Archive for April, 2010

IRON LAWS ABOUT PARTICIPATION IN THE CONTEXT OF HUMAN RIGHTS WORK.

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Food for a thought elites will have to abide by

 Human Rights Reader 238

 – If the people will lead, the leaders will follow. (M.  Gandhi)

– Changes in human rights are hardly ever achieved in a simple straightforward way –they bring about interior power struggles and resistance which need to be dealt with people’s counter-power. (F. Holtmeier) It is thus people’s counter-power that has to create demand for change.   

– In human rights work, participation is not about pointing our fingers, but about raising our hands to be counted. (S. Koenig)

I have gathered many statements about participation and empowerment (by far not all my own) that I think qualify for the status of ‘iron laws’ in our human rights (HR) work. Here they are:

1. Participation is not just a consultation process; we understand it as an empowerment process. (Reminiscent of the principle of magnetic resonance, empowering participation seeks ‘social resonance’).

2. People need outlets to voice their complaints about the injustices and HR violations they are subjected to.*

*: For instance, community-based health committees attached to health facilities should be able to hold doctors and health staff accountable and, if necessary, request they be replaced.  (P. de Vos)

3. In HR work, we must guarantee that the voice of those whose HR are being violated is heeded. But it is not only having voice: It is getting to the position of having influence.

4. The challenge of actually ‘taking part’, is thus ultimately the challenge ‘to be counted’. Ergo, making decisions is what makes people’s participation effective; only then can their informed participation be used to counter- power.

5. Civil society definitely has the capacity of making the arrangements for participation to become empowering. The power gained is to make a measurable difference in public service provision as service providers are to be made accountable at multiple local levels. (G. Kendra)

6. Since laws and policies are mostly instruments for the arbitrary discharge of office holders’ power to make solo decisions (rather than a means to help hold these officials accountable), the prevalent local notions of the HR-fairness-of-laws-and-policies can only be changed by engaging the active participation of local communities. It is them who have to proactively demand laws, policies and regulations be changed, be scrapped or be put in place to make sure they are fair in a HR sense. (In this process, using the pertinent UN Covenants and General Comments should be the basis).**

**: In defusing HR violations , new/amended laws will, most probably, be necessary to define new duties and obligations of institutions and of actors. As HR workers, the problem we face is the current lack of a moral-political framework for solving social justice- and HR-related problems. (H.P. Ruger); the introduction and widespread dissemination of such a framework will have to antecede actual legal work –hence the importance of HR learning.

7. The difference between participation and empowering participation is the latter’s explicit orientation towards social and political change.***

***: We note that, for instance, the World Bank-hijacked concept of empowerment does not consider increasing the capacity of individuals to make their own choices in relation to the actions and outcomes they long for.

8. The HR-based approach (HRBA) actually evolved from the concept of empowerment. It adds to the concept of empowerment the attributes of being entitled to the universal-right-to-seek-accountability through varied mechanisms and of having equal-rights-to-claim, to-demand-and-to-seek-redress. (P. de Vos) 

9. The type of empowering participation the HR framework fosters starts with claim holders understanding how final decisions are made (who? when? using what criteria?)

10. In empowering participation, calls for fairness that do not, early on, name who-is (i.e., the pertinent duty bearers) and what-the-forces-are behind the perpetuation of inequities and HR violations, are not really empowering. (A-E. Birn)

11. Achieving an empowering participation in the HR sense is ultimately going to be a block-by-block, household-by-household seven-days-a-week job.

12. Empowering participation processes are not cost-free; they need sustained funding. Moreover, keep in mind that empowerment processes are not linear; they evolve in quantum leaps.

13. When fostering empowering participation in HR work, we will face both contingent and organizational barriers that will attempt to prevent us from introducing the HR framework as the basis of our work.****

****: In the health professions, the biomedical training students get fosters hierarchical attitudes that act as further barriers to participatory approaches. (L. Morgan)

14. To tackle the organizational barriers, we have to start by identifying what impacts and worries people so as to link and translate those worries to concrete violations as related to the precise wording of UN HR covenants’ clauses.

15. Also early-on in empowering participation, it is necessary to talk about the ‘HR debt’ of governments and about the need for a change of paradigm that introducing the HR framework is all about. (M. Ovalle) 

16. Thereafter, still using the HR framework, the sequence of activities to follow will be: to inform, to educate, to empower, to set an agenda and to mobilize.

17. Genuine people’s empowering participation is that in which the most disadvantaged social classes and groups –those underrepresented in society– are duly represented in leadership; only this ensures the active engagement of marginalized and discriminated groups in gathering and achieving the needed  counter-power. (Caveat: This representation does not automatically decrease the risks of paternalism, patriarchy and bureaucratic overpowering).

18. As regards adapting women’s participation to make it empowering, you will have to read between the lines…since there rarely are more than a couple lines in conventional development plans when it comes to women’s issues. (I. Allende)

19. Participatory-Budget-Analysis, Participatory-Village-level-Social-Auditing and Citizens-Report-Cards are relatively new working tools with immense potential in HR work.

20. Monitoring is also an activity to be made participative; it entails embarking, jointly with beneficiaries, on monitoring the overall direction in which development interventions are being steered, their performance, the processes being applied and, last but not least, the outcomes.

21. Bottom line, empowering participation fosters enough collective strength to influence power relations. Ultimately, the process seeks to challenge the powers-that-be responsible for the status-quo of which HR violations are  part and parcel.

22. Genuine people’s participatory processes also beg for solidarity. Solidarity work is a) to be seen as a further political and HR task that supports the development of a strong democratic citizenry, and b) to be used to support, replicate and multiply citizens organizations and to mobilize them around HR principles so that a wide HR movement can be consolidated.

23. HR work thus capitalizes on the ethical sense of solidarity as it promotes a new image of a fair and just society by opening the doors to a new reflection about the transformative power of the application of the HR framework.  And finally,

24. Since there are a host of new possibilities for political participation and solidarity, internet communications have become an important political factor in HR work –a factor to reckon with and to take advantage-of.

Claudio Schuftan, Ho Chi Minh City

cschuftan@phmovement.org   

______

Partly taken and adapted from D+C 36:2, Feb 2009; D+C, 36:5, May 2009; H. Potts, Participation and the Right to the highest attainable standard of health, HR Centre, University of Essex, 2008; Campania 2007 por el derecho a la salud en Uruguay, diciembre 2008; and L. Weinstein, Ed. Multiversidad, Editorial Universidad Bolivariana, Coleccion Nuevos Paradigmas, Santiago, Chile, Mayo 2009.

For-profit insurers put profits over health, in more than one way

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(From PNHP.org)

For profit insurers put profits over health in more than one way, and now that the Patient Protection and Affordable Care Act has made all but a few American residents their captive audience they are in for a blast.

Just weeks after the passage of the Act, that will dramatically increase the number of Americans covered by private health insurers, Harvard researchers detailed the extent to which life and health insurance companies are major investors in the fast-food industry.

Although fast food can be consumed responsibly, research has shown that fast-food consumption is linked to obesity and cardiovascular disease, two leading causes of death, and contributes to the poor health of children. The evidence is so compelling that as part of the new law more than 200,000 fast-food and other chain restaurants will be required to include calorie counts on their menus, including their drive-through menus.

A new article on insurance company holdings, published online in the April 15 issue of the American Journal of Public Health, shows that U.S., Canadian and European-based insurance firms hold at least $1.88 billion of investments in fast-food companies.

“These data raise questions about the opening of vast new markets for private insurers at public expense, as is poised to happen throughout the United States as a result of the recent health care overhaul,” says lead author Dr. Arun Mohan.

Among the largest owners of fast-food stock are U.S.-based Prudential Financial, Northwestern Mutual and Massachusetts Mutual Life Insurance Company, and European-based ING.

U.S.-based Northwestern Mutual and Massachusetts Mutual Life Insurance Company both offer life insurance as well as disability and long-term care insurance. Northwestern Mutual owns $422.2 million of fast-food stock, with $318.1 million of McDonald’s. Mass Mutual owns $366.5 million of fast-food stock, including $267.2 in McDonald’s.

Holland-based ING, an investment firm that also offers life and disability insurance, has total fast-food holdings of $406.1 million, including $12.3 million in Jack in the Box, $311 million in McDonald’s, and $82.1 million in Yum! Brands (owner of Pizza Hut, KFC and Taco Bell) stock.

New Jersey-based Prudential Financial Inc. sells life insurance and long-term disability coverage. With total fast-food holdings of $355.5 million, Prudential Financial owns $197.2 of stock in McDonald’s and also has significant stakes in Burger King, Jack-in-the-Box, and Yum! Brands.

The researchers also itemize the fast-food holdings of London-based Prudential Plc, U.K.-based Standard Life, U.S.-based New York Life, Scotland-based Guardian Life, Canada-based Manulife and Canada-based Sun Life. (See table; all data current as of June 11, 2009.)

“Our data illustrate the extent to which the insurance industry seeks to turn a profit above all else,” says Dr. Wesley Boyd, senior author of the study. “Safeguarding people’s health and well-being take a back seat to making money.”

Mohan, Boyd and their co-authors, Drs. Danny McCormick, Steffie Woolhandler and David Himmelstein, all at the Cambridge Health Alliance and Harvard Medical School, culled their data from Icarus, a proprietary database of industrial, banking and insurance companies. Icarus draws upon Securities and Exchange Commission filings and news reports from providers like Dow Jones and Reuters. In addition, the authors obtained market capitalization data from Yahoo! Finance.

The authors write, “The health bill just enacted in the Washington will likely expand the reach of the insurance industry. Canada and Britain are also considering further privatization of health insurance. Our article highlights the tension between profit maximization and the public good these countries face in expanding the role of private health insurers. If insurers are to play a greater part in the health care delivery system they ought to be held to a higher standard of corporate responsibility.”

Several of these same researchers, all of whom are affiliated with Physicians for a National Health Program, have previously published data about the extent to which the insurance industry is invested in tobacco. They say that because private, for-profit insurers have repeatedly put their own financial gain over the public’s health, readers in the United States, Canada and Europe should be wary about insurance firms’ participation in care.

U.S. health system causes headaches in more than one way, and the "Patient Protection and Affordable Care Act" will do little to change this

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(From PNHP.org)

Migraines, often characterized by excruciating headache and nausea, are much worse for the uninsured, a new Harvard Medical School study shows.

Researchers say migraine sufferers who lack private health insurance get poor care for their condition. They are about twice as likely to get inadequate treatment for their headaches as their privately insured counterparts. People with Medicaid also get substandard care.

Because migraine is common in the United States, affecting about 18 percent of women and 6 percent of men, and because so many Americans lack health insurance, a startling 5.5 million people are at risk of getting substandard care for their often painful and disabling headaches, the researchers say.

The study, titled “The impact of insurance status on migraine care in the United States: a population based study,” was published on Tuesday, April 13 in Neurology, the world’s leading clinical neurology journal.

Study senior author Dr. Rachel Nardin, assistant professor of neurology at Harvard and chief of neurology at the Cambridge Health Alliance in Massachusetts, said: “The tragedy is that we know how to treat this disabling condition. But because they are uninsured or inadequately insured, millions of Americans suffer needlessly.

“Unfortunately,” she said, “the new health law doesn’t fully address this problem. At least 23 million people will remain uninsured nine years out.

“Optimizing migraine care requires improvement in our health care systems as well as educating physicians to prescribe the best available drug and behavioral treatments.”

The researchers analyzed data from two federal surveys, the National Hospital Ambulatory Medical Care Survey and the National Ambulatory Medical Care Survey, which together provide a nationally representative sample of all U.S. visits to doctors’ offices, hospital clinics and emergency rooms. They analyzed the 6,814 visits for migraine between 1997 and 2007, representing 68.6 million visits nationwide.

Neurologists recommend two types of drugs when a moderate-to-severe migraine strikes: “triptans” (such as sumatriptan) or dihydroergotamine (DHE). For the majority of migraine sufferers whose headaches are frequent or severe, neurologists also recommend a daily dose of one of several preventive medications.

The researchers used these recommendations from the American Academy of Neurology to define standard migraine treatment and found that the uninsured were nearly twice as likely as the privately insured to receive substandard treatment.

Medicaid enrollees were 50 percent more likely to receive substandard treatment, suggesting that “access to some forms of insurance is not the same as access to adequate care,” the researchers wrote.

Care in doctors’ offices was substantially better than in emergency departments. The fact that the uninsured are less likely to get care in doctors’ offices explained some, though not all, of their substandard care.

Most people with migraine are impaired by their headaches and the accompanying nausea, and lose an average of four to six days of work annually.

Dr. Steffie Woolhandler, professor of medicine at Harvard and study co-author, said: “Lack of insurance clearly takes a heavy toll on our patients and the economy. Regrettably, the health bill just signed into law will leave tens of millions of Americans uninsured or poorly insured and thus unable to get the care they need.”

What Frontline missed, and health care justice advocates should know

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Oh yeah! The progressive, single payer community did look forward to the screening of the Public Broadcasting Service (PBS) Frontline production “Obama’s deal”, frustrated as we were by our voice having been buried in a misleading, media-backed “debate” that portrayed all opponents of the “Patient Protection and Affordable Care Act” as right-wing lunatics “against reform” – yes, the usual trick “you’re with us or with the terrorists”.

And to their credit, Frontline did a terrific job of documenting the countless back-room deals struck by the White House and Congress with Big Pharma and Big Insurance. As the production illustrated, these deals chipped away whatever progressive features the Act may have initially had, and turned it into a weapon of mass destruction of the pockets of ordinary folks who already barely make ends meet, and into an extraordinary sweet deal that will substantially increase the political and economic power of for-profit insurers for years to come. Unsurprisingly of course, given that the Act was almost literally dictated by WellPoint Inc., as the Frontline production pointed out.

Disappointingly, however, Frontline did not live up to its promise. While it did reveal some of the “realities of American politics, the power of special interest groups and the role of money in policy making”, it omitted showing viewers just what “Obama’s deal” had sacrificed, and what single payer advocates were being dragged to jail for, as they entered the meetings of the Senate Finance Committee chaired by health care czar Max Baucus. Rather, it merely portrayed them as yet another disaffected group within “President Obama’s liberal base”, which had to be appeased so that our president could move on with the serious stuff — “reforming” healthcare.

But it is precisely what the deal sacrificed that matters. Because single payer advocates, including many doctors such as Margaret Flowers, risked arrest, and were arrested, for standing up for a right to health care, through a publicly-financed and publicly delivered single payer system, that was being sacrificed at the altar of special interests, even as President Obama asserted, with a straight face, that “all options (for health care reform) are on the table”.

Now, could the reason for sacrificing a right to health care be that our charismatic president received at least ten times the money that his designated health care czar, Max Baucus, received from the very industries they were supposed to rein in? We don’t know, but the hypothesis is not implausible, and Frontline producers would have done their viewers a service had they explored this or any other plausible and alternative to the mainstream hypothesis further. In so doing they would have spoken truth to power, the least we can expect from progressive mass media.

Americans have by now gotten used to having the best Congress (and Presidency) “that money can buy”. Let us not be forced to put the progressive media into an equivalent category — “it’s the best media money can buy”.

Rebuilding the US Health Left

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The most recent edition of Social Medicine, our on-line academic journal has just been published.  We will post a short description of the articles later this week, but wanted to share the lead editorial entitled: Rebuilding the US Health Left. We would be most interested in comments from readers of the Portal.

Rebuilding the US Health Left

Matthew R. Anderson, MD, MS, Lanny Smith, MD, MPH, and Victor W.  Sidel, MD

With this issue Social Medicine begins a series of invited papers on the topic: “Rebuilding the US Health Left.”  In this editorial, we will outline our vision for this series.

We undertake this project aware that our good friend and mentor, Dr. Walter Lear, one of the leading health activists of the 20th century, lies critically ill.  Walter was the creator and custodian of the US Health Left Archives, a collection that is now with the University of Pennsylvania library.  The collection reminds us of the important role Left health care workers played in US history throughout the 20th century. They advocated for a national health program (Committee on the Costs of Medical Care, Physicians Forum,  Medical Care Section/APHA, HealthPAC, Physicians for a National Health Program, National Physicians Alliance), provided international solidarity (American Soviet Medical Society, international brigades during the Spanish Civil War, Central American Solidarity Movement, Committee to Help Chilean Health Workers, Doctors for Global Health), traced the connections between disease and social class (Sigerist Circle, Spirit of 1848 Caucus/APHA), fought for workers’ health (Councils for Occupational Safety and Health; Occupational Health and Safety Section/APHA) participated in anti-war movements (Medical Committee for Human Rights, Physicians for Social Responsibility, International Physicians for the Prevention of Nuclear War, Peace Caucus/APHA), created new models of health care delivery (Health Cooperatives, Prepaid Health Maintenance Organizations, Community Health Centers, National Health Service Corps, Free Clinics), were central to the struggle for women’s rights (Planned Parenthood, Physicians for Repro-ductive Choice and Health), supported the civil rights movement both in medicine and in the broader society (National Medical Association, Medical Committee for Human Rights), played key roles in the movement for gay rights (ACT-UP, Gay & Lesbian Medical Association, Lesbian, Gay, Bisexual, and Transgender Caucus/APHA), challenged traditional models of medical education (Student Health Organizations, AMSA, Residency Program in Social Medicine), and worked in many, many other fields.

It is not by chance that “leftie” physicians were specifically targeted during the McCarthy era. Tragically, the repression of progressive ideas within the medical community had a chilling impact during the 1950’s when many progressive physicians were blacklisted and some saw their careers ruined. Organized medicine – through the AMA – made its peace with the nascent medical-industrial complex, becoming ever more conservative and eschewing the social values that had informed much of the medical community in the earlier parts of the century.  By 1961, the AMA’s Women’s Auxiliary (composed of doctor’s wives) participated in “Operation Coffeecup” during which they met to listen to Ronald Reagan discuss “the evils of socialized medicine”; their goal was to defeat an early version of Medicare.

— to read the rest, please click here.  And please leave us your comments.

posted by Matt Anderson

SOME REACTIONS TO WHAT WE HEAR (AND DO NOT HEAR) IN MANY A PUBLIC HEALTH CONFERENCE THESE DAYS.

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Human Rights Reader 237

SOME REACTIONS TO WHAT WE HEAR (AND DO NOT HEAR) IN MANY A PUBLIC HEALTH CONFERENCE THESE DAYS.                

1. Am I tired of going to such conferences? Sort of.

2. It is just that, in them, we hear about so many things that need doing and have so long been overdue (…achieving the health MDGs, strengthening health delivery systems, organizing and empowering beneficiaries to demand changes ….and on-and-on…). One gets the impression that it is in times of crisis that we finally will bring to the fore what really needs doing and has long been overdue… But not even in such circumstance does the needed happen in our meetings of the learned; almost nothing substantial, beyond a passing comment, is heard about taking actions to address the ‘condition of poverty’, about disparity reduction, about addressing the widespread and numerous violations of the human right to health and to nutrition; nothing substantial and really deep-felt is heard about empowering claim holders –or worse: the concept of empowerment is repeatedly hijacked by making it mean giving women greater self-esteem, providing them with health education and nutritional knowledge and skills and/or ‘empowering’ them to better take care of their children.

3. Empowering claim holders a) to exert growing social counter-power to the power that keeps them in poverty; b) to fight the often flagrant health and nutrition rights violations they are subjected to; and c) to fight for greater equity and access to the services they need, all still seems to be a taboo topic at the conferences I attend. A shame.

4. One gets the feeling that, after so many years of struggle to combat preventable ill-health and preventable malnutrition, we are, over and again, back to square one. Presenters in time-scarce crammed parallel sessions* do not seem to be aware at all of (or decide to overlook) the fact that there has been significant criticism of, for instance, World Bank-funded projects and the recommendations they make to ministries of health –a criticism rooted in objecting to the fact that these ignore the social, economic, political and human rights dimension and determinants of the problems at hand  –beyond a window-dressing/passing-by mention.**

*: In these sessions, questions and discussions are quelled when the chairperson says: “Sorry we have run out of time” and all of us in the audience are left boiling when some of what was said from the podium is sheer nonsense –as many others attending feel these are the take-home-messages from the gurus up there.

**: Also lately ignored are the objections many of us have voiced over and over about the ‘ten top solutions’ proposed by the Copenhagen Consensus of Eminent Economists.

5. In these conferences, we are further repeatedly asked to believe the dogma that pointedly investing-in and improving health and nutrition per-se improves equity. Well, by themselves, they do not!  Rebalancing the power equation does!… In the spirit of the interrelated and interdependent right to health and to nutrition, that calls for mobilizing claim holders to actively demand changes, and making duty bearers accountable.  [The prescriptions we hear in the conference rooms (maybe not in the corridors –the better part of these conferences) do not heed this call; the presentations we hear in the closing session, not as a surprise, only pay lip service to the processes really needed for the realization of these inalienable human rights.

6. We do not need more ‘pro-poor interventions’ that target and victimize poor people’s groups. We may target poor geographical areas, but at the same time –and never missing– we need to proactively move to sustainably reduce disparities beyond mere poverty alleviation; only that will take care of the violations we see in both health and nutrition (and will actually make mainly technical interventions ultimately irrelevant once and for all).

7. I am personally tired of our colleagues alluding to ‘the need for structural changes’ with impunity, i.e., without really meaning (or understanding) what they say.

8. The ‘window of opportunity’ for disparity reduction has been open for 3,000 years…  And what do we get at these meetings?  More of the same, i.e., ultimately not taking advantage of the window of opportunity…

9. What we get is not necessarily unimportant, but it is INSUFFICIENT.  Is now the time to act? Yes! But with more than what we usually hear at these gatherings of, so often, scientists that sadly seem to still not having climbed down from their ivory towers.

10. Only some lonely and committed souls mention the need of using the human right framework as a basis for action, as the basis for plans to tackle the major right to health and to nutrition violations –as the People’s Health Movement is doing (www.phmovement.org). The message of applying the human rights-based approach as an avenue to empower claim holders, to work with duty bearers to help them comply with their human rights obligations is hardly ever heard.

11. The power to act is different from the ability to act; thinking we can achieve quicker results, we have often given the role to individuals and institutions with the ability to (and not the ones with the power to) act. This has led to the status-quo so many of us refuse to live with.

12. Am I too harsh in my analysis? I do not think so;  I just call a spade a spade. We have to stop the infamous practice of speaking about these things in whispers.

Claudio Schuftan, Ho Chi Minh City

cschuftan@phmovement.org

[ I have here unfairly omitted denouncing the exhibitions that accompany many of these conferences where the big pharma houses and the food industry are scandalously offered a booth to advertise their wares in order for the conference organizers to get some shameful funding –which these companies use to whitewash their consciousness anyway].

China Commits to Publicly Financed Health Care

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As the U.S just passed its “healthcare overhaul” – an individual mandate to purchase a private policy with lots of promises that the government will reign on the industry’s most egregious practices — China, with a population of 1.3 billion, is advancing a plan to provide universal access to all of its residents.  In January China announced that the government would spend $125 billion to jumpstart a new program that will provide comprehensive health services to 90% of the population by 2011, and to 100% by 2020.

China provides health care by dividing its residents into three pools: The Ministry of Labor and Social Security covering the urban health sector, The Ministry of Health covering the rural residents, and The Ministry of Civic Affairs covering the poor urban and rural populations. All three programs have in common that they are government-financed, social welfare programs that put both healthy and sick residents into shared pools of health risk.

In the mid 1980s, China had enacted a health reform that went the “market way”, and intended to increase the supply of medical treatment by allowing hospitals to profit from medical care. So far, and much like the US health care system, this has not allowed all residents, or even most residents, to access health care, due to increasingly high costs. In China, rural residents, many unemployed, and the elderly suffered from this lack of access.

As the 1990s progressed, the failure of a for profit model of health insurance led the Chinese to rethink health care reform.  Lack of access due to high cost is only a failure if the goal is to eliminate financial barriers to care, which for the Chinese it was, rather than to yield the greatest profit possible for health insurers.  What’s important about China’s reform is that the Chinese have taken profit out of the equation, and the centerpiece of their health care plan is public financing and universal enrollment.

Follow the money: How health care will be paid under China’s health care reform

Under this plan, all companies (private enterprises, joint ventures, or self employed) must pay 10% of their total payroll to the government for health spending.  Half of this goes to a fund accessible by all the ministries described above for social risk pooling, and the other half goes to their employee’s individual health accounts.  In addition, each employee must pay 2% of his or her wages directly to their individual account.

Employed residents, under the Basic Medical Insurance (BMI), would first use the money from their own account to pay for health services.  If the account were exceeded, the resident would pay out of pocket up to 5% of their annual wage, after which expenses would be covered by the social risk pooling fund.  Importantly, these subsidies and financing plans are different dependent on which Ministry you are under.

Because of the poverty and geographical separation of the rural population, the Chinese have developed the New Cooperative Medical Scheme (NCMS), a government run voluntary insurance program that provides an initial subsidy of 120 yuan per farmer, and the farmer is expected to pay up to 10 yuan our of pocket.  The government plans to increase these subsidies with the newly announced tripled public spending towards health.  Rural communities have a certain degree of autonomy in that they can spend their moneys on different types of services or distribute it differently from how the national government does in urban areas.

For children, the unemployed, disabled, or elderly, China has established the Urban Resident Basic Medical Insurance (URBMI), which, like the NCMS scheme above, also supplies each member with 120 yuan per year for medical expenses. Enrollment in the URBMI is at the household level in order to reduce administrative costs and adverse selection – enrolling only those likely to need health care and financially burdening the collective pool.

Lastly, similar to American Medicaid, there is a social risk pool for the poorest Chinese residents, known as Medical Assistance (MA), where all expenses are covered.

However complex these arrangements may seem, developed as they are to meet the diverse needs of a huge population, once again, they share the principle of universal enrollment and social insurance, thus taking profit out of the financing equation.

Controlling costs of health care

In an effort to control costs of health care, the Chinese are implementing caps on prices of essential drugs.  Already 307 drugs are under prices control, and the plan is to include 770 more this year. Prices for common treatments will also be under government control in order to prevent providers from charging different prices for the same treatments, but medical professionals will be largely paid fee-for-services. Further, the plan requires that all revenues raised by public medical facilities be funneled to the state in order to restrict profit and to finance the program.

Chinese economists argue that health care will stimulate domestic spending, critical given the current economic downturn.  Bai Zhongen, Chairman of the Economics Department at Tshinghua University’s School of Economics and Management in Beijing, has said that establishing universal health care with government-financed insurance will increase general consumer spending. Already in 2007, a survey at the School examined the effect of rural health insurance on consumer behavior and “found that in government-sponsored health insurance areas, people are spending more.”  Chairman Bai expanded on this finding saying that the government already gives many people a small subsidy to pay for their health care needs, but that a unified, national health insurance program would strengthen the economy, as people would have more money in their own pockets.

It will be exciting to watch China make this progressive change towards a universal right to health care with a plan built upon public model of financing, and contrast it with the American experiment of a universal obligation to buy a for-profit policy, which the Congressional Budget Office has estimated will leave 23 million people uninsured by 2020.

While the outcomes of the Patient Protection and Affordable Care Act for patients are anybody’s guess, William Hsiaso, a Professor of Economics at the Harvard School of Public Health, has said that China’s plan is likely to work because of its “strong role of government in health, commitment to equity, and willingness to experiment with regulated markets”.

Cuban Medical Students in New York City: April 12-14, 2010

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Yenaivis Fuentes Ascencio

Yenaivis Fuentes Ascencio, 23, a medical student from Guantánamo, Cuba and Aníbal Ramos Socarrás, 30, a surgery resident from Manzanillo,  Cuba are currently on a tour of the US.  We understand that they have been in Atlanta, the Twin Cities and Chicago and will be traveling to Washington before arriving in New York City on Saturday.  They will be visiting and talking in New York on April 12 (at the Schomberg Center) on April 13th (at Rutgers University) and on April 14th (at Hofstra in the morning and Hunter College in the evening) before leaving for the West Coast on Thursday.

It is not often that we have a chance to have a face-to-face discussion with Cubans from the island in the United States.  We understand that US students who have studied at ELAM (the Latin American Medical school) will be speaking at the Schomberg Center event. For more information call: Nellie Bailey 646-812-5188 or Tom Baumann 646-256-0992.  A fairly complete list of their engagements can be found at this link.

Anibal Ramos Socarrás

For more posts about health in Cuba, click on our Cuba category in the blog roll. For information about getting a free medical education in Cuba (yes, free), please consult ifco and see some of our posting about the Latin American School of Medicine and its students.

posted by Matt Anderson, MD

What were you thinking about when you chose to become a doctor?

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I don’t know about you, but  I could not help but asking myself that question when hearing Amy Goodman’s show Democracy Now this morning about compensations of executives in the health insurance industry.

Not that there is anything to be surprised about, given how close these folks are to major policy decisions in US health care. As the Firedoglake website pointed out last year, it is not even a secret that the original Senate Finance Committee bill, a descendant of which was recently signed into law with the ambitious name of Patient Protection and Affordable Care Act, was authored by a former Wellpoint VP, so these guys know what they are doing. And since Congress released the first of its health care bills on October 30 of the past year, health care stocks have risen by almost 30%.

But it gets better (for private insurers, that is…). So take a big sip of that morning coffee, and read on!

WellPoint CEO Receives 51 Percent Salary Increase

It appears that 2009 was a good year for the CEO of the private health insurance company WellPoint. Angela Braly’s compensation package soared by 51 percent last year. She earned $13.1 million, up from $8.7 million in 2008 At least three other WellPoint executives received compensation increases of as much as 75%.

Single payer anyone?

Minamata Disease (methylmercury poisoning) on Public Health & Social Justice Website

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We have recently updated our open-access poweroint presentation on the public health and social justice website covering the history of Minamata Disease (methylmercury poisoning) and illustrated with poignant photography of W Eugene Smith. For decades the Chisso Corporation dumped methylmercury into Minamata Bay Japan, resulting in high levels of mercury in fish caught by bay’s residents, leading to miscarriages, congenital Minamata disease, and adult Minamata Disease. The slide show discusses the toxic effects of mercury on human health, the legal history of events at Minamata, and the conflicts faced by those who worked at Chisso (including many who had affected family members and the company’s chief physician/researcher). The slide show also includes some of W Eugene Smith’s famous photographs from the Country Doctor and Nurse Midwife series, as well as some of his well-known war photographs. The presentation is open-access, and can therefore be used with trainees and health professionals interested in seeing and learning more about the consequences of mercury exposure and the need for strong public health measures to reduce exposures. The presentation can be found on the Environmental Health page of the public health and social justice website at http://phsj.org/?page_id=12.

posted by Martin Donohoe, MD




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