Publications by Author: Reich, Michael R.

In 2011, Japan celebrates 50 years of kaihoken: health insurance for all. Universal health insurance was achieved in 1961, assuring access to a wide array of health services for the whole population. Since then, benefits have become more egalitarian while health expenditures have remained comparatively low: 8.5% of the gross domestic product and 20th out of countries in the Organisation for Economic Co-operation and Development in 2008. This achievement is all the more remarkable because the percentage of the population aged 65 years or older has increased nearly four-fold (from 6% to 23%) over the past 50 years.

This book applies an established analytical framework for health sector reform (Getting Health Reform Right, Oxford, 2004) to the performance problems of the pharmaceutical sector. The book is divided into three sections. The first section presents the basic ideas for analysis. It begins by insisting that reform start with a clear understanding of the performance deficiencies of the current system. Like all priority setting in the public sector, this 'definition of the problem' involves both ethical choices and political processes. Early chapters explain the foundations of these ideas and apply them to the pharmaceutical sector. The relationship of ultimate outcomes (like health status or risk protection) to classic health systems concepts like efficiency, access and quality is also explored. The last chapter in the first part is devoted to 'diagnosis'—explaining how to move from the definition of a problem to an understanding of how the functioning of the system produces the undesirable outcomes in question.

The second part of the book devotes one chapter to each of five 'control knobs': finance, payment, organization, regulation and persuasion. These are sets of potential interventions that governments can use to improve pharmaceutical sector performance. Each chapter presents basic concepts and discusses examples of reform options. Throughout we provide 'conditional guidance'—avoiding the approach of a 'one size fits all' model of 'best practices' in these five arenas for reform. Instead we stress the need for local knowledge of political systems, administrative capacities, community values and market conditions in order to design pharmaceutical sector policies appropriate to a country’s particular circumstances.

The last part of the book is a set of teaching cases. Each is preceded by questions and is followed by a brief note on the lessons to be learned. The goal is to help readers develop the skills they need to deal effectively with pharmaceutical sector reform problems in their own countries.

Many people in developing countries lack access to health technologies, even basic ones. Why do these problems in access persist? What can be done to improve access to good health technologies, especially for poor people in poor countries?

This book answers those questions by developing a comprehensive analytical framework for access and examining six case studies. Access to health technologies in poor countries is shaped by social, economic, political, and cultural processes. To understand those processes, the authors develop an analytic framework based on four A's—Architecture, Availability, Affordability, and Adoption.

The book applies this approach to explain why some health technologies achieved more access than others. The technologies include praziquantel (for the treatment of schistosomiasis), hepatitis B vaccine, malaria rapid diagnostic tests, vaccine vial monitors for temperature exposure, the Norplant implant contraceptive, and female condoms. The book is based on research studies commissioned by the Bill & Melinda Gates Foundation.

The book is available in its entirety for download at Access.

The G8 summit in Toyako offers Japan, as the host government, a special opportunity to influence collective action on global health. At the last G8 summit held in Japan, the Japanese government launched an effort to address critical infectious diseases, from which a series of disease-specific programmes emerged. This year’s summit provides another chance to catalyse global action on health, this time with a focus on health systems.

Global efforts to improve health conditions in poor countries have embraced two different strategies in recent decades, one focusing on health systems, the other on specific diseases. The interactions of these two strategies have shaped where we stand today.

In the last 20 years, orphan drug legislation (ODL) has been adopted in several countries around the world (USA, Japan, Australia, and the European Union) and has successfully promoted R&D investments to develop new pharmaceutical products for the treatment of rare diseases. Without these incentives, many life-saving new drugs would have not been developed and produced.

For economic reasons, the development of medicines for the treatment of diseases prevalent in the developing world (or tropical diseases) is lagging behind. Among several factors, the low average per-capita income makes pharmaceutical markets in developing countries appear relatively unprofitable and therefore unattractive for R&D-oriented companies.

The case of ODL may offer some useful insights and perspectives for the fight against neglected tropical diseases. First, the measures used in ODL may also be effective in boosting R&D for neglected tropical diseases, if appropriately adapted to this market. Second, small-sized companies, which have played a successful role in the development of orphan drugs for rare diseases, may also represent a good business strategy for the case of tropical diseases.

Road traffic injuries are a major cause of death and disability globally, with a disproportionate number occurring in developing countries. Road traffic injuries are currently ranked ninth globally among the leading causes of disability adjusted life years lost, and the ranking is projected to rise to third by 2020. In 1998, developing countries accounted for more than 85% of all deaths due to road traffic crashes globally and for 96% of all children killed. Moreover, about 90% of the disability adjusted life years lost worldwide due to road traffic injuries occur in developing countries. The problem is increasing at a fast rate in developing countries due to rapid motorisation and other factors. However, public policy responses to this epidemic have been muted at national and international levels. Policy makers need to recognise this growing problem as a public health crisis and design appropriate policy responses.