Investing in health
2014; Elsevier BV; Volume: 383; Issue: 9921 Linguagem: Inglês
10.1016/s0140-6736(14)60474-8
ISSN1474-547X
Autores Tópico(s)Global Maternal and Child Health
ResumoPublic financing is the path to universal health coverage (UHC). UHC is rapidly becoming the overarching goal for national health systems and two recent events mark a new consensus that public financing is the way to get there.1United NationsUnited Nations Grand Assembly Draft Resolution (A/67/L.36) Global health and foreign policy, 2012.http://www.un.org/ga/search/view_doc.asp?symbol=A/67/L.36&referer=http://www.un.org/en/ga/info/draft/index.shtml&Lang=EGoogle Scholar The Lancet Commission on Investing in Health2Jamison DT Summers LH Alleyne G et al.Global health 2035: a world converging within a generation.Lancet. 2013; 382: 1898-1955Summary Full Text Full Text PDF PubMed Scopus (756) Google Scholar focused on public financing mechanisms (including aid) in reaching UHC and explicitly rejected the 1993 World Development Report's emphasis on private health financing, including user fees.2Jamison DT Summers LH Alleyne G et al.Global health 2035: a world converging within a generation.Lancet. 2013; 382: 1898-1955Summary Full Text Full Text PDF PubMed Scopus (756) Google Scholar, 3World BankWorld Development Report, 1993.http://files.dcp2.org/pdf/WorldDevelopmentReport1993.pdfGoogle Scholar Similarly all 11 countries that presented at the Global Conference on UHC (Dec 6, 2013, Tokyo, Japan) hosted by the World Bank and Government of Japan, highlighted their use of public financing to increase service coverage and improve financial protection. None had used private voluntary financing to any significant extent. What is the basis for this consensus? UHC is fundamentally about rights and equity. It requires that the healthy and wealthy subsidise health services for the sick and poor. This cannot happen through private market-based systems of user fees and private insurance, including voluntary community-based schemes.4McIntyre D EQUINET Discussion Paper 95: Health service financing for universal coverage in east and southern Africa. University of Cape Town Health Economics Unit, Harare2012Google Scholar Across the world, countries are instead realising that the only way to secure the cross-subsidies needed for UHC is through compulsory contributions into redistributive risk pools. In particular, tax financing is proving essential to close coverage gaps for households in the informal sector. Since only the state can mandate progressive payments and ensure that benefits are allocated according to need, only public financing systems can achieve the combination of universality, equity, and financial protection needed for UHC. Many of the governments that have learnt these lessons are now the ones leading the charge for UHC to be included in the post-2015 agenda. As noted by the World Bank President, one of these countries, Thailand, achieved UHC by rejecting the advice of the World Bank in the 1993 World Development Report to not rely on public financing. These countries represent the new consensus on health financing: universal coverage can only be accomplished through public financing systems in which the state plays a leading part in raising revenues, pooling funds, and purchasing services. We declare that we have no competing interests. Global health 2035: a world converging within a generationPrompted by the 20th anniversary of the 1993 World Development Report, a Lancet Commission revisited the case for investment in health and developed a new investment framework to achieve dramatic health gains by 2035. Our report has four key messages, each accompanied by opportunities for action by national governments of low-income and middle-income countries and by the international community. Full-Text PDF Investing in health – Authors' replyThe publication of The Lancet Commission1 sparked intense discussion and debate at country, regional, and international levels. This extraordinary response is perhaps not surprising, given that the report lays out an extremely ambitious global health investment framework and claims that investing in this framework would achieve very dramatic health gains within a generation. Our claims are bold, but we are confident that they are based on rigorous and replicable analyses. Full-Text PDF
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