So much to do, so many ways to do it

The issues regarding funds and finances for global health are immense and complicated.  Increasingly problematic is the growing gap in health services between the rich and poor. High-income countries spend 30 times more on health than low-income countries, which make up 80% of the world’s population and face 90% of the global disease burden.  Low-income countries only account for 20% of the global domestic product and even worse, only receive 12% of overall health spending.

The lack of equitable healthcare coverage makes it difficult to control treatable and preventable diseases as well as chronic diseases and injuries.  If this inequity is not eradicated, the cost of healthcare will continue to rise and impede global productivity and economic growth.

Fortunately, although there is an extreme need for aid and sustainable improvements, there is also a lot of money available.  However, the money provided in the past has not been effective in eradicating issues.  In order to improve the positive effects of aid, providers and recipients must make specific changes.  Donors must meet their stated commitments, work with other aid providers, and avoid involvement with governmental corruption.  On the other side, recipient countries must help donors by improving their governance, by means of eradication of corruption and improvement in management of budgets, forming relationships with non-governmental organizations and strengthening health systems.

In addition to enhancing the effects of global health aid, healthcare systems within countries must be improved.  Countries should institute healthcare by choosing one or a combination of options: national health services, social health insurance, private/voluntary health insurance, community-based health insurance, and direct purchases by consumers.

Each model of basic healthcare has positives and negatives, requiring countries to examine the specific needs and abilities of their population.  National healthcare services provide sole control to the government and coverage to broad populations but is vulnerable to large changes with different politicians and poor individual management. Moreover, many individuals in rural and hard-to-reach areas, or impoverished communities have less access to care.  While, social health insurance is viewed positively by the population because of the belief that management and financing are stable, it is difficult to raise enough funds from tax revenues and services and the management is not cohesive.

Voluntary or private health insurance is mostly used by high-income countries because the wealthy are equipped to pay higher rates.  The obvious disadvantage to this system is the inequalities in access and quality of care, but this system does encourage innovation and experimental methods and risk pooling.  Community based insurance is controlled by volunteers, reduces out-of-pocket spending, and increases use of resources, but unfortunately, can not raise enough money to cover the entire population, particularly poor communities.

If there were a perfect combination of these policies and models, there would be no need for this blog post, so each country needs to assess their population needs and ideal outcomes in order to decide which system to put in place.

Reference:

Gottret, P. & Schieber, G.  (2006)  Health financing revisited: A practitioner’s guide.  The World Bank, 1-23. 

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