1FW2e8F

Recommendations

Info

SECTION 1 2 3 WHAT CAN BE DONE CASE STUDY HEALTH CARE COSTS BANKRUPT THE POOREST IN ARMENIA The Hovhannisyan family in rural community of Verin Getak, Armenia (2013). Photo: Oxfam in Armenia In 2010, total spending on healthcare represented 1.62 percent of Armenia’s budget. This under-investment has left people with no choice but to make substantial out-of-pocket payments to meet their healthcare needs. The high cost of healthcare in Armenia has forced Karo and his wife Anahit into a dire financial situation. Anahit suffers from arterial hypertension and a prolapsed uterus requiring surgical intervention, while Karo has had to live through a myocardial infarction and continues to suffer from complications caused by his diabetes. They do not qualify for subsidized care, and, as a result of their health conditions, they have been forced to take out expensive loans, and to sell off jewellery and livestock. With each health problem that arises, the family has been pushed further and further into debt and poverty. Dangerous distractions Significant amounts of money are being diverted from the public purse to bolster the for-profit private sector through cash subsidies and tax breaks. In India, numerous private hospitals contracted and subsidized by the state to provide free treatment to poor patients are failing to do so. 427 In Morocco, a recent rapid increase in private schools, supported through government funds and tax breaks, has gone hand-in-hand with widening disparities in educational outcomes. In 2011, the poorest rural children were 2.7 times less likely to learn basic reading skills than the richest children in urban areas; since 2006, this gap has increased by 20 percent. 428 Developing country governments are also increasingly entering into expensive and risky public-private partnerships. Lesotho is a striking example of how this strategy can divert scarce public resources away from where they are needed most, driving up inequality in a country that is already one of the most unequal in the world. 429 92
SECTION 1 2 3 WHAT CAN BE DONE CASE STUDY HEALTH PUBLIC-PRIVATE PARTNERSHIP THREATENS TO BANKRUPT THE LESOTHO MINISTRY OF HEALTH The Queen Mamohato Memorial Hospital, in Lesotho’s capital Maseru, was designed, built, financed and now operates under a public–private partnership (PPP) that includes delivery of all clinical services. The PPP was developed under the advice of the International Finance Corporation, the private sector investment arm of the World Bank Group. The promise was that the PPP would provide vastly improved, high-quality healthcare services for the same annual cost as the old public hospital. Three years on, the PPP hospital and its three filter clinics: • Cost $67m per year – at least three times what the old public hospital would have cost today – and consume 51 percent of the total government health budget; • Are diverting urgently needed resources from health services in rural areas where three-quarters of the population live and mortality rates are rising; • Are expecting to generate a 25 percent rate of return on equity for the shareholders and a total projected cash income 7.6 times higher than their original investment. Meanwhile, the Government of Lesotho is locked into an 18-year contract. The cost escalation has necessitated a projected 64 percent increase in government health spending over the next three years. Eighty-three percent of this increase can be accounted for by the budget line that covers the PPP. This is a dangerous diversion of scarce public funds from nurses, rural health clinics and other proven ways to get healthcare to the poorest and reduce inequality. For more information see: A. Marriott (2014) ‘A Dangerous Diversion: will the IFC’s flagship health PPP bankrupt Lesotho’s Ministry of Health’, Oxfam, http://oxf.am/5QA Rich-country governments and donor agencies – including the World Bank Group, USAID, the UK Department for International Development, and the European Union – are also pushing for greater private sector involvement in service delivery. 430 This can only lead to one thing: greater economic inequality. In fact, high levels of private-sector participation in the health sector have been associated with higher overall levels of exclusion of poor people from treatment and care. In three of the best performing Asian countries that have met or are close to meeting Universal Health Coverage – Sri Lanka, Malaysia and Hong Kong – the private sector is of negligible value to the poorest fifth of the population. 431 Recent and more detailed evidence from India has shown that among the poorest 60 percent of women, the majority turn to public sector facilities to give birth, while the private sector serves those in the top 40 percent. 432 Private services benefit the richest most, rather than those most in need, and have the impact of increasing economic inequality. 93
Page 1 and 2:
Even it up TIME TO END EXTREME INEQ
Page 3 and 4:
JEFFREY SACHS Director of the Earth
Page 5 and 6:
ACKNOWLEDGEMENTS The paper was writ
Page 7 and 8:
SECTION 1 2 3 FOREWORD FOREWORD The
Page 9 and 10:
SECTION 1 2 3 FOREWORD Persistent i
Page 11 and 12:
SECTION 1 2 3 EXECUTIVE SUMMARY Nth
Page 13 and 14:
SECTION 1 2 3 EXECUTIVE SUMMARY Bil
Page 15 and 16:
SECTION 1 2 3 EXECUTIVE SUMMARY The
Page 17 and 18:
SECTION 1 2 3 EXECUTIVE SUMMARY pow
Page 19 and 20:
Page 21 and 22:
Page 23 and 24:
SECTION 1 2 3 EXECUTIVE SUMMARY Des
Page 25 and 26:
SECTION 1 2 3 EXECUTIVE SUMMARY and
Page 27 and 28:
SECTION 1 2 3 EXECUTIVE SUMMARY gov
Page 29 and 30:
SECTION 1 2 3 INTRODUCTION Nthabise
Page 31 and 32:
A view across Santa Marta favela an
Page 33 and 34:
SECTION 1 2 3 EXTREME INEQUALITY ME
Page 35 and 36:
SECTION 1 2 3 EXTREME INEQUALITY FI
Page 37 and 38:
SECTION 1 2 3 EXTREME INEQUALITY TA
Page 39 and 40:
SECTION 1 2 3 EXTREME INEQUALITY 1.
Page 41 and 42:
SECTION 1 2 3 EXTREME INEQUALITY FI
Page 43 and 44:
SECTION 1 2 3 EXTREME INEQUALITY Th
Page 45 and 46: SECTION 1 2 3 EXTREME INEQUALITY EX
Page 47 and 48: SECTION 1 2 3 EXTREME INEQUALITY 20
Page 49 and 50: SECTION 1 2 3 EXTREME INEQUALITY in
Page 51 and 52: SECTION 1 2 3 EXTREME INEQUALITY Ca
Page 53 and 54: SECTION 1 2 3 EXTREME INEQUALITY ed
Page 55 and 56: SECTION 1 2 3 EXTREME INEQUALITY (C
Page 57 and 58: SECTION 1 2 3 EXTREME INEQUALITY Si
Page 59 and 60: SECTION 1 2 3 EXTREME INEQUALITY Th
Page 61 and 62: SECTION 1 2 3 EXTREME INEQUALITY CA
Page 63 and 64: SECTION 1 2 3 EXTREME INEQUALITY Id
Page 65 and 66: SECTION 1 2 3 EXTREME INEQUALITY CA
Page 67 and 68: SECTION 1 2 3 EXTREME INEQUALITY On
Page 69 and 70: SECTION 1 2 3 EXTREME INEQUALITY MY
Page 71 and 72: SECTION 1 2 3 EXTREME INEQUALITY ma
Page 73 and 74: SECTION 1 2 3 WHAT CAN BE DONE THE
Page 75 and 76: SECTION 1 2 3 WHAT CAN BE DONE BURK
Page 77 and 78: SECTION 1 2 3 WHAT CAN BE DONE In S
Page 79 and 80: SECTION 1 2 3 WHAT CAN BE DONE wage
Page 81 and 82: SECTION 1 2 3 WHAT CAN BE DONE (CAS
Page 83 and 84: SECTION 1 2 3 WHAT CAN BE DONE Some
Page 85 and 86: SECTION 1 2 3 WHAT CAN BE DONE 2.3
Page 87 and 88: SECTION 1 2 3 WHAT CAN BE DONE Inte
Page 89 and 90: SECTION 1 2 3 WHAT CAN BE DONE appr
Page 91 and 92: SECTION 1 2 3 WHAT CAN BE DONE fisc
Page 95: SECTION 1 2 3 WHAT CAN BE DONE THE
Page 99 and 100: SECTION 1 2 3 WHAT CAN BE DONE Stro
Page 103 and 104: SECTION 1 2 3 WHAT CAN BE DONE to 5
Page 107 and 108: SECTION 1 2 3 WHAT CAN BE DONE hous
Page 111 and 112: SECTION 1 2 3 WHAT CAN BE DONE CASE
Page 113 and 114: SECTION 1 2 3 WHAT CAN BE DONE The
Page 115 and 116: SECTION 1 2 3 WHAT CAN BE DONE (CAS
Page 117 and 118: SECTION 1 2 3 TIME TO ACT Today’s
Page 119 and 120: SECTION 1 2 3 TIME TO ACT • Imple
Page 121 and 122: SECTION 1 2 3 TIME TO ACT • Commi
Page 123 and 124: SECTION 1 2 3 TIME TO ACT • Ensur
Page 125 and 126: SECTION 1 2 3 NOTES NOTES 1. Based
Page 127 and 128: SECTION 1 2 3 NOTES 51. M. Carney (
Page 129 and 130: SECTION 1 2 3 NOTES 106. S. Limwatt
Page 131 and 132: SECTION 1 2 3 NOTES 168. The Transn
Page 133 and 134: SECTION 1 2 3 NOTES 245. P. Engel,
Page 135 and 136: SECTION 1 2 3 NOTES 324. Oxfam and
Page 137 and 138: SECTION 1 2 3 NOTES 390. In C. Godf
Page 139 and 140: SECTION 1 2 3 NOTES 449. P. Stevens
Page 142: The widening gap between rich and p
show all

1FW2e8F

Create successful ePaper yourself

Delete template?

Save as template?