Transcript Presentation - People`s Health Movement

Universal Coverage and
Equity in Integrated Health
Systems
David McCoy
People’s Health Assembly, Cape Town
Public Finance
Public Budgets Public Provision
The National Health Service (NHS)
Private Finance
Private
Insurance
Private provision
Public Finance
Private
Management
of Public
Budgets
Public Provision
The National Health Market
Co-payments
Private Finance
Private
Insurance
Private provision
How and why did this happen?

Finance capital - looking for new markets and profits

A government that lied, bribed and threatened

Politicians (and doctors) with conflicts of interest

Neoliberal occupation of mainstream political parties

Neoliberal and managerialist occupation of the Department
of Health

A servile and captive mainstream media

The lack of a social movement and consciousness to defend
the public sector; demand accountability

Fear
So the point is ....

We know what works; what ingredients are required

We have enough evidence

The goal of universal and equitable health systems
is a political struggle

We need to be clear about what we are up against
Factors undermining the PHC Approach
Political
Economy
Government and
bureaucratic
failure
Selective health
care
Health sector
reform
Economic
Inequality
Impoverished
households
Biomedicalisation
{
Impoverishment of
public sector health
care systems
Commercialisation
and segmentation
Fragmentation,
verticalisation and
disintegration of
health care systems
User fees
Inequity
Inadequate
domestic public
revenue
Donor and
international
programmes
Inefficiency
Lack of
community and
public
accountability
Four thoughts

Making the case: Health systems are social and
political institutions

Language and concepts: Public – Private Dichotomy

Public monitoring of health systems

Tax and Financing
1. Health systems are social and political
institutions
Not just a machine for the delivery of clinical services and
public health programmes .......

They shape patterns of social and economic inequality

They shape the experience of poverty and exclusion

They can define the experience of being powerless and poor

Inequity in access to health care is one of the most potent expressions
of social injustice

Medical impoverishment and medical insecurity
1. Health systems are social and political
institutions
A vehicle /platform for community empowerment and participatory
democracy

Active participants, not passive recipients of selective health care

Citizens, not consumers
Shape the experience of fundamental life events of birth and death
A space in society which is not governed by the dictates of the market,
commercialisation and the pursuit of wealth and profit

where social solidarity is prioritised
2. Language and concepts: Public-Private
Dichotomy

Commercialisation

Public-Public Partnerships

Communitisation
3. Public monitoring of health systems
Financing

Level of tax revenue to be at least 20% of GDP

Public sector health expenditure (government and donor finance) to be at least 5%
of GDP

Public sector health expenditure (government and donor finance) to be at least 75%
of Total Health Expenditure

Government expenditure on health to be at least 15% of total government
expenditure

Direct out-of-pocket payments less than 20% of total health care expenditure

Expenditure on district health services (up to and including Level 1 hospital services)
to be at least 50% of total public health expenditure, of which half on primary level
health care

Ratio of total expenditure on district health services in the highest spending district
to lowest spending district < 1.5
3. Public monitoring of health systems

Inequities in access and consumption

Denial of care

Incomes


Excessive profiteering
Conflicts of interest
4. Tax

Make it a key public health issue of the next ten years

for effective health systems

But linked to other struggles for health, development
and equity
Thankyou