A Global View Of Health: Country Studies

That the United States spends a great deal on health care without necessarily accruing proportionate returns on its investment in terms of number of people covered or population health indicators is hardly news. A 2007 Commonwealth Fund report, in fact, noted that among the thirty industrialized nations, the United States spends the greatest proportion of gross domestic product (GDP) on health services, while having the most potential years of life lost due to circulatory and respiratory diseases and diabetes. Such findings seemingly exert little impact on domestic health policy dynamics. If taken at face value, though, these widely cited results gain increasing significance on the world stage as the developing world begins grappling in earnest with some of the same seemingly intractable policy decisions confronting its Western counterparts. Strikingly, more and more low- and middle-income countries are beginning to show that even countries with limited resources can provide access to high-quality, cost-effective health care. As William Hsiao tells us in this theme issue, while more money might be a necessary condition for better health, it is clearly not sufficient. The financing method used, Hsiao notes, together with institutional capacity and human resources, is a key factor in leveraging even limited health care expenditures into equitable, cost-effective health care. The papers that follow offer an instructive window into the evolving experiences with these health policy tradeoffs among a culturally and ethnically diverse group of countries. First, David Hughes and Songkramchai Leethongdee evaluate Thailands six-year-old experiment with universal coverage and access to a comprehensive benefit package, drawing widely applicable conclusions about quality of care and programmatic sustainability. Next, Jennifer Prah Ruger and Daniel Kress assess the efficacy for access and reduced disparities of Moroccos dual-prong health reform extending coverage to public and formal private-sector employees through a payroll-based system, while creating a publicly financed fund underwriting health care for the poor. Maria Alicia Dominguez Ug and Isabela Soares Santos then examine the equity implications of how the cost burden of Brazils universal health care system is shared among households of different income levels using various forms of payment. Then, Mehtap Tatar and colleagues empirically document the extent and nature of informal payments in Turkeys health care sector and discuss implications for both access to care and equity in the wake of major health care reform initiatives. Finally, Patricio Marquez and colleagues take up the relationship between health and economic development through a look at Russias degraded population health status in the wake of post-Soviet socioeconomic and political upheaval.