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Health Care Overhaul Efforts of India and China Good Lesson for U.S., Experts Say

By Danielle Parnass, CQ Staff

July 8, 2008 -- The efforts of Indian and Chinese political leaders to promote a health care overhaul have been central to both countries' recent advancements in health coverage and disease prevention—and the United States should take note, said experts Tuesday.

The structure of the U.S. political system makes it hard to do something revolutionary in terms of health care, said Tsung-Mei Cheng, host and executive editor of the International Forum at Princeton University's Davis International Center. China, for example, has increased its spending to expand its health care coverage and provide equal access to everyone, she said.

"Leadership at the top does make a huge difference," Cheng said during Tuesday's Health Affairs briefing on global health care change. Currently, around 1 billion out of 1.3 billion Chinese are covered by some form of public insurance, she said.

The Chinese government has put "livelihood of the people" at the top of the national agenda, Cheng said, and the current administration views health care not only as a right but also as a means to social and economic development. China plans to reach universal coverage by 2020, she said.

To prevent and control India's HIV epidemic, its government has launched a $2.5 billion, five-year plan that stems largely from a high level of political commitment and evidence-based, targeted intervention, said Kees Kostermans, lead public health specialist for the World Bank's South Asia region. Research has shown that these prevention programs have been successful in promoting safe sexual behavior among high-risk groups in India, he said.

While data shows that better health in terms of life expectancy and infant mortality correlates to increased health spending in China and India, spending in the United States doesn't improve health as much, said Health Affairs Deputy Editor Philip Musgrove.

In addition, increased spending in China and India still does not address all the issues surrounding health care, such as decreasing out of pocket spending, solving internal inequalities, and focusing more attention to adult health and chronic disease in general, he said.

But perhaps most effective to health care overhaul is refocusing incentives, Musgrove said.

"If you get the incentives right, that's just about the best you can do," Musgrove said.

Although the United States differs from India and China on increasing health care spending to promote a health care overhaul, other challenges exist that are "surprisingly familiar to our own," said Health Affairs Editor-in-Chief Susan Dentzer. Such challenges include an aging population and increased obesity rates, as well as inequalities among different populations.

In China, the "pace of aging has been much greater than economic growth," said Somnath Chatterji, team leader for multi-country studies in the World Health Organization's Department of Health Statistics and Informatics. "Basically, they're getting older before they're getting richer," he said.

India and China will account for almost 40 percent of the world's older population by 2050, Chatterji said.

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