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The International Decision Support Initiative (iDSI) is a global network of health, policy, and economic expertise working to achieve Universal Health Coverage. The initiative works with countries to support better decision-making on how public money for health can be spent more efficiently, effectively, equitably, and sustainably. This can help ensure fairer access to the right healthcare, treatment, and medicines at the right time. The iDSI secretariat is based at the Center for Global Development.
From outbreak preparedness spending to building better health technology assessment (HTA) capacity, iDSI and CGD’s work helps governments to make better decisions for better health.
The New England Journal of Medicine recently published the results of “the Oregon experiment” based on the 2008 US Medicaid program expansion in Oregon. The study is one of very few randomized control trials on publicly-subsidized health insurance that exists to guide health policy, and found what some commentators considered a disappointing result: while health care utilization increased and households were protected from financial hardship, expanding Medicaid coverage had “no significant impact on measured physical health outcomes over a 2-year period.”
This week the World Health Organization held a major international meeting on universal health coverage (UHC), with Director General Margaret Chan reaffirming her regard for universal coverage “as the single most powerful concept that public health has to offer.” While the term “universal” signals that the entire population will be “covered,” an unanswered question is: covered with what? Another way to put the question: What health benefits or interventions would represent coverage, taking into account UHC’s implicit goals of improved health, equity and financial protection?
As governments across the world expand population access to health care, they are feeling the pressure of rising costs. According to the IMF, emerging economies will spend an additional 1.5 percentage points of GDP on health care over the next 20 years, most of which will come from excess cost growth – defined as health care cost growth related to new medical technologies and income growth, rather than aging.
"Every country, no matter how wealthy or how impoverished, cannot afford to waste money in healthcare on health technology that does not contribute to health."
These words were spoken by Harvey V. Fineberg, the President of the Institute of Medicine, at a recent event co-hosted by CGD and PAHO, which highlighted the importance of supporting health technology assessment (HTA) in the Americas. Low-and middle-income countries are increasingly interested in building capacity for priority setting, particularly in regards to public funding in a time where pressures to incorporate costly new technologies are on the rise and donor contributions are stagnating. Over the past five years Brazil, Chile, Costa Rica, Colombia, Croatia, Estonia, the Republic of Korea, Malaysia, and Uruguay have also added health technology assessment agencies—tasked with varying responsibilities, including the generation or coordination of health technology assessment and budget impact analysis, as well as the creation recommendations for coverage or reimbursement decisions related to public spending.
Pan American Progress on Priority Setting in HealthStrengthened Network Meets Needs Set out in Center for Global Development Report Washington, D.C. – The Pan American Health Organization (PAHO) is moving to tackle one of the most difficult and important challenges of health policy: strengthening regional mechanisms for assessing which health technologies are cost effective and therefore appropriate for public funding. It’s a sensitive issue that vexes poor and rich countries alike—including the United States.