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Universal Coverage and Equity in Integrated Health Systems. David McCoy People’s Health Assembly, Cape Town. The National Health Service (NHS). The National Health Market. How and why did this happen?. Finance capital - looking for new markets and profits - PowerPoint PPT Presentation
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Universal Coverage and Universal Coverage and Equity in Integrated Health Equity in Integrated Health SystemsSystems
David McCoyDavid McCoyPeople’s Health Assembly, Cape TownPeople’s Health Assembly, Cape Town
Public Finance Public Budgets
Public Provision
Private Finance Private Insurance
Private provision
The National Health Service (NHS)
Public Finance Private Management of Public Budgets
Public Provision
Private Finance
Co-payments
Private Insurance
Private provision
The National Health Market
How and why did this happen? Finance capital - looking for new markets and profitsFinance capital - looking for new markets and profits
A government that lied, bribed and threatenedA government that lied, bribed and threatened
Politicians (and doctors) with conflicts of interestPoliticians (and doctors) with conflicts of interest
Neoliberal occupation of mainstream political partiesNeoliberal occupation of mainstream political parties
Neoliberal and managerialist occupation of the Department Neoliberal and managerialist occupation of the Department of Healthof Health
A servile and captive mainstream mediaA servile and captive mainstream media
The lack of a social movement and consciousness to defend The lack of a social movement and consciousness to defend the public sector; demand accountabilitythe public sector; demand accountability
FearFear
So the point is ....
We know what works; what ingredients are requiredWe know what works; what ingredients are required
We have enough evidenceWe have enough evidence
The goal of universal and equitable health systems The goal of universal and equitable health systems is a political struggleis a political struggle
We need to be clear about what we are up againstWe need to be clear about what we are up against
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Factors undermining the PHC ApproachFactors undermining the PHC Approach
Political Economy
Health sector reform
Commercialisation and segmentation
Selective health care
Biomedicalisation
Government and bureaucratic
failure
Donor and international programmes
Inequity Inefficiency
Fragmentation, verticalisation and disintegration of
health care systems
Impoverished households
User fees
Lack of community and
public accountability
Economic Inequality
Impoverishment of public sector health
care systems
Inadequate domestic public
revenue
Making the case: Health systems are social and political institutionsMaking the case: Health systems are social and political institutions
Language and concepts: Public – Private Dichotomy Language and concepts: Public – Private Dichotomy
PublicPublic monitoring of health systems monitoring of health systems
Tax and FinancingTax and Financing
Following the moneyFollowing the money
Four thoughtsFour thoughts
Not just a machine for the delivery of clinical services and Not just a machine for the delivery of clinical services and public health programmes .......public health programmes .......
They shape patterns of social and economic inequalityThey shape patterns of social and economic inequality
They shape the experience of poverty and exclusionThey shape the experience of poverty and exclusion
They can define the experience of being powerless and poorThey can define the experience of being powerless and poor
Inequity in access to health care is one of the most potent expressions Inequity in access to health care is one of the most potent expressions of social injustice of social injustice
Medical impoverishment and medical insecurityMedical impoverishment and medical insecurity
1. Health systems are social and political 1. Health systems are social and political institutionsinstitutions
A vehicle /platform for community empowerment and participatory democracyA vehicle /platform for community empowerment and participatory democracy
Active participants, not passive recipients of selective health careActive participants, not passive recipients of selective health care Citizens, not consumersCitizens, not consumers
Shape the experience of fundamental life events of birth and deathShape the experience of fundamental life events of birth and death
A space in society which is not governed by the dictates of the market, commercialisation and the pursuit of wealth and profitA space in society which is not governed by the dictates of the market, commercialisation and the pursuit of wealth and profit
where social solidarity is prioritisedwhere social solidarity is prioritised
1. Health systems are social and political institutions
CommercialisationCommercialisation
Public-Public PartnershipsPublic-Public Partnerships
CommunitisationCommunitisation
2. Language and concepts: Public-Private 2. Language and concepts: Public-Private DichotomyDichotomy
3. Public monitoring of health systems3. Public monitoring of health systemsFinancingFinancing
Level of tax revenue to be Level of tax revenue to be at least at least 20% of GDP 20% of GDP
Public sector health expenditure (government and donor finance) to be Public sector health expenditure (government and donor finance) to be at least at least 5% 5% of GDP of GDP
Public sector health expenditure (government and donor finance) to be Public sector health expenditure (government and donor finance) to be at least 7at least 75% 5% of Total Health Expenditureof Total Health Expenditure
Government expenditure on health to be at least 15% of total government Government expenditure on health to be at least 15% of total government expenditureexpenditure
Direct out-of-pocket payments less than 20% of total health care expenditure Direct out-of-pocket payments less than 20% of total health care expenditure
Expenditure on district health services (up to and including Level 1 hospital services) Expenditure on district health services (up to and including Level 1 hospital services) to be at least 50% of total public health expenditure, of which half on primary level to be at least 50% of total public health expenditure, of which half on primary level health carehealth care
Ratio of total expenditure on district health services in the highest spending district Ratio of total expenditure on district health services in the highest spending district to lowest spending district < 1.5to lowest spending district < 1.5
3. Public monitoring of health systems3. Public monitoring of health systems
Inequities in access and consumptionInequities in access and consumption
Denial of careDenial of care
IncomesIncomes Excessive profiteeringExcessive profiteering Conflicts of interestConflicts of interest
4. Tax4. Tax
Make it a key public health issue of the next ten yearsMake it a key public health issue of the next ten years
for effective health systemsfor effective health systems
But linked to other struggles for health, development But linked to other struggles for health, development and equity and equity
ThankyouThankyou