11 September 2012

The Hidden Costs of Poor Health Coverage

The Lancet devotes a themed issue to the subject of universal health coverage (UHC). Julio Frenk, HSPH, and David de Ferranti, R4D, make an economic argument for UHC:
The cost of inaction is also important,10 and pointing this out can be helpful for reformers. People without coverage impose hidden costs on their country. Such costs are the flip side of the economic argument for health. Inadequately treated health problems result in diminished productivity, higher costs in the future, and disrupted families and communities (which can lead to underinvestment in the next generation, thereby imposing even greater future costs). Inadequate prevention results in higher treatment costs. A life saved and given the chance to be more fruitful not only imposes less cost on society but also brings more benefit to it. Furthermore, a good health system promotes human rights and enables every individual to realise his or her full potential. This outcome is the ultimate measure of success.
They continue by making the important point that aid should be an internally driven force rather one that relies upon aid and is determined by external forces.
Implicit in our argument is the further point that universal health coverage has to be driven by forces from within a country, not from outside. Aid is not the answer. Government expenditures for health from countries' own sources reached US$410 billion in the developing world in 2009, which is 16 times larger than the total development assistance for health. Even in the African region, external sources represent only 11% of the funds spent on health.11 Drawing on knowledge-related global public goods, domestically led change makes adaptation to local circumstances possible, thus building popular and political support.
It stands in contrast with Jeffrey Sachs who zeroes in on the decline in aid as a major obstacle to realizing universal health coverage in low-income settings.
And the results are clear. Malaria mortality, maternal mortality, and child mortality have all fallen sharply as increased public spending on health has been put to good use by the low-income countries.20 Sub-Saharan Africa has enjoyed a rapid decline in mortality in children younger than 5 years since the middle of the past decade, although there is still considerable ground to cover for the low-income African countries to achieve the Millennium Development Goals.21 These are mainly gains in public health in the dual sense of public financing and public provision. 
The world is getting closer than ever to universal health coverage, yet powerful headwinds have been gusting ever since the outbreak of the financial crisis in 2008. Most importantly, donor aid budgets are being cut.22 The public should understand that small additions to aid for health could bring the world to universal coverage, whereas cuts in aid at this point could undo the great progress of the past decade. Universal coverage for health is within our reach—if we persevere.
Though Sachs would likely agree with the conclusions from Frenk and de Farranti in regards to the need for UHC.
Universal health coverage sits at the intersection of social and economic policy. Introduction of reforms that promote universal coverage is not only the right thing to do on ethical grounds; it is also the smart thing to do to achieve economic prosperity. The paradox of health care is that it is one of the most powerful ways of fighting poverty, yet can itself become an impoverishing factor for families when societies do not ensure effective coverage with financial protection for all. Universal health coverage therefore holds great promise: the focus on increased access to high-quality health services with financial protection integrates social and economic policy in a way that, if done well, can benefit societies the world over.
 You can read through the full issue on universal health coverage here.