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Balancing Means and Ends for Universal Coverage: Strategies for Health Systems

Explore the essential elements of universal health coverage (UC) and the critical balance between means and ends in achieving it. Delve into the importance of financial burden reduction and service selection. Learn about the significance of universal enrollment and the tools needed to ensure quality, efficiency, and access in healthcare. Discover the various pathways to UC, emphasizing health outcomes, financial risk protection, and primary healthcare. Understand the impacts of different spending levels and resource allocation on the journey to UHC. Consider ethical considerations when making choices between means and prioritize goals for effective healthcare systems.

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Balancing Means and Ends for Universal Coverage: Strategies for Health Systems

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Presentation Transcript

  1. Element of UC: Some Opening Thoughts Peter Berman Professor of the Practice of Global Health Systems and Economics Harvard School of Public Health Boston, April 18, 2013

  2. What do we mean by “elements of UC”? • Think about ends and means

  3. Ends: Ultimate Outcomes – Level and Distribution

  4. Sessions which follow: ends or means? • Reducing financial burden – end? • Choosing services – means to ends? • Universal enrollment – means to ends? …and UC?

  5. Other important means • Sufficient resources to finance UC • Sufficient supply of health care to deliver UC • Instruments to assure quality, efficiency, access, e.g. • Incentives • Regulation • Consumer knowledge

  6. Still other means (further down the causal chain) • Mechanisms to raise the needed resources – taxation, enrollment and collection of premia/contributions. • Producing inputs for the needed supply – e.g. HRH, drugs and supplies • Information to measure and monitor • System capacity to learn and change – training, policy analysis

  7. What happens when some important means are insufficient to achieve UC? • Choices among means and ends are necessary • Should strategies for means be derived from choices across ends? • Pathways to UC

  8. Balancing Health Outcomes and Financial Risk Protection UHC Emphasize PHC and public health? Health Status Emphasize hospitalization insurance/catastrophic spending? Current Performance Financial Protection

  9. The pathway matters: A and B give different outcomes Health Status UHC A Full coverage level of spend Would different pathways affect choice of services, way to reduce financial burden, emphasis on universality? Increase spending on the road to UHC B Current Performance Starting level of spend Financial Protection

  10. In thinking about “elements” • Lets try to be clear about means and ends • When choices/tradeoffs are needed, make choices about means based on priorities among ends • Consider the ethical basis of these choices and the means and sources of these judgements

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