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Global Health Economics Colloquium: universal health care only works if quality of care is high

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Health care has become the largest sector of the global economy, now accounting for more than 10 percent of Gross World Product, or $7.5 trillion. And it’s only going to get bigger as economists expect that figure to approach $18 trillion in two decades.

And yet, the quality of care and health outcomes are not keeping pace.

Ashish K. Jha — a leading expert on health policy and director of the Harvard Global Health Institute — calls this a “critical moment” in health care as the standard of care increasingly becomes more important than the number of people who have health coverage around the world.

“The point is, coverage is not coverage is not coverage. All health financing schemes are not the same,” said Jha, noting that China and Canada have universal coverage for its citizens, but many still receive inadequate health care or are going broke due to the high cost of special medical needs.

“In many places, the problem is the shallowness of the coverage.  Everyone may be covered — but if you get really sick, shallow coverage gets people into trouble,” said Jha, a keynote speaker at the annual Global Health Economics Colloquium, which brings together health economists and policy experts from University of California San Francisco, UC Berkeley and Stanford Health Policy to discuss recent developments in their fields.

The fifth colloquium identified the health needs of vulnerable populations and developing cost-effective and scalable interventions to improve the health of socially and economically disadvantaged people here in the United States and in low- and middle-income countries.

“Our hope for the day is that our speakers will remind us why we do what we do, remind us why we support evidence-based policies, and most of all to inspire us at a time of this geopolitical craziness and why we must continue to persist,” Dhruv Kazi, a cardiologist and health economist at UCSF, who opened the daylong event.

Rising cost of global health care

Global health-care spending is so massive due to several key factors, Jha told the audience: the unprecedented rapid expansion of people moving into the middle class and the rise in treatments, drugs and medical technologies.

And while these are all positive movements, he said, as the world becomes more interdependent, it “behooves us to act” quickly so that health coverage and quality keep up.

At the end of 2016 there were 3.2 billion people in the global middle class; on average 160 million will join the middle class annually for the next five years, heavily concentrated in Asia.

So the two goals of universal health care should be financial protection and improved health.

But Jha noted that while 90 percent of China’s 1.4 billion people are covered by its national health care system, some 18 percent of Chinese are still thrown into poverty by the incidence of catastrophic health spending above and beyond what the government provides. That is nearly 8 percent higher than the global incidence of catastrophic spending, which stands at 11.7 percent.

India, by contrast, does not have a universal health-care system and only 20 percent of it 1.3 billion people have some form of health insurance. But it also has a 17-percent incidence of catastrophic health spending.

“Catastrophic payment incidence cannot be inferred from the fraction of the population covered by health insurance schemes or public health services,” Jha said, quoting a recent Lancet study.

It stands to reason that the health outcomes of those in countries with universal health care should have improved. But most studies show that that is not the case; the reason?  The quality just isn’t there.

Unsafe medical care top cause of deaths

Nearly 43 million injuries are caused in hospitals each year around the world, leading to 23 million years of healthy living that is lost among the world’s population.

“Unsafe medical care is probably one of the top 10 causes of death and disability in the world,” Jha said.

Jha wondered if quality of care isn’t a bigger problem than access to care.  For example, in one of India’s poorer rural states, Madhya Pradesh, there are 11 health-care providers within walking distance of every village, a fairly large number of private providers.

“Yet half of them have no formal training, they didn’t go to any school but they call themselves doctors,” Jha said.

And in the capital of India, New Delhi, public-sector physicians who are well trained are so overworked they spend an average of 2.5 minutes and ask one question per patient.

Ideally, universal health care must be effective and consistent with best professional practices while meeting the needs of the individual patient.

“Global health policy leaders have made universal health coverage an overarching priority.  This is a good thing.  But in order for UHC to improve the health of the world’s poor, we need to ensure people get good care. And that is the biggest challenge of all.”