Findings, Conclusions and Recommendations

A moral and economic imperative

EMCs should provide universal healthcare (i) because healthcare is a civil right; (ii) because inclusive healthcare systems spread risks and are therefore more efficient than exclusive systems; and (iii) quality healthcare extends and improves the quality of life and enhances adult productivity and lifetime learning capacity.

Spanning diverse needs

The economic, social and spatial diversity of EMCs is reflected in increasingly diverse demands for health and healthcare services. Wealthy urban elites demand state of the art treatment for chronic diseases traditionally associated with wealthier countries; burgeoning middle classes demand an expanding range of insured services; and poor urban and rural populations need protection against infectious disease and public health hazards associated with poorer countries. EMC universal healthcare systems must satisfy them all.

Long run sustainability

Because most EMCs lack the institutional, financial and human resources that underpin the centrally regulated, single payer healthcare systems of some OECD countries, they should opt for multiple delivery and payer systems. In improving or building universal healthcare systems, EMC governments should recognize that the success of mixed systems depends on strong leadership, transparency, sound financial management, effective regulation and, increasingly, the creative use of information and communications technologies and the availability of low cost, high quality, domestically produced drugs and devices.

Effective policy designs

The effectiveness of new and reformed healthcare systems depends on realistic promises, deliverable objectives, clear and evolving priorities and manageable expectations. Avoiding promises they can’t keep EMC governments should allocate resources to low cost/high yield/low risk objectives including health infrastructure, primary care for marginal populations, preventative health services for children, health education for women and fiscal, legal and other programmes that address the fact that alcohol and tobacco are leading causes of premature death, lost productivity and disability.

2. EMCs should develop new human resource paradigms for healthcare

Universal healthcare systems demand new human resource paradigms

EMCs should develop new human resource paradigms for healthcare. Their main focus should be the development and deployment of non-traditional, less-skilled, low-cost healthcare workers (e.g. community health workers) using available medical technology to deliver primary care to marginalized urban and rural populations. As in wealthier countries, highly qualified medical professionals will continue to serve those who can afford private healthcare but must also supervise and support non traditional healthcare workers using advanced information and communications technologies.

International migration of healthcare workers raises issues of global policy coherence

The migration of healthcare professionals and other healthcare workers is often cited as the proximate cause of health manpower deficits in EMCs. But not all EMCs have deficits; some are net importers; there are push as well as pull factors; and the costs are partially offset by remittances. Permanent or long term losses of skilled health workers are nonetheless legitimate issues for many EMCs, not least because manpower deficits in some wealthy countries are partly attributable to deliberate restrictions on the output of qualified medical professionals. WHO should produce an International Code of Practise to govern compensation by receiving countries; discourage source countries from viewing compensation as an alternative to action to reduce the propensity to migrate; develop international standards for healthcare qualifications; and promote quantitative research on the causes and consequences of migration.

3. EMCs should develop integrated health and healthcare strategies

Non-medical determinants of health

Universal healthcare is a necessary condition of healthier futures for individuals and communities in EMCs. But because many health issues fall beyond the domain of health departments, healthcare and public health issues must be addressed in comprehensive strategies that take full account of non-medical determinants of health including economic and social conditions, behavioural and lifestyle choices and the impact of social environments on health and life-expectancy.

Creating ‘joined-up’ health and healthcare strategies

EMC governments should coordinate the activities of all branches of government with health-related responsibilities including ministries responsible for fiscal, monetary, trade, social welfare, labour, housing, transport, urban development, infrastructure, water supply and sewerage, education, environmental, food security, transportation and traffic management and internal and external security policies. Because few OECD governments have yet developed ‘joined-up’ health strategies or successfully integrated medical education with the education of public health officers and hospital administrators they do not offer reliable models. EMC governments should therefore take innovative measures to coordinate health-related decisions across government departments and ensure universities and medical schools begin to train future generations to manage and execute them.

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