Here’s a rather prophetic story I wrote for the Fall 2004 issue of the Harvard Public Health Review. It outlines health reform principles discussed in Getting Health Reform Right: A Guide to Improving Performance and Equity, a book written by four Harvard professors, presumably for developing nations. But, maybe not.


Four HSPH experts highlight the importance of social values, politics, organization, and economic considerations to health system reform in a new book, Getting Health Reform Right: A Guide to Improving Performance and Equity. Published by Oxford University Press, the uniquely multidisciplinary "repair manual" takes reformers step by step through the complexities of patching up and replacing broken systems.

"The world is littered with failed reform efforts," observes Marc J. Roberts, one of the quartet and a professor of political economy and health policy. But given the enormous needs, notes his colleague, Peter Berman, professor of population and international health economics, "We have no choice but to do better."

Despite what the United States spends to stay healthy--about $1.5 trillion a year, more than any other nation--this country ranked 37th among Western nations in one 2000 World Health Organization report that factored in quality and disparities in care among the insured and uninsured. When you consider that 2.8 billion people--more than half the population of all developing countries--live on less than $2 a day, you get an inkling of how little people in, say, Tanzania or Honduras have to spend on medical care, let alone prevention. If a wealthy, stable country like the U.S. can't provide good health services to all its citizens, what can resource-poor countries hope to accomplish?

See Getting Health Reform Right for the complete story. 



Jacqui Christodoulou
08/15/2009 12:05

Hi Paula
We have been getting a lot of press her ein the UK about the NHS here being rubbish. In fact it is wonderful. Sure, it has it's faults like sometimes you have to wait and sometimes you can't get the 'cure' straight away. Overall, the most beneficial thing about it are that it helps those on low income primarily: there is no charge at all for treatment or prescriptions for those who earn below a threshold. Children get ALL free treatment and so do pensioners. Everyone gets a similar level of treatment. At the more afluent end, extra heathcare insurance can be taken out so that if you wnat a plush room with plasma screen TV you can have that. But basically, the 'national insurance' premium is deducted at source form salaries and treatment is provided for everyone. This inspires a basic confidence that you will definately get treatment if you get ill. The cosmetic dental and cosmetic surgery system is completely seperate - all actual illness is treated in nationally approved surgeries, clinics and hospitals. It's a wonderful thing. I hope you soon have something similar.


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