The politics and science of health and disease remain contested terrain among scientists, health practitioners, policy makers, industry, communities, and the public. Stakeholders in disputes about ...illnesses or conditions disagree over their fundamental causes as well as how they should be treated and prevented. This thought-provoking book crosses disciplinary boundaries by engaging with both public health policy and social science, asserting that science, activism, and policy are not separate issues and showing how the contribution of environmental factors in disease is often overlooked.
It has been more than 20 years since Brazil's 1988 Constitution formally established the Unified Health System (Sistema Unico de Saude, SUS). Building on reforms that started in the 1980s, the SUS ...represented a significant break with the past, establishing health care as a fundamental right and duty of the state and initiating a process of fundamentally transforming Brazil's health system to achieve this goal. This report aims to answer two main questions. First is have the SUS reforms transformed the health system as envisaged 20 years ago? Second, have the reforms led to improvements with regard to access to services, financial protection, and health outcomes? In addressing these questions, the report revisits ground covered in previous assessments, but also brings to bear additional or more recent data and places Brazil's health system in an international context. The report shows that the health system reforms can be credited with significant achievements. The report points to some promising directions for health system reforms that will allow Brazil to continue building on the achievements made to date. Although it is possible to reach some broad conclusions, there are many gaps and caveats in the story. A secondary aim of the report is to consider how some of these gaps can be filled through improved monitoring of health system performance and future research. The introduction presents a short review of the history of the SUS, describes the core principles that underpinned the reform, and offers a brief description of the evaluation framework used in the report. Chapter two presents findings on the extent to which the SUS reforms have transformed the health system, focusing on delivery, financing, and governance. Chapter three asks whether the reforms have resulted in improved outcomes with regard to access to services, financial protection, quality, health outcomes, and efficiency. The concluding chapter presents the main findings of the study, discusses some policy directions for addressing the current shortcomings, and identifies areas for further research.
Ghana has committed politically, legislatively, and fiscally to providing universal health insurance coverage for its population with the intent of reducing financial barriers to utilization of ...health care.. However, under current cost and enrollment projections the system will not be financially sustainable in the long term, so there is more work to do. This book provides an important evidence-based review of the current performance of Ghana's health system and options for reform. As such, it provides an overall picture of the Ghana health sector, how things were and how things have changed, as well as a situational analysis of the performance of the health delivery and health financing systems using the latest available data. Finally, it discusses key reform issues and options in the context of the country's likely fiscal space. An important and valuable contribution of this book is its examination of how Ghana is performing compared to its neighboring countries and compared to other countries with similar incomes and health spending, providing global benchmarks for Ghana's health system performance.
The goals of Universal Health Coverage (UHC) are to ensure that all people can access quality health services, to safeguard all people from public health risks, and to protect all people from ...impoverishment due to illness, whether from out-of-pocket payments for health care or loss of income when a household member falls sick. Countries as diverse as Brazil, France, Japan, Thailand, and Turkey that have achieved UHC are showing how these programs can serve as vital mechanisms for improving the health and welfare of their citizens, and lay the foundation for economic growth and competitiveness grounded in the principles of equity and sustainability. Ensuring universal access to affordable, quality health services will be an important contribution to ending extreme poverty by 2030 and boosting shared prosperity in low income and middle-income countries (LMICs), where most of the worlds poor live.
One Nation, Uninsured offers a vividly written history of America's failed efforts to address the health care needs of its citizens. Covering the entire twentieth century, Jill Quadagno shows how ...each attempt to enact national health insurance was met with fierce attacks by powerful stakeholders, who mobilized their considerable resources to keep the financing of health care out of the government's hands.
Since 1978 when it embarked on sweeping agricultural and industrial reforms, Chinas economic growth has been remarkable. Its success in transforming itself within just three decades from a very poor ...low-income country to a successful middle-income country is unparalleled. During this period, however, and in contrast to the first 30 years of the Peoples Republic, progress in the health sector has been disappointing. For example, during the period 1980-2007, China increased its income per head as a percentage of the OECD average from 3 percent to 15 per cent, but infant mortality fell no faster in China than in the OECD area. Government spending on health grew in real terms, but in contrast to the pattern seen in other countries, the share of GDP allocated to government health spending stayed unchanged in China despite 30 years of economic growth of over 8 per cent per year. Household out-of-pocket spending increased to fill the gap, rising as a share of total health spending from 20 per cent in 1978 to over 60 per cent in 2000. This left many households doing without care when they needed it, and others incurring expenses so large they were driven into poverty. In 2003, as part of its program of balanced development and harmonious society, the government began launching a series of policy reforms in the rural health sector where spending and policy reform had lagged. This book examines the performance and workings of the rural health system leading up to these reforms, outlines the reforms, and presents some early evidence on their impacts. It goes on to outline ideas for building on these reforms to further strengthen Chinas rural health system, covering health financing and health insurance, service delivery, and public health. Health systems often get locked into certain reform paths. The final part of the book therefore uses the
experiences of the OECD countries to gaze into Chinas future; it asks not only what Chinas health system might look like, but also how China might get there from where it is today.
Reliable information on how health service strategies affect the poor is in short supply. In an attempt to redress the imbalance, Improving Health Service Delivery in Developing Countries presents ...evidence on strategies for strengthening health service delivery, based on systematic reviews of the literature, quantitative and qualitative analyses of existing data, and seven country case studies. The authors also explore how changes in coverage of different health services affect each other on the national level. Finally, the authors explain why setting international targets for health services has been not been successful and offer an alternative approach based on a specific countrys experience.The books findings are clear and hopeful: There are many ways to improve health services. Measuring change and using information to guide decisions and inform stakeholders are critically important for successful implementation. Asking difficult questions, using information intelligently, and involving key stakeholders and institutions are central to the learning and doing practices that underlie successful health service delivery.
Indonesia has made improving the access to health workers, especially in rural areas, and improving the quality of health provider's key priority areas of its next five-year development plan. ...Significant steps and policy changes were taken to improve the distribution of the health workforce, in particular the contracted doctors program and later the contracted midwives program, but few studies have been undertaken to measure the actual impact of these policies and programs. This book is part of the inputs prepared at the request of the government of Indonesia's national development agency, Bappenas, to inform the development of the next national development plan 2010-14. Other inputs include reports on health financing, fiscal space for health, health public expenditure review, and assessments of maternal health and pharmaceuticals. Study findings highlight the importance not only of improving the supply of health care, but also of improving quality, so as to improve health outcomes. Over the period studied, important gains in the determinants of health outcomes have occurred in Indonesia. At the same time, however, the study shows that Indonesia, despite the significant gains, continues to suffer from serious challenges in the number and distribution, and in particular the quality, of its health workers.
Women's Health Research Institute of Medicine; Board on Population Health and Public Health Practice; Committee on Women's Health Research
10/2010
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Even though slightly over half of the U.S. population is female, medical research historically has neglected the health needs of women. However, over the past two decades, there have been major ...changes in government support of women's health research-in policies, regulations, and the organization of research efforts. To assess the impact of these changes, Congress directed the Department of Health and Human Services (HHS) to ask the IOM to examine what has been learned from that research and how well it has been put into practice as well as communicated to both providers and women.
Women's Health Research finds that women's health research has contributed to significant progress over the past 20 years in lessening the burden of disease and reducing deaths from some conditions, while other conditions have seen only moderate change or even little or no change. Gaps remain, both in research areas and in the application of results to benefit women in general and across multiple population groups. Given the many and significant roles women play in our society, maintaining support for women's health research and enhancing its impact are not only in the interest of women, they are in the interest of us all.
Specialist groups have often advised health ministers and other decision makers in developing countries on the use of social health insurance (SHI) as a way of mobilizing revenue for health, ...reforming health sector performance, and providing universal coverage. This book reviews the specific design and implementation challenges facing SHI in low- and middle-income countries and presents case studies on Ghana, Kenya, Philippines, Colombia, and Thailand.
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