Sustaining and Implementing Universal Health Coverage: 4 Perspectives for 5 Continents,10th February 2012, SD Bocconi School of Management, Milano/Italy


By Francesca Ramondetti, ISECN European Regional Coordinator

Key Conference Objective

“To facilitate a dialogue among all actors essential to healthcare provision, in order to learn from intersectoral actions across the various countries in order to address the policies beyond the implementation of Universal Health Coverage (UHC)”

Involving all healthcare areas into the debate towards a comprehensive understanding

A growing body of evidence shows a future healthcare demand which will be unsustainable for any government, unless clear policies aiming at more efficient resource allocation and maximisation are soon identified and implemented. So far, UHC has been considered an issue concerning low-income countries only, but an ageing population and lifestyle changes taking place in high-income countries have led to a constant struggle to tackle the impact of non communicable diseases (NCDs).

Our current frameworks need to be changed and attention needs to be drawn towards making people stay healthy instead of simply treating a disease. This paradigm shift requires interventions from all actors and all sectors: from the local to the national to the international level, and from the health system managers to the policymakers to the pharmaceutical and medical device sectors.

Are health management and health technology assessment key to sustainability?

According to Peter Spurgeon (UK), drivers of health management are represented by the following: health technology, population growth, NCDs, and access to health care. Healthcare sustainability can only improve if we improve our safety approach. A safety approach should provide the best health outcomes, but the current approach tends to be very individualistic, and focuses on a particular physician-preferred treatment. To date, universal health care systems have failed to drive the system of delivering care to improve safety; in order to make the most effective change, we would need to stop problems as they emerge, before they grow larger.

Nonetheless, we need reliable and deliverable risk and safety management together with sustainable solutions, because we continue to harm patients: this has been proven by the fact that adverse events are not diminishing even with an increase in research, available resources and new technology. With referral to research, this should help us to produce meaningful information. However, not all research is good quality and many studies can lead us to draw false conclusions  and poor reliability.  What we need now is the best evidence-based healthcare, if we want to extend research findings to the entire population and allow public health professionals to find and use research evidence reliably and efficiently. Our problem stems from our efforts to solve a failure in the healthcare system without addressing the causes of the very same problem: we need to re-think a system approach, which seems to be the only way to solve system failures. A resilience of the system is the solution to avoid them, starting from the design process. Eventually, we need system safety appraisals to check whether reliability was achieved.

Mike Drummond (UK), instead, states that technology and health technology assessment  (HTA) added value to healthcare systems. What is crucial in each health system are three important actors: payers, patients, and manufacturers. Mike argues that we need equity evaluation alongside an economic evaluation together with aligning manufacturers’ research with social objectives; furthermore, we need to begin having early dialogue between manufacturers, payers and patients, together with an increased participation of patients in HTA conditioned by the type of health system.

The contribution of health to the economy in the European Union

Martin Mc Kee (UK) describes the relationship between health and the economy as a complex one. While it has long been recognised that increased national wealth is associated with improved health, it is only more recently that the contribution of better health to economic growth has been recognised. Yet, while this relationship is now well established in low income countries, the evidence from high-income countries, such as the Member States of the European Union, has been more fragmented. Of particular relevance to Europe, with its ageing population, Martin shows how poor health increases the likelihood of early retirement. This evidence provides a powerful argument for European governments to invest in the health of their populations, not only because better health is a desirable objective in its own right, but also because it is an important determinant of economic growth and competitiveness.

New health challenges, such as rising levels of obesity, particularly among children, microbial resistance to antibiotics and newly emerging epidemics, give rise to increasing concern and are sufficiently worrying to justify undertaking a profound reconsideration of the role of the public health sector.

Great innovations of the first and second health care revolutions

Muir Gray (UK) focuses on the fact that all health services have to face five major problems: patient harm, unwarranted variation in quality and income, failure to maximise value, inequalities, and failure to prevent. Furthermore, new additional challenges are developing, among which are rising expectations, financial constraints, climate change, and carbon constraints. Hence, MG suggests that 21st century healthcare should aim at being patient-centred, should focus on systems, should operate through networks, and should aim at reducing waste in order to face the above challenges.

Using cost-effectiveness analysis for setting health priorities

Mark Pearson (OECD) argues that the current health systems have failed to incorporate cost-effectiveness and value. Hence, we should focus more on primary care issues if we aim to achieve universal health coverage worldwide, in order to ensure equity, productivity and efficiency and reducing fragmentation between public and private.

Further Issues raised during the conference to think about:

  1. Are financial resources adequate for attaining universal health coverage? Should be funding increased? If yes, then how?
  2. How can we improve our communications to politicians to make the case that more should be done to attain universal coverage?
  3. How can countries cooperate to achieve universal health coverage?
  4. Can we provide best cases of universal health coverage?
  5. Can we provide benchmarks in terms of funding arrangements?




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