Health Affairs
December 2014; Volume 33, Issue 12
http://content.healthaffairs.org/content/current
Issue Theme: Children’s Health

How A New Funding Model Will Shift Allocations From The Global Fund To Fight AIDS, Tuberculosis, And Malaria
Victoria Y. Fan1,*, Amanda Glassman2 and Rachel L. Silverman3
Author Affiliations
1Victoria Y. Fan (vfan@post.harvard.edu) is an assistant professor in the Department of Public Health Sciences and Epidemiology at the University of Hawaii at Manoa, in Honolulu, and a research fellow at the Center for Global Development, in Washington, D.C.
2Amanda Glassman is director of global health policy and senior fellow at the Center for Global Development.
3Rachel L. Silverman is a policy analyst at the Center for Global Development.
Corresponding author
Abstract
Policy makers deciding how to fund global health programs in low- and middle-income countries face important but difficult questions about how to allocate resources across countries. In this article we present a typology of three allocation methodologies to align allocations with priorities. We then apply our typology to the Global Fund to Fight AIDS, Tuberculosis, and Malaria. We examined the Global Fund’s historical HIV allocations and its predicted allocations under a new funding model that creates an explicit allocation methodology. We found that under the new funding model, substantial shifts in the Global Fund’s portfolio are likely to result from concentrating resources in countries with more HIV cases and lower per capita incomes. For example, South Africa, which had 15.8 percent of global HIV cases in 2009, could see its Global Fund HIV funding more than triple, from historic levels that averaged 3.0 percent to 9.7 percent of total Global Fund allocations. The new funding model methodology is expected, but not guaranteed, to improve the efficiency of Global Fund allocations in comparison to historical practice. We conclude with recommendations for the Global Fund and other global health donors to further develop their allocation methodologies and processes to improve efficiency and transparency.

International Survey Of Older Adults Finds Shortcomings In Access, Coordination, And Patient-Centered Care
Robin Osborn1,*, Donald Moulds2, David Squires3, Michelle M. Doty4 and Chloe Anderson5
Author Affiliations
1Robin Osborn (ro@cmwf.org) is vice president and director of the International Health Policy and Practice Innovations program at the Commonwealth Fund, in New York City.
2Donald Moulds is executive vice president for programs at the Commonwealth Fund.
3David Squires is senior researcher to the president at the Commonwealth Fund.
4Michelle M. Doty is vice president of survey research and evaluation at the Commonwealth Fund.
5Chloe Anderson is a research associate in the International Health Policy and Practice Innovations program at the Commonwealth Fund.
Corresponding author
Abstract
Industrialized nations face the common challenge of caring for aging populations, with rising rates of chronic disease and disability. Our 2014 computer-assisted telephone survey of the health and care experiences among 15,617 adults age sixty-five or older in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States has found that US older adults were sicker than their counterparts abroad. Out-of-pocket expenses posed greater problems in the United States than elsewhere. Accessing primary care and avoiding the emergency department tended to be more difficult in the United States, Canada, and Sweden than in other surveyed countries. One-fifth or more of older adults reported receiving uncoordinated care in all countries except France. US respondents were among the most likely to have discussed health-promoting behaviors with a clinician, to have a chronic care plan tailored to their daily life, and to have engaged in end-of-life care planning. Finally, in half of the countries, one-fifth or more of chronically ill adults were caregivers themselves.