Person:
Cotlear, Daniel
Author Name Variants
Fields of Specialization
Health policy,
Health systems,
Universal health coverage,
Public economics,
Development economics,
Social policy
Degrees
ORCID
Departments
Global Practice on Health, Nutrition, and Population, The World Bank
Externally Hosted Work
Contact Information
Last updated
January 31, 2023
Biography
Daniel Cotlear was the team leader for the UNICO Program (Universal Health Coverage program) and the Universal Health Coverage Study Series that produced 24 country case studies of countries implementing UHC. He also was lead author for Going Universal – a book that synthesizes the series. He is Lead Economist at the World Bank’s Global Practice on Health, Nutrition, and Population, with a focus on developing tools to support countries in the implementation of universal health coverage. He has been involved in the preparation of dozens of country studies and of many policy and investment projects in three continents. Before joining the Bank he taught economics and was advisor to the Ministry of Agriculture of Peru.
Publication Search Results
1 - 10 of 10
-
Publication
Monitoring Monitoring : Assessing Results Measurement at the World Bank
(World Bank, Washington, DC, 2010-09)This paper documents a review of results monitoring in the portfolio of the Latin America and Caribbean Region Human Development Department (LCSHD) of the World Bank. While several aspects of results monitoring have improved in recent years, and while a focused department-level action plan made additional progress, further improvements require Bank-wide action. Specifically, the report finds that the Bank does not have a fully functioning system of results monitoring. The Bank does not have a set of rules or procedures governing the measurement of development results, nor does it have a physical platform for reporting results, nor an incentive structure designed to encourage results monitoring. The paper discusses this finding along with potential recommendations. -
Publication
Going Universal: How 24 Developing Countries are Implementing Universal Health Coverage from the Bottom Up
(Washington, DC: World Bank, 2015-09-24)This book is about 24 developing countries that have embarked on the journey towards universal health coverage (UHC) following a bottom-up approach, with a special focus on the poor and vulnerable, through a systematic data collection that provides practical insights to policymakers and practitioners. Each of the UHC programs analyzed in this book is seeking to overcome the legacy of inequality by tackling both a “financing gap” and a “provision gap”: the financing gap (or lower per capita spending on the poor) by spending additional resources in a pro-poor way; the provision gap (or underperformance of service delivery for the poor) by expanding supply and changing incentives in a variety of ways. The prevailing view seems to indicate that UHC require not just more money, but also a focus on changing the rules of the game for spending health system resources. The book does not attempt to identify best practices, but rather aims to help policy makers understand the options they face, and help develop a new operational research agenda. The main chapters are focused on providing a granular understanding of policy design, while the appendixes offer a systematic review of the literature attempting to evaluate UHC program impact on access to services, on financial protection, and on health outcomes. -
Publication
Measuring Progress towards Universal Health Coverage: With an Application to 24 Developing Countries
(World Bank, Washington, DC, 2015-11)The last few years have seen a growing commitment worldwide to universal health coverage (UHC). Yet there is a lack of clarity on how to measure progress towards UHC. This paper proposes a ‘mashup’ index that captures both aspects of UHC: that everyone—irrespective of their ability-to-pay—gets the health services they need; and that nobody suffers undue financial hardship as a result of receiving care. Service coverage is broken down into prevention and treatment, and financial protection into impoverishment and catastrophic spending; nationally representative household survey data are used to adjust population averages to capture inequalities between the poor and better off; nonlinear tradeoffs are allowed between and within the two dimensions of the UHC index; and all indicators are expressed such that scores run from 0 to 100, and higher scores are better. In a sample of 24 countries for which there are detailed information on UHC-inspired reforms, a cluster of high-performing countries emerges with UHC scores of between 79 and 84 (Brazil, Colombia, Costa Rica, Mexico and South Africa) and a cluster of low-performing countries emerges with UHC scores in the range 35–57 (Ethiopia, Guatemala, India, Indonesia and Vietnam). Countries have mostly improved their UHC scores between the earliest and latest years for which there are data—by about 5 points on average; however, the improvement has come from increases in receipt of key health interventions, not from reductions in the incidence of out-of-pocket payments on welfare. -
Publication
Health-System Reform and Universal Health Coverage in Latin America
(Elsevier, 2015)Starting in the late 1980s, many Latin American countries began social sector reforms to alleviate poverty, reduce socioeconomic inequalities, improve health outcomes, and provide financial risk protection. In particular, starting in the 1990s, reforms aimed at strengthening health systems to reduce inequalities in health access and outcomes focused on expansion of universal health coverage, especially for poor citizens. In Latin America, health-system reforms have produced a distinct approach to universal health coverage, underpinned by the principles of equity, solidarity, and collective action to overcome social inequalities. In most of the countries studied, government financing enabled the introduction of supply-side interventions to expand insurance coverage for uninsured citizens—with defined and enlarged benefits packages—and to scale up delivery of health services. Countries such as Brazil and Cuba introduced tax-financed universal health systems. These changes were combined with demand-side interventions aimed at alleviating poverty (targeting many social determinants of health) and improving access of the most disadvantaged populations. Hence, the distinguishing features of health-system strengthening for universal health coverage and lessons from the Latin American experience are relevant for countries advancing universal health coverage. -
Publication
Population Aging : Is Latin America Ready?
(World Bank, 2011)The past half-century has seen enormous changes in the demographic makeup of Latin America and the Caribbean (LAC). In the 1950s, LAC had a small population of about 160 million people, less than today's population of Brazil. Two-thirds of Latin Americans lived in rural areas. Families were large and women had one of the highest fertility rates in the world, low levels of education, and few opportunities for work outside the household. Investments in health and education reached only a small fraction of the children, many of whom died before reaching age five. Since then, the size of the LAC population has tripled and the mostly rural population has been transformed into a largely urban population. There have been steep reductions in child mortality, and investments in health and education have increased, today reaching a majority of children. Fertility has been more than halved and the opportunities for women in education and for work outside the household have improved significantly. Life expectancy has grown by 22 years. Less obvious to the casual observer, but of significance for policy makers, a population with a large fraction of dependent children has evolved into a population with fewer dependents and a very large proportion of working-age adults. This overview seeks to introduce the reader to three groups of issues related to population aging in LAC. First is a group of issues related to the support of the aging and poverty in the life cycle. Second is the question of the health transition. Third is an understanding of the fiscal pressures that are likely to accompany population aging and to disentangle the role of demography from the role of policy in that process. -
Publication
A New Social Contract for Peru: An Agenda for Improving Education, Health Care, and the Social Safety Net
(Washington, DC: World Bank, 2006)This book identifies the achievements and challenges of social policy in Peru. Its objective is to provide the new presidential administration of Peru with a diagnostic of the main problems that need to be overcome to improve education, health care, and anti-poverty programs, and with recommendations on how to overcome these problems. The diagnostic uses international comparisons that put in context the achievements in coverage, quality, and equity, and presents an analysis of the evolution and distribution of public expenditures and of the service delivery institutions. In recent decades, there have been several attempts to solve some of the problems identified in this study through the introduction of reforms; the analysis of the success and limitations of these reforms is used to obtain lessons and to make recommendations. The analysis of each sector uses a combination of quantitative data from surveys and administrative information systems and qualitative information from hundreds of interviews with parents, children, teachers, nurses, doctors, and municipal, regional, and ministerial authorities in different regions of the country. -
Publication
Going Universal in Africa: How 46 African Countries Reformed User Fees and Implemented Health Care Priorities
(World Bank, Washington, DC, 2018-01)This paper describes the health financing policies used today by African countries to expand health coverage. It identifies key health financing policies used by African countries and measures the existence of regional patterns in the use of these policies. The paper does not attempt to identify best practices, nor does it try to measure the effective coverage of the policies or their impact. Rather, it aims to add value to the existing literature by providing a systematic portrayal of the health financing policies that are in place across the region. The study concludes with a discussion about the implications of its findings for planning next steps to advance universal health. The rest of the paper is organized as follows. Section 2 describes the conceptual framework and methodology used in the study. Section 3 describes the different paths chosen by African countries to expand health coverage. Sections 4 and 5 describe the two key instruments used in that journey: the universal basic package of health services and the subpopulation health coverage programs. Section 6 reviews in detail some of the technical instruments required for the successful implementation of these policies. Section 7 uses the findings of the paper to discuss the cost estimations of implementing a broader benefit package to advance universal health coverage. The paper concludes with a summary of the findings and their implications. -
Publication
Bangladesh: Unravelling the 'Good Health at Low Cost' Story
(World Bank, Washington, DC, 2019-07)This case study describes Bangladesh’s success story using the standardized approach used by the Universal Health Coverage Studies Series (UNICO Studies Series) to provide a balanced account of the key pillars that lay behind the success of pluralism in the health system of Bangladesh. The aim is to recognize the contributions of the different actors (including the Government and the informal sector, which in the past have not been sufficiently recognized) and the strengths and weaknesses of these pillars as the needs and opportunities evolve due to emerging health issues. This lack of knowledge is an impediment to policy formulation and implementation aimed at maintaining the success of Bangladesh in the health sector. The case study suggests that there were four pillars to the successful pluralism that characterized Bangladesh: (a) effective prioritization of public financing on highly cost-effective interventions, (b) effective alignment of government and DP financing based on the mechanism of the SWAp, (c) extensive use of female CHWs and innovative NGOs, and (d) a large informal private sector that functions as a retailer of an unusually large and competitive domestic pharmaceutical industry. It should be acknowledged that determinants such as significant poverty reduction, education of girls, female labor force participation, and water and sanitation interventions outside the health sector also played a significant role in achieving better health outcomes. -
Publication
PERU - Making Accountability Work : Lessons from RECURSO
(World Bank, Washington, DC, 2008-09)This note describes the experience of RECURSO - the Spanish acronym for Accountability for Social Reform (REndicion de CUentas para la Reforma SOcial), a successful effort to create the missing link: high expectations. The RECURSO program provided the impetus for the establishment of easy-to-understand standards by which citizens can measure the quality of basic public services. It enables parents to take advantage of accountability mechanisms and, ultimately, ensure better health and education services for their children. This note describes the genesis, implementation, and impact of RECURSO. The Bank has had an active human development portfolio in Peru since 1990. Looking back, it is possible to distinguish three phases in the evolution of this portfolio. The first focused on coverage, the second on improving rules of accountability, and the third on making the accountability rules enforceable by fostering the establishment of standards by which citizens can measure the quality of public services. Peru has experienced huge increases in the coverage of education, health care and some social assistance programs. Comparisons to countries with similar income levels in Latin America and Caribbean (LAC) and elsewhere indicate that Peru has higher coverage in primary, secondary, and tertiary education. -
Publication
Some Economic Consequences of Global Aging : A Discussion Note for the World Bank
(World Bank, Washington, DC, 2010-12)The note describes the importance of population aging world-wide, clarifying its prevalence among middle- and low-income countries, which suggests that many developing countries are getting old before they are growing rich. The note then asks in what way population aging is an economic problem and what are the specific challenges facing developing countries in this process. The note argues against the common, time-bomb perception?, and clarifies how a simplistic extrapolation from the impact of aging on single programs such as public pensions gives a misleading impression about the more general macroeconomic consequences of population aging, where numerous elements contribute to a more nuanced result. The note briefly discusses various topics of importance in the population aging debate, including: intergenerational flows, social contracts, the risk management element of old-age policies, and the impact of aging on health care costs. The note seeks to share a number of counterintuitive or simply non-intuitive facts, including: (i) the large impact of declines in fertility on population aging (often more important than increases in longevity); (ii) the impact of increased life expectancy on working age populations (often larger than among old age populations); (iii) the positive impact of aging on capital intensity; (iv) the need to include education in assessments of intergenerational equity (these often simply look at who pays for old-age pensions and health services); and (v) the role of long-term care programs as insurance for risks faced by young adults.