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1. Modicare Post-Election: Recommendations to Enhance the Impact of Public Health Insurance on UHC Goals in India

Author:
Kalipso Chalkidou, Nishant Jain, Françoise Cluzeau, and Amanda Glassman
Publication Date:
05-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
Hailed as one of the largest publicly funded health insurance programs in the world, India’s “Modicare” has, since its launch a little more than six months ago, made universal healthcare coverage an election theme for the first time in the country’s history.[1] In this note, we describe the program, with an emphasis on its better-known secondary and tertiary care component, and offer policy recommendations to strengthen the scheme post-election to enhance its contribution to India’s vision for universal health coverage (UHC). In a country of almost 1.4 billion people that is home to one-third of global maternal deaths, where public spending for health accounts for roughly 1 percent of GDP and where 60 million people fall into poverty every year because of healthcare bills, fixing healthcare is a daunting task that will determine the world’s performance against the Sustainable Development Goals over the coming decade.
Topic:
Health, Health Care Policy, Public Health, and Health Insurance
Political Geography:
India and Asia

2. Tackling the Triple Transition in Global Health Procurement

Author:
Rachel Silverman, Amanda Glassman, Kalipso Chalkidou, and Janeen Madan Keller
Publication Date:
06-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
There have been impressive gains in global health over the past 20 years, with millions of lives saved through expanded access to essential medicines and other health products. Major international initiatives backed by billions of dollars in development assistance have brought new drugs, diagnostics, and other innovations to the fight against HIV, malaria, tuberculosis, and other scourges. But behind these successes is an unacceptable reality: in many low- and middle-income countries, lifesaving health products are either unavailable or beyond the reach of the people who need them most. While each country’s context is unique, a reliable, affordable, and high-quality supply of health products is a vital necessity for any health system. In its absence, lasting health gains will remain elusive.
Topic:
Health, Public Health, Pandemic, Procurement, and Medicine
Political Geography:
Global Focus

3. Tackling the Triple Transition in Global Health Procurement

Author:
Rachel Silverman, Janeen Madan Keller, Amanda Glassman, and Kalipso Chalkidou
Publication Date:
07-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
There have been impressive gains in global health over the past 20 years, with millions of lives saved through expanded access to essential medicines and other health products. Major international initiatives backed by billions of dollars in development assistance have brought new drugs, diagnostics, and other innovations to the fight against HIV, malaria, tuberculosis, and other scourges. But behind these successes is an unacceptable reality: in many low- and middle-income countries, lifesaving health products are either unavailable or beyond the reach of the people who need them most. While each country’s context is unique, a reliable, affordable, and high-quality supply of health products is a vital necessity for any health system. In its absence, lasting health gains will remain elusive. Access to medicines, diagnostics, devices, and equipment is driven in large part by the efficiency of their procurement. Procurement is, therefore, central to the efforts of low- and middle-income countries to improve health, meet the Sustainable Development Goals, and achieve universal health coverage. Health product purchasing in low- and lower-middle-income countries already makes up a sizeable share of overall health spending; in fact, in just a subset of these countries, spending on health products totals an estimated $50 billion per year.[1] Procurement is not only essential to the missions of global health entities like the Global Fund, Gavi, UNICEF, UNFPA, and PEPFAR, but it also represents big money. In the case of the Global Fund, health product procurement accounts for $2 billion per year,[2] or almost half of its 2017 disbursements.[3] Yet despite its importance, procurement is an underappreciated health system function. Today’s procurement systems are hobbled by inefficiencies that leave some of the poorest countries paying some of the highest drug prices in the world.
Topic:
Health, Public Health, Transition, and Procurement
Political Geography:
Global Focus

4. Development Impact Bonds Targeting Health Outcomes

Author:
Lorcan Clarke, Kalipso Chalkidou, and Cassandra Nemzoff
Publication Date:
12-2018
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
As of December 2018, seven development impact bonds (DIBs) have been launched across seven countries with nearly US$55million in cumulative outcome funding. DIBs fund public services through contracts where private investors provide upfront flexible funding to service providers and outcome funders repay these investors based on the outcomes achieved by people receiving services. Three DIBs specifically target health outcomes: the Humanitarian Impact Bond, the Utkrisht Impact Bond, and the Cameroon Cataract Bond. The three “health DIBs” involve US$26.5 million in upfront investment, US$38.1 million in outcome funding and aim to impact the health of at least 31,600 people. Using publicly available information, we describe all seven DIBs, and evaluate the three “health DIBs” in more detail, comparing their stakeholders, implementation, and outcome structures. Building on a scoping review of relevant literature, we outline health DIBs in the pipeline and note that the potential of DIBs as a funding structure is hindered by the lack of publicly available information on their estimated impact and value for money. We offer three recommendations to improve evaluation and inform development of DIBs in the future: (1) publish plans and evaluations, (2) create and use consistent reporting guidelines, and (3) allocate funding to evaluate impact and value for money.
Topic:
Development, Health, and Humanitarian Intervention
Political Geography:
Global Focus

5. Priority-Setting in Health: Building Institutions for Smarter Public Spending

Author:
Amanda Glassman and Kalipso Chalkidou
Publication Date:
06-2012
Content Type:
Policy Brief
Institution:
Center for Global Development
Abstract:
Health donors, policymakers, and practitioners continuously make life-and-death decisions about which type of patients receive what interventions, when, and at what cost. These decisions—as consequential as they are—often result from ad hoc, nontransparent processes driven more by inertia and interest groups than by science, ethics, and the public interest. The result is perverse priorities, wasted money, and needless death and illness. Examples abound: In India, only 44 percent of children 1 to 2 years old are fully vaccinated, yet open-heart surgery is subsidized in national public hospitals. In Colombia, 58 percent of children are fully vaccinated, but public monies subsidize treating breast cancer with Avastin, a brand-name medicine considered ineffective and unsafe for this purpose in the United States.
Topic:
Development, Health, and Foreign Aid
Political Geography:
United States, India, and Colombia