Financing access to medicines and universal health coverage How are different states doing in implementing the right to health; to what extent have countries been able to provide universal coverage? Different States use different systems/try to solve the problem differently: - Welfare state/publicly funded health provision – high income/developed countries (for example France, Italy, Sweden). Generally there is good health coverage for everyone. Some of them reported difficulties (like decreasing number of covered health problems, inefficiency or corruption leading to worse treatment) - Post-Soviet States (For example Bulgaria, Russia, which were discussed yesterday) - Low (to middle) income Countries: Burma – There is no access to health insurance/financing – lots of poor people cannot even go to the city hospital because it is too far away. There is also a prevalence of corruption – if you´re not able to gain access, you have to buy from the black market to get treatment - India: There is a growing private sector for people that can afford to pay it – which leads to a decrease in the quality of the public health care/services. We can find a “creeping privatization” – though public health care would be accessible, people mortgage their earnings to go to the private sector. 30-40% report, that for financial reasons they are not able to access care. Therefore, a very similar situation to Burma That the amount of money invested in the health system is not the only factor leading to a good healthcare – is shown by two examples: USA – spend more on healthcare than anyone else but can´t assure a very good coverage, especially for low-incomes Sri Lanka – generally has less money to spend on health care, yet, manages to provide healthcare that enables 50-60% of the population to be covered outside of the hospitals. (The reason why they still are able to hold it upright since 1950, is probably that they provide free health AND free education – somehow these two together seem to be non-negotiable.) Though money is not the only factor – a certain amount of it is vital. Without proper founding you cannot start or maintain a healthcare system. So how to find the money; how to finance these systems? 1. Taxes – especially a progressive tax system is often used in high-income countries. Low to middle income countries are afraid that the richer People would leave the state if they use high taxes – which on the other hand would be necessary to cover health care for everyone. In Africa there has been this huge debate on user fees – part of the structural adjustment program – small user fees were keeping people out – WHO states that user fees should be eliminated. 2. Tobin Tax: (profiting from the Global casino) – amount of money traded in stock exchanges (8 days of that is equal to total global trade for one year) – If you put a small tax on money that is traded in the global system, then it gets added into a pool. 3. Cancellation of Debt: The Cancellation of debt is another option – the amount of debt these countries owe is much less than what has been taken out of these countries (profits of natural resources for example) 4. Charity itself: when the rich countries commit the money as aid – this should be looked at as reparation (something rich countries are obliged to pay based on what countries have taken out from these countries) More or less we are moving toward a consensus that the best funding is through a progressive tax system – and at the point of the care, when you´re the weakest, you should not have to pay out of your own pocket. If there isn´t enough money to pay for healthcare – maybe we can reduce the cost? The percentage spend on medication is much higher in low to middle income countries compared to high income. So reducing medicine prices could be a goal: - The general topic of Patent rights was discussed by another group, so we didn’t elaborate on it in this discussion. - The Student association Universities Allied for Essential Medicines (UAEM) voted that as most of the universities are to a large extend financed by the public – research done by them should therefore be accessible to the public. The goal is to prohibit exclusive licensing and demanding for every research-sale a written down strategy to make the end product available for the low to middle income countries, for example by allowing generic production for the low-to-middle income countries. - Pooled purchasing: If the public system is the major provider of care – they have more bargaining power to push down medicine prices – manufacturers are forced to negotiate because the country is the biggest buyer.