The BMJ Today: Insurance and inequalities

kellyHow can health inequities be tackled when their causes lie beyond the control of the health sector or even national governments? This was the question that a report by the Lancet-University of Oslo Commission on Global Governance for Health sought to answer and that Guddi Vijaya Rani Singh scrutinises in her blog.

“We must be careful of applauding merely another glossy report,” says Singh, who most definitely holds back her applause. Ultimately she considers that the solutions offered by the commission fall short of the challenges created by a process of globalisation, which has promoted economic growth for some, but exacerbated health inequality for others.

Michael Marmot, a member of the above commission, was the bearer of more bad health equality news when he spoke at a seminar earlier this week to announce that now more working households are living in poverty than households where all of the adults are unemployed.

These people, said Marmot, are not in poverty through lack of hard work, but “because the structure of employment is such that people in low paid jobs are not paid enough” to live healthily.

Countries everywhere are trying to balance access to healthcare against a climate of spiralling costs—a struggle that has led to some interesting healthcare systems being pioneered.

In this feature, Andrew Jack looks at the example of Chile, which introduced a groundbreaking health insurance system that offered legally enshrined medical coverage, but only for a set list of conditions.

Chile is not alone in setting restrictions like this, finds Jack, and, as demand for healthcare grows so too does the complexity of interventions—all of which have their defenders and their detractors.

Finding the right health system is a head scratcher, but if you want to puzzle over some questions with certain answers, then have a go at answering the latest Endgames quiz, which asks you to identify the structures on a radiograph of the lumbar spine.

Kelly Brendel is assistant web editor, The BMJ