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20-02-2013 | Legal medicine | Article

Trade in health ‘credits’ proposed to reach Millennium Development Goals

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medwireNews: A global market based around the cost effectiveness of health interventions could help countries get back on track with their Millennium Development Goals (MDGs) for 2015, health policy experts propose.

Likening the approach to carbon trading, the team says it could help raise much-needed funds to manage health globally.

The market would rely on exchange of Disability Adjusted Life Years (DALY) credits, whereby high- and middle-income countries can buy up credits from highly cost-effective health interventions in low-income countries if they want to implement a new health intervention that is cost-effective in their own health system, but exceeds an agreed global cost-effectiveness threshold.

"If implemented, an analogous tradable DALY credits market would incentivize countries to scale-up their global health commitments to meet the health MDGs," write study authors Luis Carrasco (University of Singapore) and team in PLoS Medicine.

Under the system, they estimate that high- and middle-income countries would respectively contribute 74% and 26% of the US$ 36-45 billion needed each year to meet necessary health targets on areas such as reducing child deaths, reducing maternal deaths, and improving the management of infectious diseases, such as HIV/AIDS, malaria, and tuberculosis.

Carrasco and colleagues explain that the underlying method links countries' global health aid donations with their domestic health investment from the perspective of reducing the disease burden globally: the greater their investment in low cost-effectiveness interventions, the more inefficiently high- and middle-income countries allocate resources to reduce that burden.

"The system then encourages compensation for the resulting inefficiency by requiring the support of highly cost-effective projects in low-income countries," they write.

Countries needing to scale up their currently expected annual contributions markedly include the USA (US$ 7-10 billion), China (US$ 2-3 billion), Japan (US$ 2 billion), and Germany (US$ 1.5 billion). A few, such as Norway, the United Arab Emirates, Luxembourg, and the UK already meet or exceed the outlay required under the DALY credit system.

The authors conclude: "A DALY tradable credit market offers the potential to increase the efficiency of global health investments while, at the same time, promoting international obligations to the pursuit of an agreed global common good."

By Caroline Price, Senior medwireNews Reporter

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