Michael Reich | Harvard School of Public Health (original) (raw)

Papers by Michael Reich

Journal of Pharmaceutical Policy and Practice, 2021

Background The implementation of pharmaceutical services in hospitals contributes to the appropri... more Background The implementation of pharmaceutical services in hospitals contributes to the appropriate use of medicines and patient safety. However, the relationship of implementation with the legal framework and organizational practice has not been studied in depth. The objective of this research is to determine the role of these two factors (the legal framework and organizational practice) in the implementation of pharmaceutical services in public hospitals of the Ministry of Health of Mexico. Methods Semi-structured interviews were conducted with four groups of actors involved. The analysis focused on the legal framework, defined as the rules, laws and regulations, and on organizational practice, defined as the implementation of the legal framework by related individuals, that is, how they put it into practice. Results The main problems identified were the lack of alignment between the rules and the incentives for compliance. Decision-makers identified the lack of managerial capaci...

PLOS Neglected Tropical Diseases, 2020

Approximately 300,000 persons in the United States (US) are infected with Trypanosoma cruzi, the ... more Approximately 300,000 persons in the United States (US) are infected with Trypanosoma cruzi, the protozoan that causes Chagas disease, but less than 1% are estimated to have received antiparasitic treatment. Benznidazole was approved by the US Food and Drug Administration (FDA) for treatment of T. cruzi infection in 2017 and commercialized in May 2018. This paper analyzes factors that affect access to benznidazole following commercialization and suggests directions for future actions to expand access. We applied an access framework to identify barriers, facilitators, and key actors that influence the ability of people with Chagas disease to receive appropriate treatment with benznidazole. Data were collected from the published literature, key informants, and commercial databases. We found that the mean number of persons who obtained benznidazole increased from just under 5 when distributed by the CDC to 13 per month after the commercial launch (from May 2018 to February 2019). Nine key barriers to access were identified: lack of multi-sector coordination, failure of health care providers to use a specific order form, lack of an emergency delivery system, high medical costs for uninsured patients, narrow indications for use of benznidazole, lack of treatment guidelines, limited number of qualified treaters, difficulties for patients to make medical appointments, and inadequate evaluation by providers to determine eligibility for treatment. Our analysis shows that access to benznidazole is still limited after FDA approval. We suggest six areas for strategic action for the pharmaceutical company that markets benznidazole and its allied private foundation to expand access to benznidazole in the US. In addition, we recommend expanding the existing researcher-clinician network by including government agencies, companies and others. This paper's approach could be applied to access programs for benznidazole in other countries or for other health products that target neglected populations throughout the world.

Health Systems & Reform, 2019

Health Systems & Reform, 2016

Esta obra es un producto del personal del Banco Mundial con contribuciones externas. Los resultad... more Esta obra es un producto del personal del Banco Mundial con contribuciones externas. Los resultados, las interpretaciones y las conclusiones expresadas en este documento no reflejan necesariamente el punto de vista del Banco Mundial, su Directorio Ejecutivo o los gobiernos que representa. El Banco Mundial no garantiza la exactitud de los datos incluidos en este documento. Los límites, los colores, las denominaciones y toda información presentada en cualquier mapa este documento no implican opinión alguna por parte del Banco Mundial relativa a la condición jurídica de cualquier territorio, o el respaldo o la aceptación de tales límites. Nada de lo indicado en el presente constituirá o se considerará una limitación o renuncia a los privilegios e inmunidades del Banco Mundial, todos los cuales se reservan específicamente. Derechos y permisos Esta obra está disponible con la licencia de Creative Commons Attribution 3.0 IGO (CC BY 3.0 IGO) http://creativecommons.org/licenses/by/3.0/igo/deed.es_ES. La licencia de Creative Commons Attribution permite copiar, distribuir, transmitir y adaptar esta obra, incluso para fines comerciales, bajo las siguientes condiciones:

Scaling Up Affordable Health Insurance, 2013

ver the last twenty years a growing number of developing countries have sought to transform their... more ver the last twenty years a growing number of developing countries have sought to transform their health fi nancing mechanisms-with the goal of achieving universal coverage, often through national health insurance. Yet successful reform is the exception rather than the rule. If scaling up health insurance coverage is popular, can greatly improve access to care, and can potentially reduce costs through risk pooling, why is it so hard to adopt and implement? INTRODUCTION: WHY POLITICAL ECONOMY? Reforms are diffi cult because they involve a series of complex political exchanges, any one of which can stop the process short of its goals. To overcome these challenges, different political skills are required at different stages of the reform process. In short, the reform of health fi nancing is diffi cult because of the political economy challenges embedded in each step of the policy reform process. Politics affects whether reform makes its way onto the national agenda, how the reform proposal is designed, the compromises needed to produce an acceptable agreement, and ultimately the implementation of reform (Reich 2002). Health fi nancing reform is often treated as a technical matter-designing the right policy to produce the intended effect. However, what is viewed as technically optimal is seldom politically feasible. Interventions often do not work in the intended manner. If reform teams wish to succeed, they need to give more attention to the political dimensions of the policy process together with the technical dimensions of policy development (Gilson and Raphaely 2007). Health policy analysts and international development organizations are giving increasing emphasis to political economy analysis to provide the missing link between reform processes and policy outcomes. The World Bank has recognized the critical role of political economy for all sectors of development (World Bank 2008) and recently formed a "community of practice" within the Bank to promote political economy knowledge and analysis. This approach involves a deeper understanding of the political, institutional, social, and economic issues at play, the power relations among actors, and the incentives that affect change. Political economy analysis can help answer a series of questions crucial to scaling up access to health insurance, such as: Why have some countries been successful at

Global Public Health, 2011

... Enter a search phrase. You can also specify a CiteULike article id (123456),. a DOI (doi:10.1... more ... Enter a search phrase. You can also specify a CiteULike article id (123456),. a DOI (doi:10.1234/12345678). or a PubMed Id (pmid:12345678). Click Help for advanced usage. CiteULike, Group: Poverty Alleviation from Acc... Search, Register, Log in, ...

Global Public Health, 2011

... Enter a search phrase. You can also specify a CiteULike article id (123456),. a DOI (doi:10.1... more ... Enter a search phrase. You can also specify a CiteULike article id (123456),. a DOI (doi:10.1234/12345678). or a PubMed Id (pmid:12345678). Click Help for advanced usage. CiteULike, Group: Poverty Alleviation from Acc... Search, Register, Log in, ...

The American Journal of Tropical Medicine and Hygiene

Health Systems & Reform, 2018

Health Systems & Reform, 2015

In recent years, the World Health Organization's "Cube Diagram" has been widely used to illustrat... more In recent years, the World Health Organization's "Cube Diagram" has been widely used to illustrate the policy options in moving toward Universal Health Coverage. The Cube has become a globally recognized visual representation of health system reform choices, with its axes defined by: (1) the services covered by pooled funds, (2) the population covered, and (3) the proportion of costs covered. The Cube shows the difference between the current national coverage situation in a country and the policy goal of universal health coverage, identifying where major gaps exist. The essential feature of the Cube diagram is that it shows a country's coverage situation in terms of national averages. As a result, it does not present or call attention to significant disparities in coverage across population groups, which are characteristic of most low-and middle-income countries. This article recommends adding a new diagram that disaggregates the Cube. The new diagram, called the Step Pyramid, allows a policy maker to visualize specific choices in expanding the coverage status of different population groups. This new diagram can help policy makers focus explicitly on equity concerns as they set priorities in moving toward universal health coverage. The paper explains how to construct a Step Pyramid diagram, provides a hypothetical illustration, and then uses data from Mexico to create an example of a Step Pyramid diagram. The paper concludes with a discussion of the strengths, limits, and implications of both the Cube and the Step Pyramid.

Globalization and Health, 2016

Background: Historically, implementing nutrition policy has confronted persistent obstacles, with... more Background: Historically, implementing nutrition policy has confronted persistent obstacles, with many of these obstacles arising from political economy sources. While there has been increased global policy attention to improving nutrition in recent years, the difficulty of translating this policy momentum into results remains. Discussion: We present key political economy themes emanating from the political economy of nutrition literature. Together, these interrelated themes create a complex web of obstacles to moving nutrition policy forward. From these themes, we frame six political economy challenges facing the implementation of nutrition policy today. Building awareness of the broader political and economic issues that shape nutrition actions and adopting a more systematic approach to political economy analysis may help to mitigate these challenges. Conclusion: Improving nutrition will require managing the political economy challenges that persist in the nutrition field at global, national and subnational levels. We argue that a "mindshift" is required to build greater awareness of the broader political economy factors shaping the global nutrition landscape; and to embed systematic political economy analysis into the work of stakeholders navigating this field. This mindshift may help to improve the political feasibility of efforts to reform nutrition policy and implementation-and ensure that historical legacies do not continue to shape the future.

Japan Medical Association journal : JMAJ, 2015

Health policy and planning, Jan 13, 2016

This study evaluated primary care attributes of patient-centered care associated with the public ... more This study evaluated primary care attributes of patient-centered care associated with the public perception of good quality in Brazil, Colombia, Mexico and El Salvador. We conducted a secondary data analysis of a Latin American survey on public perceptions and experiences with healthcare systems. The primary care attributes examined were access, coordination, provider-patient communication, provision of health-related information and emotional support. A double-weighted multiple Poisson regression with robust variance model was performed. The study included between 1500 and 1503 adults in each country. The results identified four significant gaps in the provision of primary care: not all respondents had a regular place of care or a regular primary care doctor (Brazil 35.7%, Colombia 28.4%, Mexico 22% and El Salvador 45.4%). The communication with the primary care clinic was difficult (Brazil 44.2%, Colombia 41.3%, Mexico 45.1% and El Salvador 56.7%). There was a lack of coordination...

Health Systems & Reform, 2015

The New England journal of medicine, Jan 5, 2015

Expert review of pharmacoeconomics & outcomes research, Jan 22, 2015

A new pricing policy was introduced in Korea in April 2012 with the aim of strengthening competit... more A new pricing policy was introduced in Korea in April 2012 with the aim of strengthening competition among off-patent drugs by eliminating price gaps between originators and generics. Examine the effect of newly implemented pricing policy. Retrospectively examining the effects through extracting from the National Health Insurance claims data a 30-month panel dataset (January 2011-June 2013) containing consumption data in four major therapeutic classes (antihypertensives, lipid-lowering drugs, antiulcerants and antidepressants). Proxies for market competition were examined before and after the policy. The new pricing policy did not enhance competition among off-patent drugs. In fact, price dispersion significantly decreased as opposed to the expected change. Originator-to-generic utilization increased 6.12 times (p = 0.000) after the new policy. The new pricing policy made no impact on competition among off-patent drugs. Competition in the off-patent market cannot be enhanced unless ...

Lancet (London, England), Jan 20, 2015

In recent years, many countries have adopted universal health coverage (UHC) as a national aspira... more In recent years, many countries have adopted universal health coverage (UHC) as a national aspiration. In response to increasing demand for a systematic assessment of global experiences with UHC, the Government of Japan and the World Bank collaborated on a 2-year multicountry research programme to analyse the processes of moving towards UHC. The programme included 11 countries (Bangladesh, Brazil, Ethiopia, France, Ghana, Indonesia, Japan, Peru, Thailand, Turkey, and Vietnam), representing diverse geographical, economic, and historical contexts. The study identified common challenges and opportunities and useful insights for how to move towards UHC. The study showed that UHC is a complex process, fraught with challenges, many possible pathways, and various pitfalls-but is also feasible and achievable. Movement towards UHC is a long-term policy engagement that needs both technical knowledge and political know-how. Technical solutions need to be accompanied by pragmatic and innovative...

BMJ Open, 2015

Objectives: While the benefits of Seguro Popular health insurance in Mexico relative to no insura... more Objectives: While the benefits of Seguro Popular health insurance in Mexico relative to no insurance have been widely documented, little has been reported on its effects relative to the pre-existing Social Security health insurance. We analyse the effects of Social Security and Seguro Popular health insurances in Mexico on access to healthcare of older adults, and on financial risk protection to their households, compared with older adults without health insurance. Setting: Secondary data analysis was performed using the 2012 Mexican Survey of Health and Nutrition (ENSANUT). Participants: The study population comprised 18 847 older adults and 13 180 households that have an elderly member. Outcome measures: The dependent variables were access to healthcare given the reported need, the financial burden imposed by health expenditures measured through catastrophic health-related expenditures, and using savings for health-related expenditures. Separate propensity score matching analyses were conducted for each comparison. The analysis for access was performed at the individual level, and the analysis for financial burden at the household level. In each case, matching on a wide set of relevant characteristics was achieved. Results: Seguro Popular showed a protective effect against lack of access to healthcare for older adults compared with those with no insurance. The average treatment effect on the treated (ATET) was ascertained through using the nearest-neighbour matching (−8.1%, t-stat −2.305) analysis. However, Seguro Popular did not show a protective effect against catastrophic expenditures in a household where an older adult lived. Social Security showed increased access to healthcare (ATET −11.3%, t-stat −3.138), and protective effect against catastrophic expenditures for households with an elderly member (ATET −1.9%, t-stat −2.178). Conclusions: Seguro Popular increased access to healthcare for Mexican older adults. Social Security showed a significant protective effect against lack of access and catastrophic expenditures compared with those without health insurance.

Health Systems & Reform, 2015

Rashtriya Swasthya Bima Yojana (RSBY) is India's largest health insurance scheme. Launched in 200... more Rashtriya Swasthya Bima Yojana (RSBY) is India's largest health insurance scheme. Launched in 2007, it now covers over 37 million, mostly poor, families. This massive scheme represents a major departure from past approaches to government support for health care in India. In this article, we use data from key informant interviews, published and unpublished documents, and newspaper reports, applying Kingdon's framework for agenda setting and policy adoption to explain how RSBY became national policy. India's government-operated health care delivery system had consistently failed to meet its most basic objectives-especially for the poor. A variety of previous reform efforts had been unsuccessful. Then, in 2004, the result of the national election was seen by the victors as representing a mandate to address deprivation among those in India's vast unorganized sector. That election also brought to the fore a new set of policy makers who were willing to introduce subsidized health insurance that made extensive use of the private sector. Technological advancements offered the reformers both new options and new experiences on which to base their innovations. A group of policy entrepreneurs, including Congress Party leaders, technocrats, and senior government officials, collaborated with international agencies to develop the RSBY approach, place it on the agenda, and assure its adoption as national policy. This analysis explores factors that made this significant equityoriented health reform possible in India and provides lessons for health reformers in other countries who seek to learn from India's experiences in moving toward universal health coverage. Finally, we suggest some adjustments in Kingdon's framework to help apply his ideas in different contexts.

Journal of Pharmaceutical Policy and Practice, 2021

Background The implementation of pharmaceutical services in hospitals contributes to the appropri... more Background The implementation of pharmaceutical services in hospitals contributes to the appropriate use of medicines and patient safety. However, the relationship of implementation with the legal framework and organizational practice has not been studied in depth. The objective of this research is to determine the role of these two factors (the legal framework and organizational practice) in the implementation of pharmaceutical services in public hospitals of the Ministry of Health of Mexico. Methods Semi-structured interviews were conducted with four groups of actors involved. The analysis focused on the legal framework, defined as the rules, laws and regulations, and on organizational practice, defined as the implementation of the legal framework by related individuals, that is, how they put it into practice. Results The main problems identified were the lack of alignment between the rules and the incentives for compliance. Decision-makers identified the lack of managerial capaci...

PLOS Neglected Tropical Diseases, 2020

Approximately 300,000 persons in the United States (US) are infected with Trypanosoma cruzi, the ... more Approximately 300,000 persons in the United States (US) are infected with Trypanosoma cruzi, the protozoan that causes Chagas disease, but less than 1% are estimated to have received antiparasitic treatment. Benznidazole was approved by the US Food and Drug Administration (FDA) for treatment of T. cruzi infection in 2017 and commercialized in May 2018. This paper analyzes factors that affect access to benznidazole following commercialization and suggests directions for future actions to expand access. We applied an access framework to identify barriers, facilitators, and key actors that influence the ability of people with Chagas disease to receive appropriate treatment with benznidazole. Data were collected from the published literature, key informants, and commercial databases. We found that the mean number of persons who obtained benznidazole increased from just under 5 when distributed by the CDC to 13 per month after the commercial launch (from May 2018 to February 2019). Nine key barriers to access were identified: lack of multi-sector coordination, failure of health care providers to use a specific order form, lack of an emergency delivery system, high medical costs for uninsured patients, narrow indications for use of benznidazole, lack of treatment guidelines, limited number of qualified treaters, difficulties for patients to make medical appointments, and inadequate evaluation by providers to determine eligibility for treatment. Our analysis shows that access to benznidazole is still limited after FDA approval. We suggest six areas for strategic action for the pharmaceutical company that markets benznidazole and its allied private foundation to expand access to benznidazole in the US. In addition, we recommend expanding the existing researcher-clinician network by including government agencies, companies and others. This paper's approach could be applied to access programs for benznidazole in other countries or for other health products that target neglected populations throughout the world.

Health Systems & Reform, 2019

Health Systems & Reform, 2016

Esta obra es un producto del personal del Banco Mundial con contribuciones externas. Los resultad... more Esta obra es un producto del personal del Banco Mundial con contribuciones externas. Los resultados, las interpretaciones y las conclusiones expresadas en este documento no reflejan necesariamente el punto de vista del Banco Mundial, su Directorio Ejecutivo o los gobiernos que representa. El Banco Mundial no garantiza la exactitud de los datos incluidos en este documento. Los límites, los colores, las denominaciones y toda información presentada en cualquier mapa este documento no implican opinión alguna por parte del Banco Mundial relativa a la condición jurídica de cualquier territorio, o el respaldo o la aceptación de tales límites. Nada de lo indicado en el presente constituirá o se considerará una limitación o renuncia a los privilegios e inmunidades del Banco Mundial, todos los cuales se reservan específicamente. Derechos y permisos Esta obra está disponible con la licencia de Creative Commons Attribution 3.0 IGO (CC BY 3.0 IGO) http://creativecommons.org/licenses/by/3.0/igo/deed.es_ES. La licencia de Creative Commons Attribution permite copiar, distribuir, transmitir y adaptar esta obra, incluso para fines comerciales, bajo las siguientes condiciones:

Scaling Up Affordable Health Insurance, 2013

ver the last twenty years a growing number of developing countries have sought to transform their... more ver the last twenty years a growing number of developing countries have sought to transform their health fi nancing mechanisms-with the goal of achieving universal coverage, often through national health insurance. Yet successful reform is the exception rather than the rule. If scaling up health insurance coverage is popular, can greatly improve access to care, and can potentially reduce costs through risk pooling, why is it so hard to adopt and implement? INTRODUCTION: WHY POLITICAL ECONOMY? Reforms are diffi cult because they involve a series of complex political exchanges, any one of which can stop the process short of its goals. To overcome these challenges, different political skills are required at different stages of the reform process. In short, the reform of health fi nancing is diffi cult because of the political economy challenges embedded in each step of the policy reform process. Politics affects whether reform makes its way onto the national agenda, how the reform proposal is designed, the compromises needed to produce an acceptable agreement, and ultimately the implementation of reform (Reich 2002). Health fi nancing reform is often treated as a technical matter-designing the right policy to produce the intended effect. However, what is viewed as technically optimal is seldom politically feasible. Interventions often do not work in the intended manner. If reform teams wish to succeed, they need to give more attention to the political dimensions of the policy process together with the technical dimensions of policy development (Gilson and Raphaely 2007). Health policy analysts and international development organizations are giving increasing emphasis to political economy analysis to provide the missing link between reform processes and policy outcomes. The World Bank has recognized the critical role of political economy for all sectors of development (World Bank 2008) and recently formed a "community of practice" within the Bank to promote political economy knowledge and analysis. This approach involves a deeper understanding of the political, institutional, social, and economic issues at play, the power relations among actors, and the incentives that affect change. Political economy analysis can help answer a series of questions crucial to scaling up access to health insurance, such as: Why have some countries been successful at

Global Public Health, 2011

... Enter a search phrase. You can also specify a CiteULike article id (123456),. a DOI (doi:10.1... more ... Enter a search phrase. You can also specify a CiteULike article id (123456),. a DOI (doi:10.1234/12345678). or a PubMed Id (pmid:12345678). Click Help for advanced usage. CiteULike, Group: Poverty Alleviation from Acc... Search, Register, Log in, ...

Global Public Health, 2011

... Enter a search phrase. You can also specify a CiteULike article id (123456),. a DOI (doi:10.1... more ... Enter a search phrase. You can also specify a CiteULike article id (123456),. a DOI (doi:10.1234/12345678). or a PubMed Id (pmid:12345678). Click Help for advanced usage. CiteULike, Group: Poverty Alleviation from Acc... Search, Register, Log in, ...

The American Journal of Tropical Medicine and Hygiene

Health Systems & Reform, 2018

Health Systems & Reform, 2015

In recent years, the World Health Organization's "Cube Diagram" has been widely used to illustrat... more In recent years, the World Health Organization's "Cube Diagram" has been widely used to illustrate the policy options in moving toward Universal Health Coverage. The Cube has become a globally recognized visual representation of health system reform choices, with its axes defined by: (1) the services covered by pooled funds, (2) the population covered, and (3) the proportion of costs covered. The Cube shows the difference between the current national coverage situation in a country and the policy goal of universal health coverage, identifying where major gaps exist. The essential feature of the Cube diagram is that it shows a country's coverage situation in terms of national averages. As a result, it does not present or call attention to significant disparities in coverage across population groups, which are characteristic of most low-and middle-income countries. This article recommends adding a new diagram that disaggregates the Cube. The new diagram, called the Step Pyramid, allows a policy maker to visualize specific choices in expanding the coverage status of different population groups. This new diagram can help policy makers focus explicitly on equity concerns as they set priorities in moving toward universal health coverage. The paper explains how to construct a Step Pyramid diagram, provides a hypothetical illustration, and then uses data from Mexico to create an example of a Step Pyramid diagram. The paper concludes with a discussion of the strengths, limits, and implications of both the Cube and the Step Pyramid.

Globalization and Health, 2016

Background: Historically, implementing nutrition policy has confronted persistent obstacles, with... more Background: Historically, implementing nutrition policy has confronted persistent obstacles, with many of these obstacles arising from political economy sources. While there has been increased global policy attention to improving nutrition in recent years, the difficulty of translating this policy momentum into results remains. Discussion: We present key political economy themes emanating from the political economy of nutrition literature. Together, these interrelated themes create a complex web of obstacles to moving nutrition policy forward. From these themes, we frame six political economy challenges facing the implementation of nutrition policy today. Building awareness of the broader political and economic issues that shape nutrition actions and adopting a more systematic approach to political economy analysis may help to mitigate these challenges. Conclusion: Improving nutrition will require managing the political economy challenges that persist in the nutrition field at global, national and subnational levels. We argue that a "mindshift" is required to build greater awareness of the broader political economy factors shaping the global nutrition landscape; and to embed systematic political economy analysis into the work of stakeholders navigating this field. This mindshift may help to improve the political feasibility of efforts to reform nutrition policy and implementation-and ensure that historical legacies do not continue to shape the future.

Japan Medical Association journal : JMAJ, 2015

Health policy and planning, Jan 13, 2016

This study evaluated primary care attributes of patient-centered care associated with the public ... more This study evaluated primary care attributes of patient-centered care associated with the public perception of good quality in Brazil, Colombia, Mexico and El Salvador. We conducted a secondary data analysis of a Latin American survey on public perceptions and experiences with healthcare systems. The primary care attributes examined were access, coordination, provider-patient communication, provision of health-related information and emotional support. A double-weighted multiple Poisson regression with robust variance model was performed. The study included between 1500 and 1503 adults in each country. The results identified four significant gaps in the provision of primary care: not all respondents had a regular place of care or a regular primary care doctor (Brazil 35.7%, Colombia 28.4%, Mexico 22% and El Salvador 45.4%). The communication with the primary care clinic was difficult (Brazil 44.2%, Colombia 41.3%, Mexico 45.1% and El Salvador 56.7%). There was a lack of coordination...

Health Systems & Reform, 2015

The New England journal of medicine, Jan 5, 2015

Expert review of pharmacoeconomics & outcomes research, Jan 22, 2015

A new pricing policy was introduced in Korea in April 2012 with the aim of strengthening competit... more A new pricing policy was introduced in Korea in April 2012 with the aim of strengthening competition among off-patent drugs by eliminating price gaps between originators and generics. Examine the effect of newly implemented pricing policy. Retrospectively examining the effects through extracting from the National Health Insurance claims data a 30-month panel dataset (January 2011-June 2013) containing consumption data in four major therapeutic classes (antihypertensives, lipid-lowering drugs, antiulcerants and antidepressants). Proxies for market competition were examined before and after the policy. The new pricing policy did not enhance competition among off-patent drugs. In fact, price dispersion significantly decreased as opposed to the expected change. Originator-to-generic utilization increased 6.12 times (p = 0.000) after the new policy. The new pricing policy made no impact on competition among off-patent drugs. Competition in the off-patent market cannot be enhanced unless ...

Lancet (London, England), Jan 20, 2015

In recent years, many countries have adopted universal health coverage (UHC) as a national aspira... more In recent years, many countries have adopted universal health coverage (UHC) as a national aspiration. In response to increasing demand for a systematic assessment of global experiences with UHC, the Government of Japan and the World Bank collaborated on a 2-year multicountry research programme to analyse the processes of moving towards UHC. The programme included 11 countries (Bangladesh, Brazil, Ethiopia, France, Ghana, Indonesia, Japan, Peru, Thailand, Turkey, and Vietnam), representing diverse geographical, economic, and historical contexts. The study identified common challenges and opportunities and useful insights for how to move towards UHC. The study showed that UHC is a complex process, fraught with challenges, many possible pathways, and various pitfalls-but is also feasible and achievable. Movement towards UHC is a long-term policy engagement that needs both technical knowledge and political know-how. Technical solutions need to be accompanied by pragmatic and innovative...

BMJ Open, 2015

Objectives: While the benefits of Seguro Popular health insurance in Mexico relative to no insura... more Objectives: While the benefits of Seguro Popular health insurance in Mexico relative to no insurance have been widely documented, little has been reported on its effects relative to the pre-existing Social Security health insurance. We analyse the effects of Social Security and Seguro Popular health insurances in Mexico on access to healthcare of older adults, and on financial risk protection to their households, compared with older adults without health insurance. Setting: Secondary data analysis was performed using the 2012 Mexican Survey of Health and Nutrition (ENSANUT). Participants: The study population comprised 18 847 older adults and 13 180 households that have an elderly member. Outcome measures: The dependent variables were access to healthcare given the reported need, the financial burden imposed by health expenditures measured through catastrophic health-related expenditures, and using savings for health-related expenditures. Separate propensity score matching analyses were conducted for each comparison. The analysis for access was performed at the individual level, and the analysis for financial burden at the household level. In each case, matching on a wide set of relevant characteristics was achieved. Results: Seguro Popular showed a protective effect against lack of access to healthcare for older adults compared with those with no insurance. The average treatment effect on the treated (ATET) was ascertained through using the nearest-neighbour matching (−8.1%, t-stat −2.305) analysis. However, Seguro Popular did not show a protective effect against catastrophic expenditures in a household where an older adult lived. Social Security showed increased access to healthcare (ATET −11.3%, t-stat −3.138), and protective effect against catastrophic expenditures for households with an elderly member (ATET −1.9%, t-stat −2.178). Conclusions: Seguro Popular increased access to healthcare for Mexican older adults. Social Security showed a significant protective effect against lack of access and catastrophic expenditures compared with those without health insurance.

Health Systems & Reform, 2015

Rashtriya Swasthya Bima Yojana (RSBY) is India's largest health insurance scheme. Launched in 200... more Rashtriya Swasthya Bima Yojana (RSBY) is India's largest health insurance scheme. Launched in 2007, it now covers over 37 million, mostly poor, families. This massive scheme represents a major departure from past approaches to government support for health care in India. In this article, we use data from key informant interviews, published and unpublished documents, and newspaper reports, applying Kingdon's framework for agenda setting and policy adoption to explain how RSBY became national policy. India's government-operated health care delivery system had consistently failed to meet its most basic objectives-especially for the poor. A variety of previous reform efforts had been unsuccessful. Then, in 2004, the result of the national election was seen by the victors as representing a mandate to address deprivation among those in India's vast unorganized sector. That election also brought to the fore a new set of policy makers who were willing to introduce subsidized health insurance that made extensive use of the private sector. Technological advancements offered the reformers both new options and new experiences on which to base their innovations. A group of policy entrepreneurs, including Congress Party leaders, technocrats, and senior government officials, collaborated with international agencies to develop the RSBY approach, place it on the agenda, and assure its adoption as national policy. This analysis explores factors that made this significant equityoriented health reform possible in India and provides lessons for health reformers in other countries who seek to learn from India's experiences in moving toward universal health coverage. Finally, we suggest some adjustments in Kingdon's framework to help apply his ideas in different contexts.