As mentioned last week, the next two posts will be broken into two sections. This post will discuss how government structure, culture and social differences muddy the reform waters. These challenges must be strongly considered and overcome throughout the process, because theory and empirical evidence simply isn’t enough to get an effective, efficient and equitable health system implemented.
Successful reform is often a long process – nations rarely pass comprehensive policies that tackle financing, organization, regulation and payment systems simultaneously. Such periods of major health reform, though, generally occur during political and or economic crises. Politically, a nation may experience regime change where power and cultural momentum drastically shift and allow health reform to pass. Bangladesh, for example, experienced a military takeover of government in 1979 and was able to quickly implement pharmaceutical reform. After a similar military coup in 1983, Chile pushed through comprehensive health reform. In the late 1980’s, Taiwan began setting up a democracy after breaking away from China’s authoritarian rule; this political and social transformation resulted in systematic health reform by 1995 that now provides efficient, effective and universal health care. Economic crises, such as major recessions and depressions, may also create momentum for health reform. Governments and citizens, despite numerous setbacks, occasionally seek to expand coverage and improve the efficiency of their health systems. We see this happen most often in developed nations (US, UK, etc) where GDP per capita is much higher and governments can run temporary deficits without severe repercussion. However, even during instances of extreme change governments still encounter resistance. In the aforementioned cases, Bangladesh ultimately failed to overhaul the entire health system almost a decade later due to interest group opposition; likewise, Chile required 5-10 years to successfully implement new policies due to poor resource capacity and political resistance. The United States has encountered severe resistance due to high deficits and an economy that has yet to rebound.
For the majority of cases where less expansive health reform occurs, government structure and culture present the greatest obstacles in developed societies. Evidence indicates that it is rarely possible to use a “cookie cutter” approach to transferring health policies from one nation to the next — every country is unique, and reform must be tailored to meet its individual needs and characteristics. Thus, even though two nations share similar health care markets, their political and cultural differences may prove too disparate to conveniently swap health reform solutions. That is not to say that such differences are impossible to overcome; political obstacles can be conquered with enough support and intellect, and evidence shows that changes in culture are actually quite elastic. Nonetheless, these are critical issues that must be strongly considered.
Posted March 6, 2010 by Ali Al-Rajhi under Guest Bloggers
At TED2010, Bill Gates unveils his vision for the world’s energy future, describing the need for “miracles” to avoid planetary catastrophe and explaining why he’s backing a dramatically different type of nuclear reactor. The necessary goal? Zero carbon emissions globally by 2050.
About Bill Gates
(source: TED)
Bill Gates is founder and former CEO of Microsoft. A geek icon, tech visionary and business trailblazer, Gates’ leadership — fueled by his long-held dream that millions might realize their potential through great software — made Microsoft a personal computing powerhouse and a trendsetter in the Internet dawn. Whether you’re a suit, chef, quant, artist, media maven, nurse or gamer, you’ve probably used a Microsoft product today.
In summer of 2008, Gates left his day-to-day role with Microsoft to focus on philanthropy. Holding that all lives have equal value (no matter where they’re being lived), the Bill and Melinda Gates Foundation has now donated staggering sums to HIV/AIDS programs, libraries, agriculture research and disaster relief — and offered vital guidance and creative funding to programs in global health and education. Gates believes his tech-centric strategy for giving will prove the killer app of planet Earth’s next big upgrade.
In his second annual letter, released in late January 2010, Gates takes stock of his first full year with the Gates Foundation. Read Bill Gates’ annual letter for 2010. And follow his ongoing thinking on his personal website, The Gates Notes.
After scolding President Obama for continuing to push for reform despite “electoral rebukes” in Massachusetts, New Jersey and Virginia, he complains that the cost-savings in the bill are “ridiculously insignificant.” Dismissing the popular support of the insurance industry reforms that would protect most Americans from the worst predations of the health care insurance marketplace, he goes on to describe the 30 million Americans who would get health coverage as unworthy recipients of taxpayer largesse. The half trillion dollars in Medicare “cuts,” he writes, are “not to keep Medicare solvent but to pay for the ice cream, steak and flowers.”
We’re all familiar with studies showing that marital status is associated with improved health and lower mortality. However, two recent studies suggest that having a male partner is associated with being overweight for women.
A couple of weeks ago, a colleague from our sister site Epicurious.com asked me to comment on New York City’s new campaign to reduce sodium in packaged and restaurant food. I told her I thought the across-the-board movement was probably overkill. The majority of people don’t have high blood pressure–and most of those who do are not salt sensitive. In effect, we’d be “treating” a lot of people who don’t need it in order to get at those who do. On the other hand, I said, there’s no harm in reducing sodium and it would save lives.
The US is facing many challenges in controlling the childhood obesity epidemic. Despite recent efforts and some progress, one third of US children are still overweight or obese. Yet research has shown that the road to obesity begins early in life, and it is more common and difficult to address for low-income children.
That health insurance carriers were ascending to the throne of political piñata in the health care reform debate has been apparent for some time now. Last July President Barack Obama began referring to health care reform as health insurance reform. A couple of weeks later Speaker Nancy Pelosi described insurance companies as “almost immoral” for opposing the creation of a government-run health plan. That insurance companies were to be cast as the villains was pretty much inevitable. People like and trust hospitals and doctors much more than health insurance carriers. And pharmaceutical companies, while profiting far more from health care than medical carriers are a bit removed from people’s daily experience. The reality is the only group Americans trust less when it comes to health care reform than insurance companies are Republicans in Congress.
Ali Al-Rajhi writes with the purpose of informing individuals in the Public Health field about pressing issues in environmental health, public health policy, epidemiology, and behavioral health. Learn more here.
