Challenges In Managing Health Care: Who Pays for Health Care and How it Supplied?

During this plenary panel, Brazil and China, and one organization, the OECD, were represented.

Mr. Wen Chen of the School of Public Health at Fudan University explained that China is a developing country in transition. He briefly presented the health system in his country explaining that there were 3 types of health covering: one financed by city workers of the private and the public sector, one covering those who are not working (like students) and finally one for people working in rural areas mainly financed by the government. For Mr. Chen, one of the main challenges is the huge variations between rural and urban areas and the need of continuous improvements to solve those inequalities. Another challenge concerns the balance to find between the need of investments in health and in the mean time the need to encourage the economic development. And finally the issue of introducing innovations into the system: How to do it and what incentives have to be used?

Mr. A.J. Ogata, President of the Brazilian Quality of Life Association also presented briefly the Brazil’s system explaining that since 1988 his country offers a unique public and universal free healthcare system for all the population (spending 8.4% of its GDP for health care). But for him the problem is that only 45% of the health budget comes from the public system with 55% coming from private funds. Among the positive aspects of the system in Brazil, he featured the HIV program which offers free treatment and succeeds quite well in this disease. But on the other hand, he also made reference to problem such as access to some specialists, long waiting time in hospital, the fragmentation of the private system and the lack of synergy. Brazil needs to make efforts to improve the access to specialists, the processes in hospitals, and the management of the health system.

For Ms Yuki Murakami, Health Economist/Policy Analyst at the OECD, health topics in emerging countries are quite similar. She puts the emphasis on the human resources issue, and also on the issue of quality of care. Moreover, in her opinion, one major aim for countries as big as China and Brazil is to reduce the geographical disparities across the country, especially between urban and rural areas where it is difficult to attract nurses or physicians.

An audience member asked if it was possible to compare Brazil and China that are huge countries, with for instance Scotland which has a fantastic system with really good health indicators. But clearly what it is possible to achieve at the level of Scotland is not possible in bigger countries! And in countries like Brazil or China universal access doesn’t always mean universal access to quality.

Another audience member asked what was the perfect mix between private and public in term of financing but also delivering of care?
– For Mr Ortega it’s very hard to answer this question and there is no magical system! But good systems must have the following characteristics: long term strategies, synergies between sectors, synergies between actors and cooperation between public and private sector.
– For Ms Yuki Murakami there is no ideal situation, and that’s why we are here today! Every country is facing a lot of challenges in order to provide an equal access to health care and struggles to find the fair balance of cost sharing between government and private sectors.
– For Mr Wen Chen it depends on the value for healthcare in each country and a way to increase efficiency of the health care system could be by creating competition between health care providers that can results in many positive outcomes.

This means for business students as future leaders that there is no unique answer to the issue of health care financing. It’s already a burning issue and it will be even more true in the future. Wherever we are coming from, we will have to deal with the challenge to find the perfect balance between public and private funding in our countries. Moreover, as many of us will be leaders in ageing countries, it means that even if we work in another sector that health this type of issues will inevitably impact our business and thus, will represent a challenge for each of us.

My opinion is that there is no perfect system but each country has to learn from the others in order to improve its own system. It is also important to keep in mind that every country has its own constraints and strengths, and it is only possible to compare what is comparable. Taking in account the level of development, the size of the country, and the demographic distribution is an obligation if we want to find the ideal system that fits with the characteristics of each country. I quite agree that competition between health care providers can provide outcomes but as it was said at the end of the session, I do believe that the patient should be at the center and must stay the priority!

By Arnaud Bayle, ESSEC Business School

 

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