National health systems and policies


We studied health systems and policies in order to assess pro-market reforms, and their alternative options.


 

Find here two summaries of our policy research conclusions

 

Unger, JP., Morales, I. & De Paepe, P. Objectives, methods, and results in critical health systems and policy research: evaluating the healthcare market. BMC Health Serv Res 20, 1072 (2020). https://doi.org/10.1186/s12913-020-05889-w


https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05889-w

 

International Health and Aid Policies. Editors: J.-P.Unger, P.De Paepe, K.Sen, W.Soors. Cambridge University Press, 2010 (275 pages). http://www.cambridge.org/us/catalogue/catalogue.asp?isbn=9780521174268


https://www.cambridge.org/core/books/international-health-and-aid-policies/3563875B2D979D6AE81E20C7BA55A504

 

A review of the same book: Journal of American Medical Association (JAMA) by David Chinitz, PhD. JAMA. 2012; 308(8): 819-820


https://jamanetwork.com/journals/jama/article-abstract/1352088


National health policies and access to / quality of health care

 

In High Income Countries, we compared the performance of countries with mandatory private health insurance schemes to the other OECD countries

 

Unger, J.-P., & De Paepe, P. (2019). Commercial Health Care Financing: The Cause of U.S., Dutch, and Swiss Health Systems Inefficiency? International Journal of Health Services, 49(3), 431–456. https://doi.org/10.1177/0020731419847113


https://journals.sagepub.com/doi/10.1177/0020731419847113

 

In Latin America, we compared the operations and productivity of health systems that diverged in terms of marketization

 

Colombia, a good student by international standards, had a tragic health record

 

De Groote T., De Paepe P., Unger J.-P. Colombia: in vivo test of health sector privatization in the developing world. International Journal of Health Services 2005;35(1): 125–141.


https://www.researchgate.net/publication/7973989_Colombia_In_vivo_Test_of_Health_Sector_Privatization_in_the_Developing_World

 

Ingrid Vargas; Amparo Susana Mogollon-Perez; Pierre De Paepe; Maria Rejane Ferreira da Silva; Jean-Pierre Unger; Maria-Luisa Vazquez. Barriers to healthcare coordination in market-based and decentralized public health systems: a qualitative study in healthcare networks of Colombia and Brazil. Health Policy and Planning 2016; doi: 10.1093/heapol/czv126


https://pubmed.ncbi.nlm.nih.gov/26874327/

 

Ingrid Vargas, Irene Garcia-Subirats, Amparo Susana Mogollón-Pérez, Pierre De Paepe, Maria Rejane Ferreira da Silva, Jean-Pierre Unger, M.B. Aller, María Luisa Vázquez; Patient perceptions of continuity of health care and associated factors. Cross-sectional study in municipalities of central Colombia and north-eastern Brazil. Health Policy Plan 2017; 32 (4): 549-562. doi: 10.1093/heapol/czw168


https://academic.oup.com/heapol/article/32/4/549/2926034

 

Garcia-Subirats I, Ingrid I Vargas, Amparo Susana A.S. Mogollón, Pierre J De Paepe, Rejane R Ferreira da Silva, Pierre P Unger, Carme C Borrell and María Luisa ML Vázquez. Inequities in access to health care in different health systems. A study in municipalities of central Colombia and north-eastern. Brazil International Journal of Equity in Health. International Journal for Equity in Health 2014;13(10):1-15.


https://link.springer.com/article/10.1186/1475-9276-13-10

 

Garcia-Subirats I, Ingrid Vargas, Amparo Susana Mogollón, Pierre De Paepe, Maria Rejane Ferreira da Silva, Jean Pierre Unger, María Luisa Vázquez. Barriers in access to healthcare in countries with different health systems. A cross-sectional study in municipalities of central Colombia and north-eastern Brazil. Social Science & Medicine 2014; 106C:204-13.


https://www.sciencedirect.com/science/article/pii/S0277953614000951

 

Vargas I, JP Unger, A Mogollon, ML Vazquez. Effects of managed care mechanisms on access to healthcare: results from a qualitative study in Colombia. Int J Health Plan Manag 2013;28(1):e13-e33


https://pubmed.ncbi.nlm.nih.gov/22865727/

 

The public services of Chile covered 84% of the population with half of the country’s expenditure on health. With this half, Chile managed to make the country a positive outlier on most health indicators related to health care. Efficiency of public services but no social justice….

 

Unger J.-P., De Paepe P., Arteaga Herrera O., Solimano Cantuarias G. Chile’s Neoliberal Health Reform: An Assessment and a Critique. PLoS Medicine 2008; 5(4) e79: 0001-0006.


https://journals.plos.org/plosmedicine/article/authors?id=10.1371/journal.pmed.0050079

 

Finally, in 2002, the US and Costa Rica, with its heterodox policy, had similar demographic and epidemiologic characteristics … while Costa Rica was spending 9 times less per capita than the US on health (the challenge of our research was to establish the probable, causal relationship between health systems performance and the health services characteristics).

 

Unger J.-P., De Paepe P., Buitrón R., Soors W. Costa Rica: Achievements of a heterodox health policy. American Journal of Public Health 2008; 98(4): 636-643.


https://ajph.aphapublications.org/doi/10.2105/AJPH.2006.099598

 

Not only hasn’t the WHO promoted the Costa Rican model instead of the US one, but UN agencies, and in particular the World Bank undermined its performance while promoting managed care techniques in Costa Rican public services. 

 

W.Soors, P.De Paepe, JP Unger. Management commitments and primary care: another lesson fro Costa Rica for the World? International Journal of Health Services, Volume 44, Number 2, Pages 337–353, 2014


https://journals.sagepub.com/doi/10.2190/HS.44.2.j


National health policies: regulation and control

 

Regulation and control have a special function in the discourse of policies that privatize health care services. The Rockefeller Foundation, for instance, says that regulation and control can tame inequity admittedly attached to care commoditization. The Foundation even  admits that without regulation and control, privatization of services cannot produce equity in access to care (G.Lagomarsino, S Nachuk, S Singh Kundra. Public stewardship of private providers in mixed health systems. Synthesis from the Rockefeller Foundation. Results for Development Institute. . Washington DC, 2009).


https://www.r4d.org/wp-content/uploads/Public-Stewardship-of-Private-Providers-in-Mixed-Health-Systems.pdf

 

There are theoretical and empirical reasons to believe that although needed, regulation and control can only achieve quite limited results in improving access to and quality of care when it is commoditized.  

 

Shuftan C, JP Unger. The Rockefeller Foundation’s “Public Stewardship of Private Providers in Mixed Health Systems”: A Point-by-Point Critique: Social Medicine, Vol 6, No 2 (2011): 128-136


https://www.socialmedicine.info/index.php/socialmedicine/article/view/594

 

Besides, we showed on empirical observations in China, India and Vietnam how and why (maternal) care regulation and control are destined to be ineffective in LMICs – e.g. because of weak governance, medical secrecy and conflicts of interest related to physicians’ dual employment.

 

Jean-Pierre Unger, Patrick Van Dessel, Casper van der Veer, Sarah Shelmerdine (2012) Maternal health regulations in Vietnam, India and China. A comparison across case studies and countries. Deliverable 5.1. HESVIC project ‘Health system stewardship and regulation in Vietnam, India and China’. Institute of Tropical Medicine, Antwerp. A project financed by the European Commission. 154 pages,


http://medhealth.leeds.ac.uk/info/691/research/338/hesvic


Conclusions regarding the design of international health policy

 

We concluded that while the international policy substituted public health programs to individual care delivery in LMICs public services, it drastically restricted access to care, provoking thereby suffering, avoidable mortality, political instability and international migrations (that Europeans and Americans seem to fear so much). 


Notice: other aspects of international health policies, in particular regarding disease control programmes, are discussed in the 'Development Cooperation' section.