MMI Network News, October 2013 – Medicus Mundi International

Why health insurance schemes in low- and middle-income countries are leaving the poor behind (guest editorial)

Dear reader,

In a new report published today, Oxfam is warning that health insurance schemes introduced in the name of universal health coverage (UHC) are excluding the majority of people and leaving the poor behind. The Oxfam contribution takes up a key element of the recently published MMI discussion paper on UHC – and makes it more explicit.

The report celebrates the growing momentum for universal health coverage (UHC) but says that in some cases health financing reforms are driving up inequality by prioritising already advantaged groups in the formal sector and leaving the most poor and marginalised people – especially women – last in line to benefit.

Oxfam questions the almost exclusive focus on contributory-based health insurance schemes as the way to achieve UHC. Although no country in the world has achieved anything close to UHC using voluntary insurance, private and community-based voluntary schemes are still being promoted by governments and donors. India’s voluntary RSBY insurance scheme for people below the poverty line is widely praised as a success but offers limited financial protection and has skewed public resources to curative rather than preventative care.

Instead of importing inappropriate health financing models from high-income countries, Oxfam is calling on developing country governments to look to learn from the increasing number of home-grown UHC success stories in other, more comparable countries.

The countries making most progress towards UHC agree that entitlement to health care should be based on citizenship and/or residency and not on employment status or financial contributions. While their specific journeys differ, these countries fall into two broad camps. First there are examples of countries at all income levels, including Sri Lanka, Malaysia, and Brazil, which use tax revenues to fund UHC. Crucially, the only low-income countries to achieve universal and equitable health coverage have done by relying mainly on tax financing. A second option increasingly being adopted by another set of successful UHC countries, including Thailand, Mexico, and Kyrgyzstan, is to collect insurance premiums only from those in formal salaried employment, and to pool these where possible with tax revenues to finance health coverage for the entire population.

The growing momentum for UHC is welcome, exciting, and challenging. UHC has the potential to transform the lives of millions of people by bringing life-saving health care to those who need it most. But rather than focus efforts on collecting contributions from people who are too poor to pay, governments and donors should focus on the financing that works to deliver universal and equitable health care for all. The preoccupation with health insurance as the ‘default’ UHC model has left the crucial question of how to generate more tax revenues for health largely unexplored. This blind spot should be urgently addressed.

At its core, UHC is about the right to health. This means moving away from the idea of an employment or contributory basis for entitlement. People must be entitled to receive benefits by virtue of their citizenship and/or residency and not because they are formally employed or have paid to join a scheme. Women and men living in poverty must benefit at least as much as the better off every step of the way.

Guest editorial by:
Ceri Averill, Oxfam GB
caverill@oxfam.org.uk

Reference and resources

Oxfam’s report ‘Universal health coverage: why health insurance schemes are leaving the poor behind’ (with full references, e.g. on the India case) is available to download from www.oxfam.org/en/policy/universal-health-coverage
MMI discussion paper on UHC: www.bit.ly/uhc-mmipaper
MMI thematic guide on UHC: www.bit.ly/mmi-uhc
MM Switzerland, UHC Symposium in Basel, 6 November 2013:
http://www.medicusmundi.ch/mms-en/services/events/symposium2013

MMI Network meeting in Brussels

………….
27 November 2013:
Assembly, Board meeting, workshops

Extraordinary Assembly of the Medicus Mundi International Network (focus: work plans and budget 2014), Board meeting (focus: results of the strategy review) and two workshops (review of MMI Network Policy; results of Nicole Moran’s work on a research toolbox for NGOs). All events are open for Network members and partners. Informal talks with our local host Memisa (celebrating, on 29 November, its 25^th Anniversary) and a dinner for Network members and invited guests will complete the day. A formal invitation for these MMI events will be sent to Network members and partners in the last week of October.

> www.bit.ly/mmi2013-brussels

………….
28 November 2013:
Health-y answers to comple#ity:
Are we able to move beyond the control panel?

The seminar organized by Be-cause health will take place on 28 November at the Egmont Palace in Brussels. If the event’s title is confusing, this might even be intentional: the conference is all about providing health care in a complex environment and how to deal with this complexity. After Brescia (mother and child health, 2011) and Amsterdam (health in fragile states), we are happy to offer to MMI Network members again a great opportunity for sharing and debating a key issue related to our work. Register now!

> www.bit.ly/mmi2013-brussels

MMI Network events, news, and resources

………….
Network event: Medicus Mundi Switzerland
6th High-Level Symposium on Globbal Health Diplomacy:
Health diplomacy meets science diplomacy

Geneva, 12 November 2013. The annual high-level symposium of the Global Health Programme explores critical issues and new developments in global health diplomacy, with particular relevance to the interface between foreign policy and health. This year’s symposium focuses on the interplay of health diplomacy and science diplomacy, following on from a highly successful event that explored new approaches to research and development in support of global health. Organized by the Global Health Programme of the Graduate Institute, Geneva, a member of Medicus Mundi Switzerland.

> www.graduateinstitute.ch/

………….
Network event: Medicus Mundi Switzerland
What does it take to eliminate a disease?

Basel, 29 November 2013. The eradication of smallpox in 1980 has proven that although complex and difficult, eliminating a disease is possible. This remarkable feat continues to inspire other elimination efforts, and while there has been marked success in diseases such as Guinea worm and polio, other campaigns such as in the case of leprosy have fallen short as fewer patients are detected and knowledge of the disease declines. Organized by the Novartis Foundation, a member of Medicus Mundi Switzerland.

> www.novartisfoundation.org

………….
Network resource: DWA Cuamm
Health: taking care of Europe

The focus of the last issue of Health and Development, the journal of Doctors with Africa Cuamm, is on health in Europe, with contributions by Cuamm director don Dante Carraro (Health: a universal value, even during recession), Gavino Maciocco (Health in Europe) and many others.

A must read – not only because of the great cover – and a symbol for a new focus of many MMI Network members having traditionally worked in the field of development assistance. Let’s care for not allowing the lights go out in European health systems.

> www.cuamm.org/

………….
Network resource: Medicus Mundi Switzerland
Global Health: An Interdisciplinary Overview

The University of Geneva just launched a 8 week “Massive Open Online Learning Course” on global health. The course includes video presentations by a range of 36 experts from the University of Geneva and other organisations, plus a course guide and interactive online discussion forum activities. One third of presentations will be from presenters affiliated with other international institutions from Geneva and surrounds, including The Graduate Institute of International and Development Studies, the World Health Organisation, United Nations Development Program, World Trade Organisation, International Union for Conservation of Nature and the Medicines Patent Pool. Currently around 11,000 students from across the globe are enrolled in this course. The Division of International and Humanitarian Medicine (DIHM) of the Geneva University is a member of Medicus Mundi Switzerland.

> https://www.coursera.org/course/globalhealthoverview

………….
Network news: Memisa
Annual Report 2012

The annual report of Memisa is available in French and Dutch language.

> www.memisa.be/

International Health Policy: MMI Updates

Bits and pieces of news on international health policy: each “MMI update” is 140 characters or less – these are the rules of the game on twitter. Just enough for a headline, eventually an author, a date, the source – and a link to the website where you find the full information. Have a look at some of our “tweets” published during the last month. As usual, it’s a bit much, so take it or leave it.

………….
Health systems strengthening
Health services, health financing

Health Equity and Financial Protection in Asia. Bruno Meessen et al.
http://e.itg.be/ihp/archives/health-equity
Performance-based financing as a health system reform: key dimensions for monitoring and evaluation. Witter et al.
http://www.biomedcentral.com/1472-6963/13/367
Cutting health spending and increasing co-payments is a false saving! OECD Deputy SG Leterme at EPHAconference
http://www.oecd.org/health/health-systems/

………….
Universal health coverage

Universal health coverage, real or selective? Time for global health advocates to unite. Gorik Ooms
http://uhcforward.org/blog/2013/oct/1/universal-health-coverage-real-or-selective-time-global-health-advocates-unite
Public Expenditure on Health in the Post-2015 Agenda: Let’s Think About it Again. Joan Tallada
http://t.co/DeHJOJpiFC
Aligning Universal Health Coverage with civil society priorities. J. Jay
http://www.msh.org/blog/2013/10/02/
WHO PAHO Director cites “a clear Pan American consensus” in favor of UHC, as 52nd Directing Council ends
http://bit.ly/1cqp7En
Health leaders from the Americas support universal health coverage. WHO PAHO press release at RC meeting
http://bit.ly/1aixzR5
Promoting universal financial protection in LMICs: Factors facilitating or hindering progress. McIntyre et al.
http://www.health-policy-systems.com/content/11/1/36