Universal health coverage
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This document provides an overview of universal health coverage. It defines universal health coverage as access for all to quality health services without financial hardship. The document discusses why moving toward universal health coverage is important for health, economic, and political benefits. It also examines how countries can accelerate progress through health financing reforms and by raising sufficient funds, pooling resources, and purchasing health services. Key challenges around measuring and achieving equity in universal health coverage are also addressed.
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Universal health coverage
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- 3. CONTENTS • INTRODUCTION • WHAT IS UNIVERSAL HEALTH COVERAGE? • WHY IS MOVING TOWARDS UNIVERSAL HEALTH COVERAGE IMPORTANT? - HEALTH BENEFITS - ECONOMIC BENEFITS - POLITICAL BENEFITS • HOW CAN COUNTRIES ACCELERATE PROGRESS TOWARDS UNIVERSAL HEALTH COVERAGE? • HOW CAN HEALTH FINANCING REFORMS ACCELERATE PROGRESS TOWARDS UNIVERSAL HEALTH COVERAGE? • CONCLUSION 3
- 4. GLOBAL HEALTH – KEY FACTS • 400 million people globally lack access to one or more essential health services. • Every year 100 million are pushed into poverty and 150 million people suffer financial catastrophe because of out-of-pocket expenditure on health services. • 32% of total health expenditure worldwide comes from out-of-pocket payments. - WHO 4
- 6. “The world health organization is working around the world so that all people and communities receive the quality services they need, and are protected from health threats, without suffering financial hardship” The Concept 6
- 7. Universal: All people regardless of race, gender, social status Health services: curative, health promotion, prevention, rehabilitation, and palliative Quality: sufficient quality to be effective Financial hardship: lowering out of pocket costs and the risk of catastrophic health expenditure The Concept Decoded 7
- 8. Key Elements Relating to people’s use of the health services they need The economic consequences of doing so 8
- 9. Historical Perspectives 1883 Health Insurance Bill, Germany became the first country to make nationwide health insurance mandatory. In U. K. Enactment of the National Insurance Act in 1911 and the National Health Service (NHS) in 1948. Article 25.1 of the 1948 Universal Declaration of Human Rights states right to health as an important fundamental right. 1966, The International Convention on Economic, Social and Cultural Rights recognized "the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. 1978: Alma-Ata declaration & the vision of "health for all.“ World Health Assembly adopted the term 'Universal Health Coverage' in 2005. 9
- 10. MDG 2000 • UHC and the Millennium Development Goals (MDGs) are strictly connected. • UHC implies open access for all to health services,& involves strengthening efforts to improve the quality, availability & affordability of services linked to the current MDGs including, for example, the fight against HIV/AIDS, TB, malaria & child and maternal mortality. 10
- 11. UHC and SDGs Goal 3: Ensure healthy lives and promote wellbeing for all at all ages Target 3.8: Achieve UHC 11
- 12. Health Goal is Not in Isolation UHC also supports achievement of other SDGs 12
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- 14. THE THIRD GLOBAL HEALTH TRANSITION 14
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- 18. WHY IS MOVING TOWARDS UHC IMPORTANT? Health Benefits Economic Benefits Political Benefits 18
- 19. Health Benefits of UHC 19
- 20. Story of Brazil • 1988 brazil initiated an extensive program of health reforms with the intention of increasing the coverage of effective services for the poor and otherwise vulnerable. • Prior to 1988, just 30 million brazilians had access health services. • Today, coverage is closer to 140 million, roughly three- quarters of the population. 20
- 21. END RESULT • Significant improvements across a range of health indicators • IMR - fell from 46 per 1000 live births in 1990 to 17.3 per 1000 live births in 2010. • Life expectancy at birth has also improved, reaching 73 years in 2010 compared to 70 years just a decade earlier. The reforms also reduced health inequalities with the life expectancy gap between the wealthier south of the country and poorer north falling from 8 years to 5 years between 1990 and 2007 21
- 23. STORY OF THAILAND An independent review report on the first ten years of Thailand’s Universal Coverage Scheme(UCS) Dramatic reduction in the proportion of out-of-pocket health expenditure,& associated falls in the number of households suffering catastrophic health expenditures &impoverishment due to health care costs. Between 1996 and 2008 the incidence of catastrophic health care expenditure amongst the poorest quintile of households covered by the UCS fell from 6.8 % to 2.8 %. 23
- 24. END RESULT The review calculated that the comprehensive benefit package provided by the UCS and the reduced level of out-of- pocket expenditure protected a cumulative total of 292,000 households from health related impoverishment between 2004 and 2009. 24
- 25. POLITICAL BENEFITS UHC is popular across the world and if UHC reforms are implemented properly they can build peace and security in countries & deliver substantial political benefits to governments. Many leaders coming to power after a national crisis (be it economic or political) have implemented rapid UHC reforms 25
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- 28. UHC : good health, good economics 28
- 29. EPIC The trends examined in universal health coverage can be called as EPIC Acronym, in view of the epic transition now underway as the world moves towards universal coverage. 29
- 30. E for ECONOMICS Good health is not only a consequence of economic development, but also a driver of it, since healthier people can do more. • In particular, improved financial protection for families against large medical bills reduces their risk of financial ruin and makes assets and savings more secure, enabling them to save more; when many families benefit, their increased economic activity can stimulate improved economic 30
- 31. Idea of health as an investment rather than an expenditure. 10% improvement in life expectancy at birth is associated with annual economic growth increases of 0.3 – 0.4%. 31
- 32. P for POLICIES & POLITICS The importance of good policies and good management of the political challenges is compellingly evident from the huge differences in health achievements between countries with similar per head incomes. Ex:Thailand Extensive investment in health infrastructure, successful integration of vertical programmes into the primary health-care system, robust training institutions paired with policies mandating rural service by health workers, and health financing reforms to ensure equitable access to care have enabled Thailand to make great strides in improving health at 32
- 33. Mexico Has benefited from paying close attention to policies and politics. Its achievement, announced this year, of universal coverage, after initiating reforms in 2003, means that 50 million Mexicans who formerly were among the poorest and most excluded now have access to care. 33
- 34. I for INSTITUTIONS • Economics, policies, and politics enable change, but institutions have to deliver. • Both public and private institutions have crucial roles, and good health system performance needs an optimum mix of functions between them. • Delivery of services is best served through a pluralistic mix that includes the private sector and civil society. 34
- 35. C for COST • Economics, policy, politics, and institutions can go far, but if the costs of improved health cannot be met in a sustainable and equitable manner, all is lost. • Countries that have planned how to cover health-care costs reasonably well (by collecting enough revenue fairly and deploying it efficiently) thrive; those that have not struggle. 35
- 36. GLOBAL PERSPECTIVES• Universal health coverage can be achieved in many different ways, as the diversity of approaches around the world shows. • Every country will develop its own path, reflecting its own culture and legacy from existing health systems • Joint Learning Network of countries that currently includes Ghana, Mali, Nigeria, Kenya, Vietnam, Thailand, India, Indonesia, the Philippines, and Malaysia Adapting rather than adopting 36
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- 38. HEALTH REFORMS In considering their financing options, governments need to consider three main functions of the health financing system: = Raising sufficient financial resources to cover the costs of the health system = Pooling financial resources to protect people from the financial consequences of ill-health, such as loss of income and having to pay for health services = Purchasing health services to ensure the optimal use of available resources 38
- 39. How much should countries be spending on health? There is not really a correct answer to this question “ but if UHC is the goal, then countries need to move towards predominant reliance on public funding for their health systems, as well as an organization of their systems that serves the entire population rather than catering to privileged groups ” UNIVERSAL IS UNIVERSAL. 39
- 40. Problem Does Not Go Away As Countries Get Richer….. Evidence suggests that as countries develop, the relative demand for health services by the population compared to other goods and services increases, so the proportion of a country’s gross domestic product (gdp) spent on health actually increases. 2011 global health expenditure data WHO member states 40
- 41. “Universal health care is not one-size-fits- all and does not imply coverage for all people for everything” But remember… UHC IS NO HOLY GRAIL!!! who is covered what services are covered, and how much of the cost is Universal health care can be determined by three critical dimensions: 41
- 42. UHC Cube 42
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- 44. FILLING THE CUBE The ultimate goal of UHC is to move toward filling more of the larger cube depicted above from prepaid and pooled funds. Decision makers should recognize that progress along only one of these axis is not sufficient. Therefore the best way to make progress towards UHC is to involve all relevant stakeholders (including the general population) in producing a strategy that is most appropriate for the country. 44
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- 47. UHC AND EQUITY • The UHC endeavour should be built on a foundation of human rights and equity. • Countries should ensure that the coverage needs of all their citizens are addressed. ‘Universal’ means universal and any strategy that explicitly leaves any person (especially people with greater needs) uncovered should be deemed unacceptable. 47
- 48. • This does not mean that everybody has to receive their health services using the same financing sources and the same providers. • Richer members of society – should be free to purchase health services using out-of pocket financing or private insurance. • However, strategies that prioritise covering privileged groups first – e.g. formal sector workers or civil servants – with better quality services and which leave poorer people to fend for themselves in the health care market are fundamentally inequitable, and indefensible in human rights 48
- 49. Measuring UHC: It is a challenge! WHO and World Bank UHC Measurement Framework (2014) Population coverage with equity • Disaggregate population coverage by gender, wealth quintile, place of residence Health service coverage • Antenatal care (% pregnant women) • Skilled birth attendance (% pregnant women) • Immunization (% children) Financial protection • Households experiencing catastrophic health expenditure (%) • Households pushed into poverty (%) 49
- 50. GAP IN KNOWLEDGE • Indicators for health service coverage and financial risk protection are measureable – i.e. progress towards UHC is measureable • This will have to include an equity dimension • But there are currently data gaps for many indicators that need to be addressed as part of UHC monitoring, especially in low income countries Regular household surveys and health facility reporting 50
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- 52. Universal health coverage day 52
- 53. CONCLUSION - Dispelling myths about UHC UHC is not just health financing, it should cover all components of the health system to be successful. UHC is not only about assuring a minimum package of health services. UHC does not mean free coverage for all possible health interventions, regardless of the cost, as no country can provide all services free of charge on a sustainable basis. UHC is comprised of much more than just health; taking steps towards UHC means steps towards equity, development priorities, 53
- 54. HEALTH IS A HUMAN RIGHT NO UNIVERSAL FORMULA FOR UHC ADAPTING RATHER THAN ADOPTING IS THE WAY FORWARD 54
- 55. REFERNCES 1)OECD (June 27, 2013). "OECD Health Data: Social protection". OECD Health Statistics (database). Paris: OECD. doi:10.1787/data-00544-en. Retrieved 2013-07-14. 2)Constitution of the World Health Organization. Geneva, World Health Organization, 1948. 3)World Health Organization. Universal health coverage factsheet [Internet].cited 2016 Aug 10]. Available from: http://www.who.int/mediacentre/factsheets/fs395/en/ . 4)World Health Organization. The world health report: health systems financing:path to universal coverage. Geneva: World Health Organization; 2010. 5) Universal Health Coverage for Inclusive and Sustainable Development-Tracking universal health coverage: first global monitoring report;World Health Organization 2015 55
- 56. 6) Mexico City Political Declaration on Universal Health Coverage: sustaining universal health coverage, sharing experiences and promoting progress. April 2, 2012. http://www.who.int/healthsystems/topics/financing/MexicoCityPoliticalDeclarationUnive rsalHealthCoverage.pdf 7) Conference. Jan 28, 2012. http://www.pmaconference.mahidol.ac.th/index. php?option=com_content&view=article&id=525:2012-bkk statementfinal&catid=981:cat-2012-conference 8) Garrett L, Chowdhury AMR, Pablos-Méndez A. All for universal health coverage. Lancet 2009; 374: 1294–99. 9) Moreno-Serra R, Smith PC. Does progress towards universal health coverage improve population health? Lancet 2012; 380: 917–23. 56
- 57. 10) Rodney and Hill: Achieving equity within universal health coverage: a narrative review of progress and resources for measuring success. International Journal for Equity in Health 2014 13:72. 11) Lagomarsino G, Garabrant A, Adyas A, Muga R, Otoo N. Moving towards universal health coverage: health insurance reforms in nine developing countries in Africa and Asia. The Lancet. 2012 Sep 8;380(9845):933-43. 12) Rodin J, de Ferranti D. Universal health coverage: the third global health transition?. The Lancet. 2012 Sep 8;380(9845):861-2. 13) Evans DB, Marten R, Etienne C. Universal health coverage is a development issue. The Lancet. 2012 Sep 8;380(9845):864-5. 14) Frenk J, De Ferranti D. Universal health coverage: good health, good economics. The lancet. 2012 Sep 8;380(9845):862-4. 57
- 58. THANK YOU
Editor's Notes
- 1)DEMOGRAPHIC TRANSITION 2)EPIDEMIOLOGICAL TRANSITION 3)GLOBAL HEALTH TRANSITION