While Americans quarrel over the Affordable Care Act — Obamacare — much of the rest of the world has established or is moving toward universal health care for all citizens, and the World Bank is taking a lead in setting measurable targets for meeting that goal as a priority in human development.
“The quest for universal coverage is not only a demand for better health — it’s a demand for equity,” the World Bank president, Jim Yong Kim, told an international conference in Tokyo in early December. “At the World Bank Group, achieving universal health coverage and equity in health are central to reaching the global goals to end extreme poverty by 2030 and boost shared prosperity.” Japan and the World Health Organization are partners in the project. Japan has had a national health care system since 1961.
Kim, the bank’s president since July 2012, brought a strong background in public health to the organization. President of Dartmouth College at the time of his current appointment, Kim, a physician, was earlier a professor at the Harvard Medical School, co-founder of Partners in Health, a Boston-based group working in poor countries on four continents, and a former director of the HIV/AIDS department at the World Health Organization.
In Tokyo, Kim released a new report based on studies of health care systems in 11 diverse countries, drawn from the poorest nations to rich members of the Organization for Economic Cooperation and Development (OECD). The United States was not included in the study. In the OECD, it ranks below most nations, 26th out of 34 in the group on important measures of health care, a profile the administration of President Barack Obama is trying to improve against political odds.
An article earlier this year in the Journal of the American Medical Association, said that numerous factors hurt US performance. “For instance,” the Journal wrote, “the percentage of the population in poverty is much higher in the United States than in the [other] OECD countries (17 % vs 9%) and poverty is a predictor of early death. Health is probably distributed less equally in the United States than in the OECD countries because the United States has more individuals without insurance and greater income inequality.”
In the survey report released by the World Bank in Tokyo, the two OECD countries represented at the high end of the scale were Japan and France. At the lowest end in the study were Bangladesh and Ethiopia, which had only begun to introduce programs that could lead to universal care. Above them in the study was a group of developing nations with systems in place but needing more work to reach universal coverage: Ghana, Indonesia, Peru and Vietnam. Next up the scale were Brazil, Thailand and Turkey, emerging rising-income nations just below the top, with the focus on improving services and financial protections in their universal coverage system.
In Tokyo, Kim said that political leadership and the involvement of professional and advocacy organizations were important in promoting universal health care in every nation. “But in order for countries to continue learning from one another, and to benchmark progress, the world needs a measurement framework that can provide a common, and comparable, set of metrics,” he said. “That’s why at this conference, the World Bank and WHO are releasing a joint framework for monitoring progress toward universal health coverage with two targets, one for financial protection and one for service delivery.”
“For financial protection, the proposed target is by 2020 to reduce by half the number of people who are impoverished due to out-of-pocket health care expenses,” Kim said. “By 2030, no one should fall into poverty because of out-of-pocket health care expenses. This is no small feat: this would mean moving from 100 million people impoverished every year now to 50 million by 2020 and then to zero by 2030.
“For service delivery, the proposed target is equally ambitious,” he said. “Today, just 40 percent of the poor in developing countries have access to basic health services such as delivering babies in a safe environment and vaccinating children. We propose that by 2030 we will double that proportion to 80 percent coverage. In addition, by 2030, 80 percent of the poor will also have access to many other essential health services such as treatment for high blood pressure, diabetes, mental health and injuries.”
Details on how targets will be tracked are to be worked out in coming months between the World Bank and WHO in consultation with partners, he added.
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