I am spending this week visiting health care service providers in Tamale, in order to find out more about how Ghana's national health insurance works.
Ghana's national health care scheme is supposed to be open to anyone. The cost is low (although I am still trying to figure out the exact price; I suspect it varies by region), and some groups, including pregnant women and the very poor, get coverage for free. My first couple of stops were at pharmacies, and what I found out about how they deal with insurance was fascinating. Like Medicaid and Medicare in the United States, Ghana's national health insurance plan does not reimburse service providers at the same rate as private insurance, or the rate that would be charged to those with no insurance. The national health insurance may reimburse pharmacies at perhaps 75% of the market price for many drugs. To make up for this, pharmacies require patients to "top-off"-- to pay the difference between the market price and the insurance price. Although this difference may only be 25 cents or so, many people cannot afford it; those who are covered for free are usually so poor that they cannot buy food. Another alternative is for the patient to accept a smaller quantity of the drug, while the original quantity is reported in the insurance claim. (I'm not an expert, but I'm pretty sure that would constitute Medicare fraud in the United States.) Finally, in some cases the pharmacist will give the patient the medicine without requiring the top-off, and the pharmacy will take a loss on that transaction. The National Health Insurance Authority expects pharmacies to behave as health providers in the United States, and accept the prices they are given. However, Ghanaian pharmacies are required to accept insurance, and for many, a large share of their patients use the national health insurance. They could not survive on the prices set by the national insurance. I have heard that the prices are too low because the price list is not updated frequently. I do not know if this is true. Raising the prices will certainly make the already-struggling insurance scheme more expensive. It may be that a co-pay on drugs could even make sense. However, it will not work for the poorest of the poor, and pharmacies should not be alone in bearing the cost of providing medicines to these people at below market rates.
3 Comments
This paper isn't new, but I recently saw Ricardo Hausman give a presentation on it, and it is quite interesting. The basic premise is that the products that countries produce can be grouped according to the inputs required to produce those products. Knowing how products related to each other could help developing economies figure out what industries to focus on. It is easier to develop industries that share production inputs with products you are already making than it is to develop industries that require a completely new set of production inputs: it is easier for monkeys to swing to a nearby tree than it is for them to swing to a farther tree. The researchers used product categories and job categories to figure out how closely different products were related to each other in terms of inputs. They then looked at several sets of countries, and mapped which products they were producing. The diagrams above show the result of this exercise: the colored dots are products, the lines connect those products that share inputs, and the black squares show what each group of countries is producing. Developed economies produce goods near the center of the cluster. The goods on that part of the map are things like electronics, that require a lot of inputs, but share inputs with a lot of other products. Developing economies are at the periphery of the map, making goods with fewer inputs, and that don't share inputs with many other goods. The point: developing economies are less diversified (no surprise) and less flexible if their main product goes bust.
I've added labels describing important product clusters for each group of countries. Developed economies are clustered around high-value, complex product manufacturing. Latin America and Sub-Saharan Africa both have oil as an important product. Asia has clusters in the areas garments, textiles, and electronics. This point about garments and textiles is interesting. Although it might seem obvious these should go together, they actually don't share many inputs. It's possible that the inputs, though not shared, have similar attributes. Perhaps they require workers with similar levels of education, even if the jobs those workers do are quite different. Or perhaps proximity matters: maybe it is cheaper to make fabric closer to where you sew it. Either way, it suggests targeting industries for development is even more complicated that the charts above suggest. Today I attended a World Bank training on survey methods in developing economies. (I would just like to say, the World Bank has great food, and where do they get their papaya, because when I buy papaya here it always tastes funny.) One interesting bit of the training seminar had to do with calibrating surveys to adjust for differences in perceptions or attitudes among respondents. To get a more concrete idea of the problem, imagine asking two people to rank their health from 1 to 10. The first person is a young, Olympic athlete with a cold and sprained ankle, who rates her health as 5. The second is an old, barely mobile man who had a good day and was able to do a lap around his building with his walker. He ranks his health as 8. Is he really more healthy than the athlete? No, but the respondent's relative baseline matters. An example from actual research: Gary King, Christopher Murray, Joshua Salomon, and Ajay Tandon asked survey respondents in China and Mexico to rate their ability to participate in governance. Chinese respondents, on average, ranked their political efficacy higher than Mexican respondents. Few people would really believe that citizens have more political efficacy in China than Mexico. More likely, what Chinese citizens considered to be a "high" level of efficacy was different from what Mexican citizens considered to be a "high" level of efficacy. The researchers devised a way to account for differences in the respondents' relative baselines. They used vignettes, or stories illustrating a particular level of political participation, and asked respondents to compare themselves to the hypothetical. Using this method, Chinese respondents ranked their political efficacy lower than Mexican respondents, on average. Similar use of hypothetical vignettes can be used in surveys on other topics, including health, access to resources, education, etc., to ensure that respondents interpret questions similarly, and that their responses have the same meaning.
This fascinating map (source here) highlights how much trouble the human species has feeding itself. If you are unfortunate enough to live in Africa or South Asia, you will struggle to consume sufficient calories to survive. If you are unfortunate enough to live in the United States, Canada, Australia, a handful of European countries, or a Gulf state, you will struggle to consume few enough calories.
Wouldn't it be great if developed economies could just ship off their excess calories and send them to calorie-deficient countries? Hey, don't eat that second donut-- FedEx it to India. We actually do this with clothing. Clothing that is donated to Goodwill or similar stores, but goes unsold, is baled and sold by weight to developing countries. I purchased some of it when I was in Dakar. It provides local consumers with inexpensive, good quality clothing-- but it also puts local textile workers out of business. Food, of course, is yet more complicated. Hungry people don't need your second donut so much as they need the protein- and vitamin-rich lentil veggie stew you SHOULD be eating. Many people who are calorie or vitamin deficient work in agriculture themselves, and they need not only food but a sustainable way to make a living. However, eating less would have the effect of lowering prices-- which would make food more affordable. And eating less junk food would lower demand for empty-calorie crops like sugar and corn, which might free up land for healthier crops. I think the main lesson from this map, however, is to remind those of us in the developed world how lucky we are to have the problems we have. Health care costs exploding because people are overweight and living longer? At least they aren't starving and dying of malaria as toddlers. So we have to push people to go to the gym? The fact that physical work is optional is a sign that we live luxurious lives. If we can't figure out how to keep our population healthy, what chance is there for developing economies, whose challenges are even more daunting? This interesting story in the New York Times describes how cell phones are being used in rural Uganda to track banana diseases.
Africa has more mobile phones than it does land lines. This is very believable to me, as I saw for myself the proliferation of cell phones in Dakar, Senegal, in 2005. In urban Dakar, the primary draw of the cell phone seemed to be the cool factor, and the ability to talk to friends any time or place. (Senegalese youth really aren't that different from American teenagers, afterall.) At times it seemed bizarre however, to see people talking on cell phones who couldn't afford cars, school, medical care, or even -- in extreme cases -- sufficient food for their children. It is easy to jump to the conclusion that when people without electricity or clean water carry cell phones, this is a serious lack of spending priorities. An article about cell phone use among Washington DC's homeless prompted some similar sentiments among reader comments. However, both of these articles illustrate how cell phones can be a key tool for bringing real improvements to people's lives. The same wealthy Americans who view cell phones as luxuries have access to fast transportation, land lines, television, prolific bank branches, disposable cameras, iPods, and computers with internet. For the poor, both in the United States and in Africa, cell phones have the potential to give people access to news and other information, connect them to friends and relatives who live several days' walk away, allow them use modern banking, and let them enjoy music and entertainment that wealthy Americans take for granted. The newest generation of cell phones have most of the same basic functions as laptops, but cost much less, which could make them valuable in education. Cell phones can be tools at work too. In Dakar, I occasionally saw workers using cell phones to coordinate with their employers and fellow employees, to make the business more productive. Cell phones present a great opportunity to help a large number of low-income people in both developed and developing economies. Programs like the one mentioned in the NYT article, that teach people how to make the best use of cell phones' powerful capabilities, are right on target. The G20 summit meeting recently concluded in Pittsburg. The summit resulted in approval of a"Framework for Strong, Sustainable, and Balanced Growth". The framework includes acknowledgement that stimulus spending is needed in the short run, but that countries need to develop exit strategies to withdraw fiscal and financial sector support. The G20 also agreed to give developing economies more ownership in the International Monetary Fund.
Some G20 participants, as well as commentators, suggested that the G20 should replace the G7 as the most important forum for coordinating international economic policy. What is with all these Gs, and what do they do? Here is my quick list of important G- summits, and their members: G7: This is a meeting of the finance ministers of Canada, France, Germany, Italy, Japan, the United Kingdom, and the United States. G8: This is a meeting of the heads of state of the G7 countries, plus Russia. Fun fact: after shirtless pictures of Sarkozy and Putin emerged a couple years ago, snarky journalists suggested a "G8 calendar". G20: This is a meeting of finance ministers and central bank heads from 20 countries, including the G8 countries, Australia, whichever country is the current president of the EU (provided that country is not already included), and 10 large emerging market economies: Argentina, Brazil, China, India, Indonesia, Mexico, Saudi Arabia, South Africa, South Korea, and Turkey. G2: Not really an official designation, this is sometimes used to refer to China and the United States. The idea is that agreements between these two countries could become necessary and sufficient to drive international policies. Besides generating fun photo ops, the G7, G8 and G20 meetings allow countries to meet to coordinate policy on security, economics, and the environment. The efficacy of these meetings is limited by the fact that the members are sovereign nations, so any agreements that might be reached are only worth as much as each nation's commitment to hem (and domestic political realities!) While the G8 may retain importance on security, in part because of the difficulty in coordinating policy among 20 countries, it is very likely that G20 will indeed become the more important forum for economic policy-- it seems bizarre to discuss the global economy without China, and developing economies are becoming a larger share of the world economy. The IMF projects that the G7 share of world GDP will drop below 50% in 2014, down from near 70% in the early 1990s. Final fun fact: At summits such as the G7 or G20 summits, the person who in charge of the meeting for each country (who develops materials, schedules officials' participation, etc.) is called the "Sherpa". (They help you up the summit, haha, get it?) Borrowing from the culinary world, the Sherpa's deputy is known as the Sous-Sherpa. Just finished Tracey Kidder's latest, Strength in What Remains. I highly recommend it. It is the story of a refugee from Burundi's 1994 ethnic civil war who comes to New York City as an illegal immigrant.
Quick facts about Burundi: Burundi is a small country located in central Africa, just south of Rwanda. Burundi has a population roughly equal to that of New Jersey, and an area is a little larger. Like Rwanda, its recent history has been dominated by conflict between the Hutu majority and Tutsi minority. The CIA estimates that Burundi's per capita GDP was $400 (in PPP terms) in 2008; the third lowest in the world after DR Congo and Zimbabwe. In comparison, U.S. per capita GDP is about $47,000. Burundi's real GDP per capita is growing more slowly than U.S. real GDP per capita. That means that if current growth rates continue, Burundi will never catch up to U.S. standard of living; rather, the gap between the two countries will grow wider and wider. |
About Liz
I have worked in economic policy and research in Washington, D.C. and Ghana. My husband and I recently moved to Guyana, where I am working for the Ministry of Finance. I like riding motorcycle, outdoor sports, foreign currencies, capybaras, and having opinions. Archives
December 2016
Categories
All
|