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51. Imagining the Alternative Worlds of 2030: Policy Implications for the Future of Global Health Procurement

Author:
Janeen Madam Keller and William Savedoff
Publication Date:
06-2019
Content Type:
Working Paper
Institution:
Center for Global Development
Abstract:
The availability and affordability of health products—medicines, diagnostics, devices, and equipment—are critical to achieving universal health coverage and improving health outcomes. Yet low- and middle-income countries face multiple challenges in procuring health products related to institutional inefficiencies, market failure, and fragmented demand. At the same time, the world is evolving rapidly in ways that will affect health procurement, from changes in countries’ eligibility for foreign assistance to advances in information technologies. Looking forward, efforts to improve global health procurement must proactively address the sweeping changes on the horizon. Drawing on a range of political, economic, and social trends, this paper envisions how the global landscape might change between now and 2030, with a focus on the implications for global health, particularly the procurement of health products. The paper develops three possible but distinct futures—worlds characterized as atomistic, privately led, or multilateral.It concludes by describing the policy options and locus of action to improve global health procurement in light of these scenarios, emphasizing three areas of work: financing and modes of collaboration, procurement procedures and tools, and procurement capacity.
Topic:
Health, Health Care Policy, Public Health, and Health Crisis
Political Geography:
Global Focus

52. NextGen Network Key Takeaways: Prague, Czech Republic

Author:
Aspen Institute
Publication Date:
03-2019
Content Type:
Working Paper
Institution:
Aspen Institute
Abstract:
Aspen Central Europe hosted the Network in Prague in January 2019, with participants from Hungary, Poland, Slovakia, and the Czech Republic. Participants emphasized that there should be a focus on mapping where exactly AI can support existing professions, create new ones, but most importantly streamline the education system towards current trends and lifelong learning. It is essential to speed up the adoption of AI in Europe, as well as connect it with major challenges in society, such as tackling climate change or innovating healthcare, where, for example, AI can be explained by its promoters as a way of delivering better services rather than merely introducing a new technology.
Topic:
Climate Change, Science and Technology, Health Care Policy, and Artificial Intelligence
Political Geography:
Europe, Czech Republic, and Central Europe

53. Healing One-fifth of Humanity: Progress and Challenges for China’s Health System

Author:
Karen Eggleston
Publication Date:
10-2019
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
China’s national health reforms over the past two decades have brought the system closer to the modern, safe, reliable and accessible health system that is commensurate with China’s dramatic economic growth, improvement in living standards, and high hopes for the next generation. Celebrating a decade this year, China’s national health reforms of 2009 consolidated a system of social health insurance covering the entire population for basic health services, contributing to a surge in healthcare utilization while reducing out-of-pocket costs to patients – which declined from 56% to 28% of total health expenditures between 2003 and 2017. An expanded basic public health service package, funded by per capita government budget allocations that include a higher central government subsidy for lower income provinces, provides basic population health services to all Chinese. A higher percentage of Chinese accessed hospital admissions in 2017 than in the average high-income (OECD) country – a large increase from the turn of the 21st century.i A recent re-shuffle of the governance structure consolidates the purchaser role for social health insurance schemes under the newly created National Healthcare Security Administration, with most other health sector functions under the re-christened National Health Commission, among other changes. China’s world-leading technological prowess in multiple fields spanning digital commerce to artificial intelligence—and accompanying innovative business models such as WeDoctor that have not yet been fully integrated into the health system—hold promise for supporting higher quality and more convenient healthcare for China’s 1.4 billion.
Topic:
Health, Science and Technology, Governance, and Health Care Policy
Political Geography:
China and Asia

54. Palliative Care: A Human Rights Approach to Health Care

Author:
Isabel Pereira
Publication Date:
05-2018
Content Type:
Working Paper
Institution:
Dejusticia
Abstract:
This report compiles the results of a research project aimed at describing the current palliative care situation in eight Latin American countries. The project’s general objective—to raise awareness and influence public policy around the need to approach palliative care from a human rights perspective—was achieved through rapprochement among professionals from various fields in the region, which in and of itself is a key step forward in terms of bringing together communities that defend patients’ rights with communities that advocate a drug policy embracing a public health focus.
Topic:
Health and Health Care Policy
Political Geography:
Latin America

55. Analysis of the Technical Efficiency of Public Hospitals in Togo: A non-Parametric Approach

Author:
Esso-Hanam Atake
Publication Date:
01-2018
Content Type:
Research Paper
Institution:
African Economic Research Consortium (AERC)
Abstract:
Most health facilities in Togo are poorly equipped. Consequently, the rate of post-natal consultation remains low and varies between 9.5% and 39.4%. Barely half of all deliveries (47.1%) take place in health facilities. In this study, we analysed technical efficiency scores of 139 Togolese public hospitals over the period 2008–2010, and then identified the determinants of this efficiency. Double bootstrap data envelopment analysis was used to draw consistent inferences. We first estimated bootstrapped efficiency scores. Then, bootstrapped truncated regression was used to identify the determinants of public hospitals efficiency. The results indicate that, on average, small-sized hospitals (periphery care units) investigated, had the highest efficiency scores. The University Teaching Hospitals and regional hospitals which have significant material, human and financial resources were associated with lower efficiency. The most significant and robust factors of technical efficiency are per capita income, competition, hospital’s balance, types of contract, and medical density. We found that income constraint and accessibility to health facilities are obstacles to efficiency. According to our results, we can infer that non-competitive public provision of health services is likely to be inefficient. Another important practical implication is that Togo must vigorously promote reform of the management system in public hospitals which regards corporate quality governance as the core. We hypothesize that if subsidies are allocated according to performance, they can positively affect efficiency. Policy makers should consider tying grant revenues to performance indicators.
Topic:
Education, Health, Health Care Policy, and Public Policy
Political Geography:
Africa and Togo

56. What’s next for healthcare in Poland: diagnosis and prognosis

Author:
Alicja Domagała, Christoph Sowada, Krzysztof Kuszewski, Marzena Tambor, and Stanisława Golinowska
Publication Date:
12-2018
Content Type:
Special Report
Institution:
Center for Social and Economic Research - CASE
Abstract:
The health protection system is the object of constant pressures and difficulties in mitigating them, and even more so eliminating or at least reducing them. Changes are undertaken under the influence of a one-sided political assessment, the interests of various groups of participants or the protests of successive groups of medical staff. There is no professional and fully documented diagnosis of the system, made by independent experts, which could serve as the basis for a comprehensive health protection reform plan, rather than individual, incidental changes that disrupt the system’s already very fragile balance. A well thought-out reform, properly distributed over time, so that at no point does it cause negative health effects. A reform agreed among stake-holders and adopted with understanding of the need for changes, so that it is supported by society. A reform for which there will be funds, institutions and engaged professionals – leaders in health protection. A reform that won’t be criticized or changed when the government changes. Such a reform is waiting to be presented and debated. We begin this process by pointing out and presenting the system’s main problems. At the top of the list of issues that must be taken up urgently we place the problem of insufficient resources, but associated with other activities that are essential to achieve higher effectiveness in accomplishing health goals. There is no single miraculous way of balancing and fixing the functioning of the health protection system. This requires both greater financing, qualitatively and quantitatively appropriate staffing, and good institutions. Financial resources are a necessary condition but not a sufficient one – if there is no staff or appropriate institutions, and these are shaped over years. In this publication we present four subjects, corresponding to that list of the main issues that must be addressed urgently. We begin with the problem of good governance, meaning achieving a decisive improvement in institutional solutions in health protection. Next we take up the problem of the need for growth in financial outlays, with judicious public and individual responsibility. We strongly accent the need for development in Poland of medical and support staff, presenting the problems of neglect and the deep shortage of professionals, which is currently paralyzing the health service. The final text, though no less important in the group of priority problems in health protection, concerns public health and demands that it be properly valued by treating care for the health of the population as an investment in human capital with a measurable and significant rate of return.
Topic:
Demographics, Health, Labor Issues, Governance, Health Care Policy, Social Policy, and Public Policy
Political Geography:
Europe and Poland

57. ACKNOWLEDGING THE FLEXIBILITIES OF THE TRIPS AGREEMENT: ENSURING THE RIGHT TO ACCESS TO MEDICINES OR A STRATEGY OF PASSIVE REVOLUTION?

Author:
Sevgi BALKAN-ŞAHİN
Publication Date:
10-2018
Content Type:
Journal Article
Journal:
Alternative Politics
Institution:
Department of International Relations, Abant Izzet Baysal University, Turkey
Abstract:
The Doha Ministerial Declaration on the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement and Public Health adopted in November 2001 clarified the right to use the TRIPS flexibilities to promote public health. Examining the hegemonic struggle of opposing social forces from a neo-Gramscian perspective, the paper attributes this outcome to the strategy of trasformismo used by market-oriented social forces to legitimize the policies of the World Trade Organization (WTO) and prevent resistance against the market-driven TRIPS Agreement. It argues that although non-governmental organizations (NGOs) such as Medecins Sans Frontieres, Third World Network, and Oxfam worked as a counter-hegemonic force to ensure the access of least developed countries to generic versions of patented drugs, flexibilities confirmed by the Doha Declaration can be seen more as a strategy of trasformismo to absorb counter-hegemonic ideas than the counter-hegemonic groups’ successful incorporation of the right to ensure public health into the TRIPS Agreement.
Topic:
Health, World Trade Organization, Hegemony, Health Care Policy, NGOs, and Public Health
Political Geography:
United States, Europe, Asia, and North America

58. Rural-Urban Disparities in the Utilization of Mental Health Inpatient Services in China: The Role of Health Insurance

Author:
Junfang Xu, Jian Wang, Madeleine King, Ruiyun Liu, Fenghua Yu, Jinshui Xing, Lei Su, and Mingshan Lu
Publication Date:
01-2018
Content Type:
Video
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
Reducing rural-urban disparities in health and health care has been a key policy goal for the Chinese government. With mental health becoming an increasingly significant public health issue in China, empirical evidence of disparities in the use of mental health services can guide steps to reduce them. We conducted this study to inform China’s on-going health-care reform through examining how health insurance might reduce rural-urban disparities in the utilization of mental health inpatient services in China.
Topic:
Health, Health Care Policy, Mental Health, Urban, and Rural
Political Geography:
China and Asia

59. Dual Practice of Public Hospital Physicians in Vietnam

Author:
Ngan Do and Young Kyung Do
Publication Date:
04-2018
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
Although many public hospital physicians in Vietnam offer private service on the side, little is known about the magnitude and nature of the phenomenon of so-called dual practice, let alone the dynamics between the public and private health sectors. This study investigates how and to what degree public hospital physicians engage in private practice. It also examines the commitment of dual practitioners to the public sector. The analysis is based on a hospital-based survey of 483 physicians at 10 public hospitals in four provinces of Vietnam. Nearly half of the participants in the study sample reported themselves as dual practitioners. Various types of private practice were mentioned. Private practice at health facilities owned by the private sector was the most prevalent, followed by private practice delivered at health facilities owned by the dual practitioners themselves. Private practice inside public hospitals was also noted. Dual practitioners were likely to be senior and hold management positions inside their public hospitals. Substantial income differences were found between dual practitioners and those physicians practicing in only the public sector. The majority of dual practitioners, however, reported the willingness to give up private practice if certain conditions were met, such as a basic salary increase or non-pecuniary benefits. The main reasons dual practitioners gave for not leaving the public sector included a sense of public responsibility and opportunities to gain a broader professional network and more training. This study reiterates the significant challenges associated with dual practice, including its financial implications and possible effects on health care quality and access. The need for a high-quality workforce committed to the public sector is particularly critical, given the possibility of universal insurance coverage. Future research should address the need to improve data collection on physicians’ dual practice and incorporate the topic in policy debates on health reform.
Topic:
Health, Health Care Policy, Reform, and Hospitals
Political Geography:
Asia and Vietnam

60. Economic Dimensions of Personalized and Precision Medicine in Asia: Evidence from Breast Cancer Treatment in Taiwan

Author:
Jui-fen Rachel Lu and Karen Eggleston
Publication Date:
04-2018
Content Type:
Working Paper
Institution:
Walter H. Shorenstein Asia-Pacific Research Center
Abstract:
High costs of precision medicine raise concerns about exacerbating income-related disparities in healthcare utilization and health outcomes. One approach to expanding coverage in Asia has been to cover the precision therapy but require the pharmaceutical firm to cover the costs of the companion diagnostic test. Taiwan’s National Health Insurance (NHI) adopted this approach for lung cancer, colorectal cancer and leukemia, but not for the first target therapy covered by NHI, trastuzumab for the treatment of HER2-positive breast cancer. Analyzing a unique dataset linking medical claims, cancer registry data and proxies for income between 2004 and 2015, we find that lower-income patients are more likely to be diagnosed with later stages of breast cancer, and this pattern renders NHI coverage of anti-HER2 therapy pro-poor even before full coverage of the diagnostic tests. Moreover, the expansion of NHI coverage—including the FISH diagnostic test and trastuzumab for early-stage breast cancer—strengthened the pro-poor distribution of genetic testing and target treatment, albeit only marginally. The extent of pharmaceutical company coverage of testing and its impact on patient access are topics of our ongoing research, contrasting breast cancer with colorectal cancer.
Topic:
Health, Health Care Policy, Economic Inequality, and Medicine
Political Geography:
Taiwan and Asia