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Developing countries have also been figuring out how to make the most of limited resources. In Mexico, a tax on soda is providing new revenue for public health — with the added bonus of reducing consumption and improving health outcomes.
Unhealthy diets high in sugar contribute to childhood obesity, diabetes and other chronic diseases. Taxes on soda and other sugary foods and beverages could help reduce consumption of these products, especially among children, leading to better health along with a budgetary boost. Efforts to tax unhealthy food (currently exempt from sales tax) in Massachusetts haven’t gotten much traction, but should be a focus of health advocates.
4. Create incentives for prevention
In the latest National Committee for Quality Assurance survey, Massachusetts ranked above the national average on 23 out of 24 primary care quality measures. Yet among more than 150 Massachusetts medical groups there was up to a two-fold variation in performance measures for vital preventive services such as breast cancer screening, colorectal cancer screening and well-care visits for adolescents.
To address quality gaps like these, a growing number of developing countries have introduced performance-based financing (PBF), a system of setting targets, monitoring progress and providing modest incentives for increasing in the quantity and quality of essential health services. Rwanda has used PBF to simultaneously increase performance in medical services for conditions like HIV/AIDS and tuberculosis as well as preventive services such as childhood vaccination, prenatal tetanus immunization and prenatal care. Rwanda reports over 95 percent health service coverage for a population nearly twice that of Massachusetts. This level of coverage — combined emphasis on prevention and improvements in the standard of living — has led to has more than doubling of life expectancy over the last two decades.
Insurance is saving lives in Massachusetts because it enables people to seek care sooner, before health concerns become major health problems. The positive impact of expanding health insurance coverage --especially in underserved areas — provides inspiration for countries around the world, too.
Unfortunately, Massachusetts hasn’t escaped the technological problems that have plagued other state health insurance exchanges, as well as the federal HealthCare.gov. Overly ambitious plans contributed to the failure of the Massachusetts Health Connector website, forcing stopgap coverage measures. In addition to wasting scarce funds, any threat to insurance coverage is a threat to health.
Still, beyond insurance, Massachusetts could be doing even more to improve health. The experience from developing countries shows that in addition to increasing financial protection, there are cost-effective ways to further increase access to services. Strategies like CHWs and accredited drug dispensing outlets bring the health care to your doorstep. Soda taxes and performance-based financing can create incentives for prevention.
As we appreciate the achievements of Massachusetts health reform, let’s also take a moment to draw inspiration from these unlikely places to make the commonwealth even healthier.
Dr. Jonathan D. Quick, a family physician and health management specialist, is President and CEO of Management Sciences for Health (MSH), an international non-profit organization based in Massachusetts with teams in Africa, Asia, and Latin America.
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