The path to Universal Health Coverage

The WHO’s World Health Report (2010) is the most recent of the World Health Reports to focus on health systems, and it lays out the vision for Universal Health Coverage (UHC) which reflects current thinking about health system objectives. The report defines UHC as: “all people have access to services and do not suffer financial hardship paying for them” (page ix).

The report recognises, as do Frenk and colleagues (2014), that health is dependent on many factors outside the health sector. However, it argues that “timely access to health services – a mix of promotion, prevention, treatment and rehabilitation – is also critical” (page ix).

The report documents how far the world is from achieving UHC and estimates that:

• Closing coverage gaps in skilled birth attendance, for example, could save 700,000 lives in low income countries.
• Globally, about 150 million people suffer financial catastrophe as a result of health care costs.

Three pillars are identified as being needed to support a UHC strategy:

1. Raising sufficient funds to ensure the availability of health services that meet the major health needs of the population. In order to do this, it is suggested that countries need to:

   • Increase the efficiency of revenue collection
   • Reprioritise government budgets to give money to health
   • Explore innovative financing opportunities like taxes on air tickets, foreign exchange transactions or tobacco
   • Access development assistance (aid) for health

2. Reducing reliance on out of pocket payments (where people pay directly for health services they use) as a way to finance health services. Instead of charging fees for health services, the report recommends using tax or insurance schemes to finance health services. This reduces financial risk for individuals and shares risk across the population. Poor people will need subsidised health services, and payment through tax or insurance should be compulsory for those who can afford it, or people with low risk will opt out of the payment system.

3. Reducing inefficient and inequitable use of resources during the process of delivering health care. The main strategies proposed to achieve this are:

   • Selecting and procuring appropriate medicines
   • Selecting appropriate technologies and services
   • Motivating health workers
   • Improving hospital efficiency
   • Reducing medical errors
   • Eliminating waste and corruption in the health system
   • Critically assessing what services are needed
   • Reducing inequalities in coverage

All these ideas and strategies will receive substantially more attention throughout the course, especially in the week focused on financing.

Our view of what constitutes a health system, and the scope of health systems strengthening, has greatly widened over time. In the strategies discussed above, are there things you would consider ‘outside’ the scope of health systems strengthening? Reflect on this as we take a deeper look in the next two videos of the history of health systems strengthening.

References

Frenk, J., Gómez-Dantés, O. and Moon, S. 2014, ‘From sovereignty to solidarity: a renewed concept of global health for an era of complex interdependence’. The Lancet, vol. 383, pp.94-97.

World Health Organization 2010, Health systems financing: the path to universal coverage. World health report 2010. [online] Geneva: World Health Organization. Available at: https://www.who.int/whr/2010/en/ [Accessed 21 Jun. 2019].