Equity in Health

DARWIN DECLARATION

The Network: Towards Unity for Health (TUFH) an official non-state actor of WHO, is an international organization that works with national, state, and community partners to foster equitable community-oriented health services, education and research with the goal of improving health locally and globally. The participants of TUFH 2019 in Darwin, collectively, as a result of the Global Solutions Challenge Inclusive Process, curated and endorse the following declaration.  

ACHIEVING EQUITABLE HEALTH CARE BY RESPONDING TO POPULATION HEALTH NEEDS Whereas, 

1.The world desires and the future deserves Universal Health Coverage and Equitable Health Care for ALL; 

2.Universal Health Coverage and Equitable Health Care for the disadvantaged, neglected, and minorities rarely exists;  

3.The voices of marginalized populations including but not limited to First Nations, Indigenous, Elderly, Women, Migrants and Refugees, and people living in remote and rural areas are not adequately represented or invited to the table where health, system and funding decisions are made; 

4.Non-health sectors are not adequately represented or invited to the table where health, system and funding decisions are made; 

5.There is often a disconnect between the wisdom and ideas of the elders and the youth where both voices are often lost in healthcare discussion;  

6.Institutions who adopt and implement social accountability and interprofessional education and practice standards aren’t recognized;  

7.Climate change is increasingly effecting the environment, health and healthcare;  

8.Health Education and Training is rarely tailored to, addresses community needs, or informed by community implementation;  

9.Global siloed policy recommendations, consuming the majority of financial resources, are majorly ineffective as they are not developed with and by the communities they are targeted to impact and do not often engage and support the work of local clinicians and teams. 

We collectively declare we will work toward inclusiveness, education, and advocacy.

We will work toward INCLUSIVENESS defined by:  

 1.A global effort of caring for each other returning the human spirit to health care including community voices, culture, lived experiences, empathy, and compassion.  

2.Frequent and consistent communication in the creation of priorities for local action between and within the health sector both regionally and globally and with and for the people and communities of the world.  

3.Frequent and consistent communication in the creation of joint priorities of action beyond the health sector with non-health sectors.  

We will work toward EDUCATION defined by:  

4.Alternative health practitioners (e.g. community health workers) and emerging healthcare professionals are engaged, competently trained, certified, and represented in health workforce policies and practices. 

5.The next generation of health workforce leadership is prepared by creating greater opportunities for students with mentorship being one of the opportunities.  

6.Capitalize on the advancement of technology to enhance the sharing and education for academics, health workers and students regionally and around the world. 

7.Healthcare Education is tailored to and addresses community needs and incorporates community best practices (e.g. field case studies) reflecting what people are doing and not publishing. This includes the formation of additional health education and training platforms from communities, in communities, by communities, and for communities.  

We will work toward ADVOCACY defined by:  

8.Advocacy to ensure the voice of marginalized populations including but not limited to First Nations, Indigenous, Elderly, Women, Migrants and Refugees, and people living in remote and rural areas are adequately represented at the table where health, system and funding decisions are made.  

9.Provide international structures and systems for the structural implementation of Social Accountability (e.g. curriculum accreditation that responds to and does not increase disadvantages).  

10.A global effort recognizing the climate change and its impact on the environment, health, and healthcare.  

11.Demonstrate through evidence that Social Accountability, Interprofessional Education, and the Integrated Health Team create positive impact toward students, health professionals, and community.

12.Support the certification and recognition of institutions as the global leaders in implementing Social Accountability, Interprofessional, and Population Health that includes, at a minimum, the standards as listed below: 

 •Policies, curricula, and regulatory standards that promote social accountability, community involvement, and interprofessional education and practice; 

 •Environmental Impact of Healthcare including the monitoring waste production, efficiency, challenging the need of single use devices; 

 •Inclusion of the student and patient/community voice in the development of policies, curricula and regulatory standards; 

 •Holistic approach in delivering quality health that includes the healthcare team driven by patient goals verses silos. 

 •Ensure training from communities, in communities, by communities, and for communities. 

TUFH commits to be a vibrant and effective network of networks that realizes, implements, and assesses the effectiveness of the above actions.

 

Germany Health System

Universal Health Care

 The United States should look to Germany, not Canada, for the best model.

By Jamie Daw

 A sign indicates the passage to the delivery area in the Neustadt am Rübenberge Clinic in the Clinic for Gynecology and Obstetrics in Germany.

CreditCreditHolger Hollemann/Picture-Alliance, via Associated Press

As a Canadian living and studying health policy in the United States, I’ve watched with interest as a growing list of Democratic presidential candidates — Senators Bernie Sanders, Kamala Harris, Elizabeth Warren, Kirsten Gillibrand and Cory Booker — have indicated support for a Canadian-style single-payer plan with little or no role for private insurance. Approval of such a system has become almost a litmus test for the party’s progressive base.

But rather than looking north for inspiration, American health care reformers would be better served looking east, across the Atlantic.

Germany offers a health insurance model that, like Canada’s, results in far less spending than in the United States, while achieving universal, comprehensive coverage. The difference is that Germany’s is a multipayer model, which builds more naturally on the American health insurance system.

Although it receives little attention in the United States, this model, pioneered by Chancellor Otto von Bismarck in 1883, was the first social health insurance system in the world. It has since been copied across Europe and Asia, becoming far more common than the Canadian single-payer model. This model ensures that all citizens have access to affordable health care, but it also incorporates age-old American values of choice and private competition in health insurance.

Germans are required to have health insurance, but they can choose between more than 100 private nonprofit insurers called “sickness funds.” Workers and employers share the cost of insurance through payroll taxes, while the government finances coverage for children and the unemployed. Insurance plans are not tied to employers. Services are funded through progressive taxation, so access is based on need, not ability to pay, and financial contributions are based on wealth, not health. Contributions to sickness funds are centrally pooled and then allocated to individual insurers using a per-beneficiary formula that factors in differences in health risks.

The United States has the foundation for this kind of system. Its Social Security and Medicare systems use taxation to pay for social insurance policies, and the health care exchanges created by the Affordable Care Act provide marketplaces for insurance policies.

In an American version of this system, private insurers would have to be heavily regulated to ensure that coverage was affordable and to prevent the sort of rapid increases in premiums, deductibles and cost-sharing that have occurred over the past decade. Similar to regulations for Medicare and Medicaid, insurers would be required to provide a comprehensive set of benefits with limits on patient cost-sharing, which could be means-tested or tied to other criteria, such as having a chronic disease.

In Germany, for example, insurers can charge only small out-of-pocket fees limited to 2 percent or less of household income annually. Compared with the mostly fee-for-service, single-payer arrangements in Canada or the Medicare system, enrolling Americans in managed care plans paid on a per-patient basis would offer greater incentives to increase efficiency, improve quality of care and promote coordination of care.

Under a German-style plan, states could still be given flexibility in regulating nonprofit insurers to reflect regional priorities, similar to the flexibility offered to states in managing Medicaid and the A.C.A. exchanges.

Germany, Austria, the Netherlands and other countries with similar systems vastly underspend the United States. Americans may be concerned that lower spending reflects rationing of care, but research has consistently found that not to be the case. Other high-income countries spend less on health care than the United States because they have lower prices, not because they receive less care. In Germany, sickness funds leverage market power to secure lower prices, coming together regionally to negotiate contracts with doctors and hospitals, and nationally to negotiate drug prices.

Administrative and governance costs in multipayer systems are higher than in single-payer systems — 5 percent of health spending in Germany compared with 3 percent in Canada. But there is much room to cut prices. If, for example, insurers were able, on average, to achieve hospital and physician prices at the level of Medicare, and prescription drug prices at the level of the Department of Veterans Affairs, the savings would be significant.

While recent polls indicate that a majority of Americans support so-called Medicare for all, approval diminishes when the plan is explained or clarified. The former Starbucks chief executive, Howard Schultz, who is considering running for president, called the proposal to eliminate private health insurance “not American.” A German-style multipayer road to universal coverage might receive a much warmer reception.

Americans have long valued choice and competition in their health care. The German model offers both: Patients choose private insurers that compete for enrollees, in the process driving innovation and improving quality. If the United States adopted this model, insurance companies would be more tightly regulated and required to become nonprofits, and some job losses would be likely. But they would not need to be eliminated, an idea suggested, and then retracted, by Ms. Harris in her call for Medicare for all.

The diversity of health financing arrangements globally demonstrates that there are many possible paths to achieving universal health care at an affordable cost — as Ms. Harris’s advisers acknowledged after walking back her call for the elimination of private insurance.

Advocates and policymakers should pick carefully among these paths, choosing one that strikes a balance between what is possible and what is ideal for the United States health system. While the single-payer model serves Canada well, transitioning the United States to a multipayer model like Germany’s would require a far smaller leap. And that might encourage Americans to finally make the jump.

* Jamie Daw is assistant professor of health policy and management at Columbia University’s Mailman School of Public Health.

A version of this article appears in print on Feb. 21, 2019, on Page A27 of the New York edition with the headline: A Better Path to Universal Health Care.

Agenda de Prioridades de Pesquisa do Ministério da Saúde (APPMS)

Ministério publica agenda com prioridades de pesquisa na saúde

 

 

O Departamento de Ciência e Tecnologia do Ministério da Saúde publicou a Agenda de Prioridades de Pesquisa do Ministério da Saúde (APPMS). A iniciativa tem o objetivo de alinhar as prioridades atuais de saúde com as atividades de pesquisa científica, tecnológica e inovação e direcionar os recursos disponíveis para investimento em temas de pesquisas estratégicos para o SUS.

A construção da agenda foi realizada em um processo participativo envolvendo todas as sete Secretarias do Ministério da Saúde em todas as etapas, que traz 172 linhas de pesquisa distribuídas em 14 eixos temáticos.

Durante a elaboração da APPMS, os problemas de saúde e de pesquisa foram identificados juntos às áreas técnicas e gestores do Ministério da Saúde. Esses problemas foram priorizados dentro das secretarias e, então, criadas linhas de pesquisa que refletem as necessidades de pesquisa do SUS. O trabalho iniciou em 2017, considerando o conceito amplo de saúde, seus determinantes e condicionantes, por meio da metodologia proposta pelo Global Forum for Health Research (2009) e adaptada para as nossas necessidades.

O documento APPMS não substituirá a Agenda Nacional de Prioridades de Pesquisa (ANPPS). Trata-se de um instrumento para subsidiar a destinação de recursos, o planejamento institucional e a tomada de decisão no Ministério da Saúde nos próximos dois anos.

Confira os 14 eixos temáticos: 

Eixo 1 – Ambiente, Trabalho e Saúde
Eixo 2 – Assistência Farmacêutica
Eixo 3 – Avaliação Pós-Incorporação
Eixo 4 – Desenvolvimento de Tecnologias e Inovação em Saúde
Eixo 5 – Doenças Crônicas Não Transmissíveis
Eixo 6 – Doenças Transmissíveis
Eixo 7 – Economia e Gestão em Saúde
Eixo 8 – Gestão do Trabalho e Educação em Saúde
Eixo 9 – Programas e Políticas em Saúde
Eixo 10 – Saúde da Mulher
Eixo 11 – Saúde da População Negra e das Comunidades Tradicionais
Eixo 12 – Saúde do Idoso
Eixo 13 – Saúde Indígena
Eixo 14 – Saúde Materno Infantil

Acesse a Agenda aqui.

 

Democracia e Saúde

16ª Conferência Nacional de Saúde

No próximo ano, teremos a 16ª Conferência Nacional de Saúde com tema central "Democracia e Saúde: Saúde como Direito e Consolidação e Financiamento do SUS".

 

O chamado é para retomarmos o ideário da decisiva 8ª CNS e discutirmos sobre os avanços e desafios nestes 33 anos.

A 16º CNS ocorrerá em Brasília nos dias 4-7/08/019 e, espera-se, deve ser precedida de intensos debates nas etapas municipais e estaduais.

 

Para tal, o Conselho Nacional de Saúde preparou um texto de apoio para ser socializado e utilizado pelos conselhos locais,municipais e estaduais e pelas instâncias dos serviços e da academia.

 

 

Clique aqui para ler e fazer o download do documento.