Health
Insurance, access to care and public health. Real interventions, each with its sources: what worked, what didn't, and why.
10 worked3 mixed1 didn't work
What worked
- WorkedHealth
Mutuelles de Santé: community-based health insurance
ChallengeOut-of-pocket fees kept many Rwandan families from seeking health care.
Community-run health insurance, with premiums based on household wealth.
91%of the population enrolled by 2010ObservationalRead case - WorkedHealth
Thailand's Universal Coverage Scheme
ChallengeAbout 30% of Thais had no health insurance, and medical bills pushed families into poverty.
Health coverage for everyone not already insured, funded from general taxes.
37.4%fewer households impoverished by health costs in 2008, vs no-UCS scenarioObservationalRead case - WorkedHealth
UK Soft Drinks Industry Levy
ChallengeHigh sugar intake from soft drinks was driving childhood obesity.
A tiered tax on drink makers based on how much sugar their drinks contain.
−33.8 ptsshare of drinks over the levy's sugar threshold, by February 2019Quasi-experimentalRead case - WorkedHealth
Mexico's tax on sugary drinks
ChallengeMexico had very high sugary drink consumption and rising obesity and diabetes.
One peso per liter on sugar-sweetened beverages, in a country with very high consumption.
−12%purchases of taxed drinks by end of 2014Quasi-experimentalRead case - WorkedHealth
Ireland's workplace smoking ban
ChallengeBar and restaurant workers were exposed to secondhand smoke every shift.
The world's first national ban on smoking in all enclosed workplaces, including pubs.
−13%immediate fall in all-cause mortality after the ban, ages 35+Quasi-experimentalRead case - WorkedHealth
Australia's plain tobacco packaging
ChallengeBranded cigarette packs worked as advertising, especially to young people.
Cigarettes sold in drab, standardized packs with large health warnings and no branding.
25countries and territories with plain packaging by 2024Quasi-experimentalRead case - WorkedHealth
Free versus subsidized malaria bednets
ChallengeMalaria killed many children, and too few families slept under insecticide-treated nets.
Testing whether charging a small price for bednets makes people value and use them more.
−75%drop in net uptake when price rose from $0 to $0.75RCTRead case - WorkedHealth
Ending polio in India
ChallengeIndia had about half the world's polio cases and millions of hard-to-reach children.
Mass vaccination days reaching every child under five, repeated until polio disappeared.
0polio cases since January 2011ObservationalRead case - WorkedHealth
Youth substance use prevention model: Iceland
ChallengeIcelandic teenagers had some of the highest rates of drinking and smoking in Europe in the 1990s.
Surveys, parent engagement, curfews and funded after-school activities to steer teens away from drinking.
9%10th graders currently drinking in 2015 (Europe average 48%)ObservationalRead case - WorkedHealth
Smoke-Free Air Act: New York City
ChallengeNonsmokers, including bar and restaurant workers, were widely exposed to secondhand smoke indoors.
Banned smoking in virtually all workplaces, including bars and restaurants, alongside public education.
−11%adult smoking prevalence in NYC, 2002–2003, under the full tobacco-control packageObservationalRead case
Mixed results
- MixedHealth
Oregon Health Insurance Experiment
ChallengeOregon could only afford Medicaid for a fraction of eligible low-income adults.
A Medicaid lottery that became a rare randomized test of health insurance.
−9.15 ppin positive depression screens from Medicaid coverage, about two years onRCTRead case - MixedHealth
Opt-out organ donation in Wales
ChallengeToo few people registered as organ donors, and families often refused at the bedside.
Everyone is a donor unless they opt out.
44.4% → 64.5%family consent, 2014 to mid-2017, but donor numbers barely changedObservationalRead case - MixedHealth
Social prescribing link workers: England
ChallengeMany GP visits stem from loneliness, debt or housing problems that medicine cannot fix.
The NHS funded link workers in GP practices to refer patients to community groups and services.
15 of 15UK evaluations rated at high risk of bias (2017 review)Meta-analysisRead case