Financing Universal Access to Healthcare A Comparative Review of Landmark Legislative Health Reforms in the OECD 10629_9789813227163_TP.indd 1/3/18 10:15 AM World Scientific Series in Health Investment and Financing ISSN: 2591-7315 Series Editor: Alexander S Preker (Columbia University, USA and Health Investment & Financing Corp, USA) Most western developed countries offer universal access to healthcare through mechanisms that provide financial protection against its high cost, either through insurance or government subsidy programs In most middle- and low-income countries, financing is often at the center of reforms in the healthcare sector Success or failure of these reforms can have major impact on the political survival of governments that get involved, and major implications for the dynamics of the healthcare industry and overall economy With this series, World Scientific will contribute knowledge about a policy area which is still poorly-understood The series merges policy and practice, exploring the economic underpinnings of real trends in health investment and financing The series will appeal and be accessible to investors, the health insurance industry, healthcare actuaries, business schools with healthcare tracts, healthcare management programs, researchers, graduate students, policy makers and practitioners working in the health sector worldwide Vol Financing Universal Access to Healthcare: A Comparative Review of Landmark Legislative Health Reforms in the OECD by Alexander S Preker Forthcoming Financing Universal Access to Healthcare: A Comparative Review of Incremental Health Insurance Reforms in the OECD Alexander S Preker Financing Micro Health Insurance: Theory, Methods and Evidence David M Dror Role of Private Financing in the Education of Health Workers: Gaining the Competitive Edge Alexander S Preker, Hortenzia Beciu and Eric Keuffel Capital Finance in the Health Industry: A User Manual for Investors and Companies Alexander S Preker and Les Funtleyder Handbook on Health System Financing and Organization Dov Chernichovsky WS Series in Health Investment and Financing.indd 01-03-18 11:12:02 AM World Scientific Series in Health Investment and Financing – Vol Financing Universal Access to Healthcare A Comparative Review of Landmark Legislative Health Reforms in the OECD Alexander S Preker Columbia University, USA Health Investment & Financing Corporation, USA World Scientific NEW JERSEY • LONDON 10629_9789813227163_TP.indd • SINGAPORE • BEIJING • SHANGHAI • HONG KONG • TAIPEI • CHENNAI • TOKYO 1/3/18 10:15 AM Published by World Scientific Publishing Co Pte Ltd Toh Tuck Link, Singapore 596224 USA office: 27 Warren Street, Suite 401-402, Hackensack, NJ 07601 UK office: 57 Shelton Street, Covent Garden, London WC2H 9HE Library of Congress Cataloging-in-Publication Data Names: Preker, Alexander S., 1951– author Title: Financing universal access to healthcare : a comparative review of landmark legislative health reforms in the OECD / by Alexander S Preker (Columbia University, USA) Other titles: World Scientific series in health investment and financing ; v Description: New Jersey : World Scientific, 2018 | Series: World Scientific series in health investment and financing ; volume | Includes bibliographical references Identifiers: LCCN 2017035131 | ISBN 9789813227163 (hc : alk paper) Subjects: | MESH: Organisation for Economic Co-operation and Development | Health Services Accessibility economics | Healthcare Financing | Universal Coverage legislation & jurisprudence | Health Care Reform legislation & jurisprudence | Health Expenditures Classification: LCC RA971.3 | NLM W 76.1 | DDC 362.1068/1 dc23 LC record available at https://lccn.loc.gov/2017035131 British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library Copyright © 2018 by World Scientific Publishing Co Pte Ltd All rights reserved This book, or parts thereof, may not be reproduced in any form or by any means, electronic or mechanical, including photocopying, recording or any information storage and retrieval system now known or to be invented, without written permission from the publisher For photocopying of material in this volume, please pay a copying fee through the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, USA In this case permission to photocopy is not required from the publisher For any available supplementary material, please visit http://www.worldscientific.com/worldscibooks/10.1142/10629#t=suppl Desk Editors: Herbert Moses/Shreya Gopi Typeset by Stallion Press Email: enquiries@stallionpress.com Printed in Singapore Herbert Moses - 10629 - Financing Universal Access to Healthcare.indd 28-02-18 9:19:17 AM 9”x6” b2932 A Comparative Review of Landmark Legislative Health Reforms in the OECD DEDICATION This volume is dedicated to all those who will continue the struggle of achieving “Health for All” so that the dream of a world with “Universal Health Care Coverage” will be achieved in the twenty-first century The “giants among giants” of the past, like the late Professor Brian AbleSmith, have passed the baton for this agenda to the next generations of leaders b2932_FM.indd 2/27/2018 6:46:40 PM b2530 International Strategic Relations and China’s National Security: World at the Crossroads This page intentionally left blank b2530_FM.indd 01-Sep-16 11:03:06 AM 9”x6” b2932 A Comparative Review of Landmark Legislative Health Reforms in the OECD FOREWORD This year, as we commemorate the 40th Anniversary of the Alma-Ata Declaration of “Health for All” on October 25–26 in Almaty, Kazakhstan, as well as the 70th Anniversary of the UK National Health Service, we also celebrate the great achievements in bringing affordable access to quality health services for billions of people across the world over the past decades This book provides a seminal review of the political process, the economic underpinnings and implementation challenges involved in achieving Universal Health Coverage (UHC) The creation of the UK National Health Service out of the ashes of the bombs dropped on London during the Second World War was a stark reminder of the important role that hospitals and emergency services played in complementing primary care under UHC Although this volume focusses on OECD countries that provide access to comprehensive health service based on clinical need, available to all — not on the ability to pay — through major legislative reforms, other European countries like Germany, France, Switzerland and the Netherlands achieved similar coverage through a more gradual incremental legislative process How these latter countries also achieved UHC for their populations and similar stories in low- and middle-income countries will be the focus of a forthcoming volume by Professor Alexander S Preker During his 25 year career at the World Bank and International Finance Corporation, the author was an influential voice on UHC in the Bank, the International Labor Organization, and the World Health Organization His international work during these past three decades emphasized the need to underpin worthy aspirations and declarations with needed funding, human vii b2932_FM.indd 2/27/2018 6:46:40 PM 9”x6” b2932 A Comparative Review of Landmark Legislative Health Reforms in the OECD viii Foreword resources and implementation capacity at the country level As a member of the World Bank team which wrote the World Development Report 1993 on “Investing in Health” and the WHO team which wrote the World Health Report 2000 on “Health Systems: Improving Performance”, and throughout his career, the author has emphasized that good health is part of economic development and that “investing in health” is a worthy economic goal, not just a lofty social aspiration The comparative health systems framework and country case studies reviewed in this volume reflect this philosophy During this period, it was an honor to have had a chance to work with Professor Preker and to have benefited from his insights on and innovative approaches to health care financing and service delivery The International Hospital Federation (IHF) is committed to advancing the UHC agenda throughout the world, giving billions of people better access to critical hospital care and basic health services when needed, irrespective of their income or geographic location in the world Since its establishment in 1929, the IHF recognizes the essential role of hospitals and health care organizations in providing health care, supporting health services and offering education to health care providers as a critical partner during the drive for UHC throughout the world This pragmatic philosophy underpins the Almaty Declaration 2.0, which will reflect the changing expectations of health care providers, the needs of patients, and the challenges posed by the Sustainable Development Goals 2030 I am optimistic that the renewed approach to both primary and more advanced health care will respond to the health needs and aspirations of people throughout the world through better access and more effective use of all available health services and their associated technologies The conditions are now present to move to a real health systems approach in which all players from front-line workers to higher levels of the referral system in both the public and private sectors can contribute effectively to all the dimensions of the UHC agenda This volume is a tribute to this renewed effort in achieving “Health for All” Eric de Roodenbeke Executive Director International Hospital Federation Geneva b2932_FM.indd 2/27/2018 6:46:40 PM 9”x6” b2932 A Comparative Review of Landmark Legislative Health Reforms in the OECD PREFACE Financing Health for All What is the most practicable system of charging people for health care … … Thirteen years after the Health-for-All programme [Alma Ata 1978] was launched, the availability of the necessary finance remains a formidable obstacle to future progress in many developing countries The hope that governments would increase spending on health care to 5% of the national income is in most cases unlikely to realize Nor is there evidence that donors are willing to increase their aid to developing countries or to divert more of it to the health sector Ministries of health are being left to find their own solution Is the way forward to be found in user charges, community financing, private insurance, or some system of formal compulsory insurance? How does one decide which are the more promising options for a particular country? What has been learned from the experience of countries which have tried to go down particular roads? Brian Able-Smith (1991) “Financing Health-for-All” World Health Forum, Vol 12 The public sector of all western developed countries has become increasingly involved in financing health care during the past century Today, 13 OECD countries have passed landmark legislative reforms that call for compulsory prepayment and universal entitlement to comprehensive services, while most of the others achieve similar coverage through a mixture of public and private voluntary arrangements This study carried out a ix b2932_FM.indd 2/27/2018 6:46:40 PM ... in the health sector worldwide Vol Financing Universal Access to Healthcare: A Comparative Review of Landmark Legislative Health Reforms in the OECD by Alexander S Preker Forthcoming Financing. .. 11:12:02 AM World Scientific Series in Health Investment and Financing – Vol Financing Universal Access to Healthcare A Comparative Review of Landmark Legislative Health Reforms in the OECD Alexander... Financing Universal Access to Healthcare: A Comparative Review of Incremental Health Insurance Reforms in the OECD Alexander S Preker Financing Micro Health Insurance: Theory, Methods and Evidence David