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Ethical Issues on the Path to Universal Coverage Nine questions for the WHO Consultative Group on Ethical Issues in UC. Ole F. Norheim Professor in Medical Ethics and Philosophy of Science Dept. of Global Public Health and Primary Care University of Bergen ole.norheim@igs.uib.no.

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Ethical Issues on the Path to Universal CoverageNine questions for the WHO Consultative Group on Ethical Issues in UC

Ole F. Norheim

Professor in Medical Ethics and Philosophy of Science

Dept. of Global Public Health and Primary Care

University of Bergen

ole.norheim@igs.uib.no

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T h e e t h i c s o f p r i o r i t y s e t t i n g i n g l o b a l h e a l t h

Coverage of antiretroviral therapy among people with advanced HIV infection (CD4 < 350): 56 %(Ethiopia: WHO Global Health Observatory, 2013)

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Source: World Bank. 2012. Health Equity and Financial Protection Datasheet. Washington D.C: World Bank

three simple questions
Three simple questions

Is it fair that people pay a large proportion of the costs for key services out-of-pocket?

Is it fair that coverage is far below 100% for so many key services?

Is it fair if some citizens have access to open heart surgery while others do not have access to key priority services like treatment for pneumonia?

three hard questions
Three hard questions
  • Should governments reduce direct payments or expand services?
  • Shouldgovernments include more people or expand services?
  • Should governments include more people or reduce direct payments?
three even harder questions
Three even harder questions

What criteria for including more people for key services?

Priority to sickest, the poor, the marginalized, those hard to reach?

Civil servants, military personnel, labor force, farmers

How to rank and choose key services?

Cost-effectiveness?

Priority to the worse off?

Financial risk protection?

For which patient groups should direct payments for key services be reduced first?

The lowest quintile?

Everyone?