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World Health News
A new turn back towards universal health careDecember 2010
Short Report on the Ministerial Conference "Health Systems Financing - Key to Universal Coverage" held in Berlin, Nov. 22-23, 2010.
Here's an interesting report from the People's Health Movement on what might be a historic turning point and the revival of a policy that seemed to have been killed off by neoliberalism. Note the omission of any serious mention of the private sector either in funding or providing services or even through "Public Private Partnerships".
Thanks for this report to Thomas Gebauer:
The conference was convened by two German Ministries on the occasion of the presentation of the "World Health Report 2010". It turned out to be a most interesting gathering of almost 30 Ministers of Health from all over the world plus government officials, politicians, some researches and a few NGOs.
Everyone agreed on the aim to achieve universal coverage. The model that was presented by WHO concerning this doesn't speak about just going for "some coverage" or essential packages, but demands from all countries to do their utmost to set up pooled funds that cover three dimensions: expanding the number of people covered, expanding the scope of services and reducing cost sharing (direct payment such as user fees).
Dr Margaret Chan had demanded to get rid of user fees, because "user fees punish the poor". Everywhere there are people too poor to contribute financially to health care, therefore they need to be subsidised from pooled funds, generally tax-based health systems. "Out of pocket" payments have to be reduced by promoting prepayment und pooling systems (tax-based or mandatory social heath insurance). All agreed that there is no "silver bullet" that serves as a solution for all countries.
There is no global scheme that has to be "adopted" by all countries, but the need is to "adapt" a way to move forward in the three dimensions (population covered, the scope of services expanded and cost sharing reduced) at national level. This opens space for national adaptations and provides civil society organizations with the chance to continuously challenge their governments, e.g. to expand the scope of services.
With exception of only few participants nobody mentioned private companies as relevant actors. Achieving universal coverage requires the strengthening of health systems. Ensuring affordable access to health is ultimately a public responsibility and not related to private assurance companies.
To ultimately realize the right to health, governments have to create the needed fiscal space. In this regard, the "World Health Report" mentions as possible new sources of revenue: a special levy on large and profitable companies, a currency transaction levy, a financial transaction tax, and the so-called sin-taxes (alcohol, tobacco). No reference is made to for profit PP Partnerships.
In the context of global responsibility, the "Report" stated that donor countries should do more to meet their international commitments by providing a more predictable and long-term aid-flow.
It should not be surprising that a ministerial conference tends to produce documents with nice and bubbly words. Most of the presenters mixed up risk-sharing with solidarity-actions, and when it came to actions (with exception of the Brazilian Minster of Health), almost al preferred to be vague in their statements.
Nevertheless, there is an interesting shift in the international debate on global health. 32 years after its coinage, the concept of" Health for all" is back on the agenda.
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Thomas Gebauer
medico international
www.medico.de
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