Duke Faculty Headline Health Affairs Briefing on Global Health

Gavin_Yamey_at_Health_Affairs_Forum

At the Health Affairs forum in Washington DC on June 14, DGHI's Gavin Yamey moderated a panel on Universal Health Coverage.

Published June 17, 2016, last updated on June 3, 2020 under Research News

In a wide-ranging discussion hosted on June 16 by the journal Health Affairs, Duke University faculty members Gavin Yamey and Mark McClellan joined an international panel to brief policymakers on current global health issues.

Yamey, professor of global health and a member of the Duke-Margolis Center for Health Policy moderated a distinguished panel on Universal Health Coverage. His opening remarks reviewed the NHS founding in the aftermath of World War II and the United Kingdom’s reconstruction, noting that the original pamphlets for the service – slipped under every door in the UK – stressed avoidance of financial hardship due to health issues. Likewise, at the 1965 signing of the Medicare bill, President Lyndon Johnson said, “No longer will illness crush and destroy” the savings of older Americans. He then placed the panelists’ remarks in the context of asking what the opportunities, barriers and challenges are to achieving Universal Health Coverage globally.

Sir David Nicholson, former CEO of the UK’s National Health Service, then discussed the culture of the NHS and its role in UK society, issues of cost-benefit tradeoff, recent progress in removing inefficiency from the health care system and the next set of challenges facing the NHS. His remarks were followed by Tania Dmytraczenko from the World Bank, discussing different models of UHC in Latin America, noting areas of progress in areas such as maternal and child health, but acknowledging the challenges of fragmented systems – public and private – creating access issues. Harvard’s Margaret Kruk underscored these issues of quality and access, pointing out that consumers of health care in rural Zambia and Uganda will “vote with their feet” to avoid low-quality care – a trend particularly clear in preference for hospital births over local clinics.

Later in the briefing, McClellan, director of the Duke-Margolis Center for Health Policy, discussed global innovations in accountable care as part of a larger panel on Innovations in Health Care, moderated by Health Affairs’ editor Alan Weil. Outlining episode-based and population-based payment models, McClellan explained the environmental, policy, and organizational competencies and conditions for successful accountable care reforms. Pointing out that metrics of quality should include both the population and patient perspective, he discussed how these factors played out in population health pilots in Germany’s Gezundes Kinzigtal, where multi-modal treatment models reduced care utilization and patient acuity. In contrast, Nepal’s Possible Health project, including a cloud-based electronic health record significantly increased care coordination, with positive results for patients and the system.  

Despite complexity and challenges, the overall tone of the briefing was optimistic for the prospects for global health policy to change the health status of populations and patients, but the majority of participants echoed McClellan’s warning that health systems and organizations must innovate if they are to improve quality and lower costs for societies around the globe.

Read the live tweets from the event at Health Affairs social media summary.