Alex Azar’s Excellent UHC Adventure

US HHS Secretary Alex Azar endorsed the private sector at a UHC event on May 24, 2018. (Image: Brian W. Simpson)
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US HHS Secretary Alex Azar endorsed the private sector at a UHC event on May 24, 2018. (Image: Brian W. Simpson)


A bright line clearly divided 2 sections at a World Health Assembly side event on universal health coverage Thursday at the Swiss Press Club. It demarcated “Before Azar” and “After Azar.”

US Health and Human Services Secretary Alex Azar brought a crystal clear Trump Administration message of improving health care and access by relying more on the private sector, while global health experts who spoke after him emphasized more collaborative, public efforts.

“We applaud efforts to encourage universal coverage and access, understanding this need not only happen through government interventions,” said Azar, who, like later speakers, emphasized that each country must make its own journey to UHC.

Azar boldly endorsed the private sector’s role in health care. “In many cases, private delivery systems offer more responsive services, greater efficiencies in care, and they play an important role in nearly every country’s health system,” said Azar.

He challenged centralized, government assessments of the cost-effectiveness of treatments. “We believe there is an indispensable role for consumers and patients and the private sector in assessing and securing this value,” he said. “Academic research can only tell us so much.”

Azar shared his priorities with the audience, which include giving consumers more control over health information, increasing transparency in price and quality from providers and payers like private insurers, deploying experimental models in US government health programs like Medicare to “drive value throughout the entire health system,” and removing various “government burdens” that inhibit coordination of care.

“Getting more bang for the buck, as we say, will be major step for universal health care and universal access to quality care in the United States,” said Azar, who did not take questions and left immediately after his 5-minute speech at the event sponsored by the Global Health Council, Living Goods and others.

Kwanele Asante, an advocate for people with noncommunicable diseases, followed the Secretary and lifted the discourse from the macro and technical and into more personal terms.

“In Alma Ata in 1978, we said we will give universal coverage. As a patient, I want to say, we are late. We’re failing. There’s too much of good English words. We need to distill to real things,” Asante said. “What patients want are not political commitments. We want to see clear pathways of how you … are going to finally bring us to universal health coverage.

“The global health patient community is tired of rhetoric. We need to see action,” Asante said. “We need real change now.”

Jane Aceng, Uganda’s Minister of Health, recounted her country’s steps to UHC, including the introduction of a minimum health care package in 1999, the decentralization of health services, the abolishment of user fees in health facilities in 2001 and the creation of village health teams.

She candidly assessed the challenges that remain: expanding access to comprehensive care, strengthening the health system, improving financing of care and addressing social determinants of health.

Ashish Jha, director of the Harvard Global Health Institute and moderator of the event, picked up on the theme of the need for ongoing improvements, citing the UK’s National Health Service struggles 70 years after its debut. “This is really a journey that never ends,” Jha said. “It is a constant, ongoing challenge.”

Jha framed UHC around 2 broad issues: How to finance it and, once you have the money, how make sure that people get the care they need.

Barbara Stillwell, a senior director with IntraHealth International, said she’s been listening to the discussion about expanding access to health care “roughly since the earth was cooling.” She prescribed 3 steps to achieving that: Expand use of digital tools that allow community health workers to be tracked to ensure delivery of care and keep them connected, build a pipeline of trained health workers and continually educate them.

Ed Note: See the latest news from #WHA71 here.  

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