Money not cure-all for health care

Since money and health care are inextricably linked, reforms in the United States have tried to curb runaway medical inflation, while initiatives internationally have worked to provide funds that tackle health problems. But officials attending a Harvard Business School think tank said that money alone isn’t the answer.

“Spending by itself doesn’t really get you too far,” said Julian Schweitzer, head of health, nutrition and population for the World Bank. “The poor don’t always benefit from higher public spending [on health]. Resources and need are often misaligned.”

Similarly, Katherine Baicker, professor of health economics at the Harvard School of Public Health (HSPH), said much of the conversation around health care reform in the United States has focused on insurance and cost, which misses the central point.

“You want to cover the uninsured to improve their health, not to save money,” Baicker said. “We need to think about what we are getting for our money, not just about the money.”

Baicker and Schweitzer were among dozens of authorities on health care who gathered at Harvard Business School last week for a Health Care Reform Think Tank sponsored by the Advanced Leadership Initiative at Harvard.

The think tank was one of three sponsored by the initiative this year, according to initiative chair and director Rosabeth Moss Kanter, the Arbuckle Professor of Business Administration. Kanter said that “advanced leadership” as envisioned by the institute is not merely about great leadership. “Advanced leadership,” she said, is needed in areas where clarity is lacking and conflict is common, where action is needed on multiple fronts, where authority is diffuse, and the stakeholders are diverse.

“If anything calls for advanced leadership, this field does,” Kanter said. “It’s such a vital issue, one that affects everybody, and is a huge part of our economy and the economies of countries around the world.”

The think tank, which ran May 6 to 8, featured speakers from a variety of health care backgrounds, including Barry Bloom, the former dean of the Harvard School of Public Health, who served as a think tank co-chair; current HSPH Dean Julio Frenk; Paul Farmer, Harvard Medical School professor and co-founder of the nonprofit Partners In Health; Rifat Atun of the Global Fund to Fight AIDS, Tuberculosis and Malaria; Jon Kingsdale of the Commonwealth Health Insurance Connector Authority; and Sean Hogan, vice president of global health care delivery for IBM Wellness Programs.

Topics covered over the three days included health reform, the role of the private sector in improving health, innovations in health, and lessons to be learned from developed countries.

In introducing the event, Bloom said reforming health care is difficult because so many factors affect a person’s health outside the care system, such as poverty and war.

“Health is really affected by every other sector in society,” Bloom said. “We are entirely focused on diseases, but what’s killing people in developing countries is not just diseases.”

U.S. health care needs reform, Bloom said, because costs are rising at an unsustainable rate. Though the United States spends almost half of all global health care dollars, the system doesn’t provide the world’s best care.

Schweitzer, who teamed up with Bloom and Baicker for the think tank’s opening “Big Picture” presentation, said international health should be important to Americans because health problems don’t respect borders. Further, new funding organizations, treaties, and international institutions bind the world tighter as it seeks solutions to health problems.

In this era of rising health spending, there have been some successes, Schweitzer said, such as the increased number of people living with AIDS because of access to life-saving antiretroviral drugs. Still, there are both “donor darlings” and “orphans,” Schweitzer said, that leave the global health picture uneven. Malnutrition, for example, remains the largest cause of childhood mortality and causes lasting damage to children who survive it.

“Some things get a lot of attention; other things fall off the map,” Schweitzer said.

Though the poor use just a tiny fraction of the world’s health services, the impoverished in developing countries pay far more out of pocket for the care they do receive. The design of health care systems is critically important to ensure that money funds services that help those in greatest need. Public spending on health care now often goes to city hospitals that serve the urban well-off, rather than impoverished rural dwellers.

“It’s the poor who have to bankrupt themselves to get a modicum of health,” Schweitzer said.

Sanitation, another cornerstone of public health and a low-cost way to head off diarrheal diseases afflicting many of the world’s children, gets little attention, Schweitzer said, adding that it’s time for action, rather than more discussion.

“Talk is cheap, and I can assure you, in international health, there’s an awful lot of talk,” Schweitzer said. “We need to scale up based on evidence, not rhetoric. There’s very little research funding going into what I call ‘implementation science.’”