BMG<strong>krant</strong> InternationalpagesHer Royal Highness Princess Máxima advocates worldwideaccess to health insurance during Rotterdam Global HealthInitiative ConferenceHighlights from the speechAs UN Special Advocate, I lookclosely at the factors that influencedevelopment and health is of coursea very important one. Health affectsall of us. Health is an especiallypressing concern for poor families.This is even more so in developingcountries, where health care andfinancial safety mechanisms maybe limited. When poor people getsick, they commonly sell productiveassets, pull children out of schoolor take expensive loans in order toget the care they need. Or they justsimply do without. As a result, dailypriorities such as food and sheltersuffer. And there are long-termconsequences. In fact, about 100million people around the worldfall into poverty every year due tohealth expenses.So protecting poor people fromthese devastating financial impactsshould be a concern for all of us.Today, we will explore some of theways that health insurance can help.But health insurance is somewhatdifferent than other financialproducts. For example, it involvesa big element of public good. It islinked to broader, complex issuesthat require national leadership anddiverse partnerships. So, this issueis about financial inclusion, but alsoabout so much more.One of the responsibilities ofgovernment is to address theavailability of health care foreverybody needing it. Somecountries do so through a totallygovernment-run health system.Others do it through a combinationof public and private healthproviders. Some finance healthmostly through tax revenues, somethrough insurance schemes andsome through diverse financingmechanisms. The Philippines,Thailand, Colombia and Mexicoare among countries that haveintroduced nation-wide healthinsurance. The point I would liketo stress is that there is no singleapproach. Whatever we do todo this successfully, it will entaila combination of coverage andquality care that is accessible andaffordable.In the best cases, health insuranceworks in combination with publichealth goals to reinforce or evenchange behavior. But this canpresent some challenges. Why?Typically, insurance generally coversinfrequent events and large losses.Health insurance that covers regularclinic visits and medication is just thereverse — high frequency, low riskand small amounts. This can makeit very expensive and complicatedfor an insurance provider. So,knowing that prevention is themost effective means of improvinghealth outcomes and reducing costs,this issue needs to be addressed.Moreover, health insurance is no useif there are no good doctors, clinicsand hospitals. We must also considerthe availability of care as well.I am especially encouraged byinnovations that go beyondinsurance to support client needsand social goals. For example, inBrazil, a company is designinga small savings to go with itsinsurance. This can be used to paypremiums when money is tight.And in Indonesia, another companyis piloting a savings account foreducation. This account comes withsmall life insurance and hospitalcash coverage as a benefit, thusprotecting the family’s educationalgoal. I would be remiss in my dutiesas Special Advocate if I did not pointout that we also need to make basicsavings accounts much more widelyavailable. After all, savings is thesimplest form of insurance.Now, knowledge is of coursea factor. Low-income familiesare often not aware of healthinsurance or they do not understandprecisely how it can help. But basicknowledge is not always sufficient.Trust matters. And trust results fromexperience as well as knowledge.The more a person understands the
obligations, costs and benefits, themore his expectations will match theactual experience. For these reasons,financial education is very importantand something everyone shouldhelp to provide. This leads me to myfinal topic. What can each of us doto increase access to health?National governments have themost important role. We see manyexamples of national commitmentand leadership to expand nationalhealth systems, provide accessand build medical and nursingcapacity. I am thrilled that we havepolicymakers with us today to sharetheir experiences and priorities.Donors and other partners are alsokey. I am proud of the supportthat the Netherlands along withmany other countries has givenin the past years to global health.This has brought tangible benefitsand, importantly, fostered somany national initiatives. But tomake sure that all the efforts havepositive outcomes, it is all the moreurgent that we together share whatwe know about what works andwhat does not. What is certainlyimportant is to ensure that healthcare reaches the poorest and mostmarginalized families. Subsidiesof premiums and supplementalsupport conditional on regular visitsto health clinics are all provingeffective. It should go withoutsaying that providers have a leadrole in product design. Donors andacademics can also help, for examplewith research to understand clientneeds. There is so much more thatwe would like to understand. Whenit comes to sustainability, providersare also best placed. We have seenlots of good projects that have notsucceeded due to costs. This andreaching the poor are two areaswhere public-private partnershipsare essential to get the scale neededto be able to pool risks.I am so happy that this conference istaking place, with so many diversestakeholders coming together. Ithink the day will be successful ifas a result of the discussions wecontinue to address the followingfour issues:» Identify knowledge gaps. Whereis there consensus and enough said?What needs to be studied more?» Prioritize where we need morepilots and on what aspects.» Agree, more or less, on somesuccesses and also failures, so thatwe can communicate this clearly topolicy makers and practitioners» Call attention to the importanceof this subject. Of course, not onlytoday, but as you return home andin months to come.In closing, I would like to remindeveryone that investments inhealth pay very high dividends.If through insurance we can helppeople to become more healthyand productive and preventimpoverishment when they get sick,then we really need to focus onwhat is stopping us from doing so.