa’s national health insurance (NHI), which was hosted in Pretoria by the Human Sciences Research Council (HSRC). A key recurring theme and consensus emerged: South Africa must develop a clearer plan and strategy for the “piloting” phase of its national health insurance.

Some background: In 2011, the government of South Africa committed itself to providing all of its citizens with “a defined package of comprehensive (health) services” through national health insurance. While the details are still up in the air, the government issued a preliminary policy paper which estimated NHI to cost R255 billion (~US$30 billion) per year by 2025, if implemented as planned over a 14-year period.

What the Pre-Post Evaluation of AMFm Can Tell Us

This is a joint post with Heather Lanthorn, a doctoral candidate at Harvard School of Public Health.

In mid-July, amidst the busy global-health month of July, in between the Family Planning summit and the AIDS conference, the near-final draft of the independent evaluation of the Affordable Medicines Facility - Malaria (AMFm) was released.

Financing Universal Access to ART: Reflections From IAC 2012

Two messages reigned supreme at last month’s International AIDS Conference (IAC) in Washington DC: 1) that there should be universal coverage of HIV/AIDS treatment and 2) that international funding for HIV/AIDS has been flat-lining recently and may even shrink. The most optimistic scenario to reach universal coverage will cost $22 billion dollars annually, which means raising an additional $6 billion per year. Clearly, the goal to provide treatment to the 34 million people currently living with AIDS, and the approximately 2.5 million newly infected each year, conflicts with the reality of shrinking aid budgets.

Results-Based Aid in Liberia: USAID Forward (and one step back)

In a recent working paper, Jacob Hughes, Walter Gwenigale and I describe Liberia’s unique experience in pooling donor funds for health in a post-conflict setting, with good results. We also describe a new and complementary agreement between Liberia and USAID, called the Fixed Amount Reimbursement Agreement (FARA). It’s been heartening to see USAID take this step towards implementing results-based aid in Liberia, but the process has also highlighted the problems that such aid faces in the ‘real world’.

Does Efficiency Matter in Getting to Universal Health Coverage?

How do we get to universal health coverage? This was the focus of a panel with William Hsiao, David de Ferranti and Yanzhong Huang at the Council for Foreign Relations in Washington yesterday. Of the many salient points discussed, including defining “universal health coverage”, Hsiao emphasized the importance of improving efficiency. He noted that 20-40% of money in health-care is “wasted” due to inefficient processes, as cited in the World Health Report 2010 (see p. 79) and Hsiao’s own research in China. Other studies have found similar results. In the Philippines, Paul Gertler found that providers (i.e. hospitals and doctors) capture rents from social insurance.

“Stunning Progress” but OOPs! in Afghanistan

Today NPR reports on the “stunning progress” made on health in Afghanistan. A USAID-funded survey conducted in 2010 –excluding parts of the high conflict South Zone- finds that mortality and fertility have dropped and coverage of essential services increased dramatically. Male adult mortality has been halved in roughly a decade. Average life expectancy for girls and boys is now 64 years, versus 45 years old in 2001.

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