Category Archives: Intervention

Universal Health Care in Reach? Not So Fast

The magazine, The Economist, published a ten-page special report in their April 28th edition on universal health care worldwide.

The report, which one social media commenter said was a perfect example of title and context differentiation, and gave no data or reason why health care was closer to being universal, is an example of a neoliberal publication going out on a limb with an issue vital to all human beings, and giving it short-shrift.

Throughout the report, The Economist mentions the World Bank and the World Health Organization (WHO), as well as the Gates Foundation as international organizations involved with public health in developing countries. The report contains statistics on the percentage of people in certain countries who do not have insurance, and other statistics to paint a bleak picture of health care in developing countries.

What the report fails to do is mention that it is exactly the World Bank, the IMF, international financial organizations, philanthropies like the Gates and other foundations, and the WHO, that have been responsible for preventing these countries from improving their health care systems.

Chapter Nine of the Waitzkin, et al., book previously reviewed in this blog, discusses in detail how these institutions influenced health care around the world for the benefit of multinational corporations in the developed world, and to the detriment of the health care in the Global South.

In particular, the WHO, which began in 1948 as a sub-organization of the United Nations, lost considerable funding due to ideological opposition to several programs operated by sub-organizations of the UN, and because the Reagan administration withheld annual dues. The UN began experiencing increasing budgetary shortfalls, which was passed onto organizations like the WHO.

But to the rescue, came the World Bank, and with this influx of private funds, the agenda of WHO changed to match that of the World Bank, international financial institutions and trade agreements. It was in the interest of these entities that health care be carried out in a vertical, top-down approach that left out key parts of the health care services needed in developing countries, namely surgery and concentrated on addressing infectious diseases like AIDS, malaria, and tuberculosis.

But there is another reason why public health in developing countries is in such a dismal state, and it has to do with the debt crisis these nations and others were subjected to by the nations of the Global North and the World Bank, IMF and international financial institutions.

According to the blog, One.org, “Developing countries spent years repaying billions of dollars in loans, many of which had been accumulated during the Cold War under corrupt regimes. Years later, these debts became a serious barrier to poverty reduction and economic development in many poor countries. Governments began taking on new loans to repay old ones and many countries ended up spending more each year to service debt payments than they did on health and education combined.

After many years of activism on the part of advocates for the poor and other activists, the nations of the Global North, through such organizations as the G8, the IMF and World Bank, decide to abolish debts worth billions of dollars owed by developing countries. Yet, despite this action, data in the World Bank’s global development finance 2012 report shows total external debt stocks owed by developing countries increased by $437 billion over 12 months to stand at $4 trillion at the end of 2010, the latest period of available data, according to the Guardian.

Third world debt was a serious issue when I was in college studying international relations and foreign policy, and I was aware of the efforts to reduce or eliminate this debt, so when I read in The Economist that the World Bank and WHO are engaged in public health issues around the world, I have to ask myself how is it possible that the very institutions responsible for the state of affairs experienced in developing countries as pertains to health care, are the very same institutions undoing the wreckage they created. Or at least not in ways that are advantageous to the citizens of those countries.

Instead of the vertical, top-down orientation these institutions are engaged in, a broad, horizontal orientation needs to be implemented that will radically alter the health care systems of these countries and provide all of their people with truly universal health care.

Lastly, The Economist looks at the US, and rightly points to our stubborn adherence to individualism and even quotes Republican congressman, Jason Chaffetz, who said, “Americans have choices.And they’ve got to make a choice. And so maybe, rather than getting that new iPhone that they just love, and they want to go spend hundreds of dollars on that, maybe they should invest in their own health care.”

Many Republicans, like Rep. Chaffetz, says The Economist, believe health care is not a right but something people choose to buy (or not) in a marketplace.  I can tell you, dear readers, I did not choose to have End-Stage Renal Disease, nor did I choose to be long-term unemployed (that is due to neoliberal economic policies and to the financial meltdown caused by the very institutions that have a negative impact on universal health care), so Rep. Chaffetz and his Republican colleagues are wrong. And besides, you can’t buy health, as we all get sick and we all die. What you buy is a policy, but policies are not the same as care.

One other reason The Economist cites for the US being an outlier in providing universal care is resistance to reform by powerful interest groups.

I don’t believe this report did anything to move the debate forward towards universal health care, either here in the US, or around the world. It really did not cover any new ground, and its prediction for health care universally achieved is either wishful thinking or a delusion. Either way, until the economic order changes, nothing in health care will.

 

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Understanding Medical Tourism’s Role in Early Intervention in Workers’ Compensation

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Early intervention strategies in workers’ compensation cases are key to improving workers’ compensation results, as my LinkedIn connection, Paul Binsfield writes today in his article, Early Intervention Strategies in Workers’ Compensation in PropertyCasualty360.com. Paul is CEO of Company Nurse, a firm specializing in injury management for workers’ compensation.

In his article, he writes that In a tough economy, employers require effective and innovative ways to improve workers’ compensation results. Many program managers are updating their approach and leveraging early intervention such as prompt reporting, nurse triage, proactive claims management, and integrated return-to-work (RTW) coordination to improve performance. These strategies are designed to manage work-related injuries right from the start and bring about best possible outcomes.

He lays out five key areas employers need to focus on to insure better outcomes for their injured workers. These areas do not necessarily relate to how those wishing to implement medical tourism into workers’ compensation would be involved, but it gives one the background of what the employer has already done before the medical tourism option is considered.

The five key areas are:

  • Improving the Reporting Process
  • Quality Medical Care
  • Pre-Injury Foundation for Success
  • Post-Injury Program Improvements
  • Injury Triage as Backbone to Future Success

If medical tourism is to be successful in being implemented into workers’ compensation, a knowledge, understanding and appreciation of the process laid out by Paul and others in the workers’ compensation arena, is essential for those wishing to seek out employers and insurance carriers as partners in this venture. In much the same way that salespersons know, understand and appreciate the manufacturing process of the products they sell, so too should medical tourism facilitators and the personnel at medical tourism destinations.

By doing so, the entire process from first report of injury to initial treatment and final medical tourism care, if that occurs, would be a seamless flow from beginning to end with all interested parties working together to get the patient the best care possible and back to work as soon as medically possible. In this way, medical tourism could be seen as the end stage of the entire workers’ compensation process and the cost savings realized could be used to incentivize the employee to chose the medical tourism option, and in turn, be re-directed back to making improvements in the five key areas above.