MANILA – Universal health coverage (UHC) means that all people have access to the quality health services they need, when and where they need them, without financial hardship. All countries have committed to achieve UHC as part of the Sustainable Development Goals (SDG 3). However, a new World Health Organization (WHO) report finds that while access to essential health services like antenatal care and management of infectious diseases has increased over the past two decades, it has come at a high cost to families in the Western Pacific Region.
Released ahead of UHC Day on 12 December, Progress Towards Universal Health Coverage: Monitoring financial protection in the Western Pacific Region reports that the percentage of people in the Western Pacific who suffered catastrophic health expenses − defined as out-of-pocket spending on health that exceeds 10% of the household budget − doubled between 2000 and 2017. In 2000, one in 10 people in the Region incurred catastrophic health spending. By 2017, this proportion had increased to one in five – totalling some 385 million people in the Western Pacific facing catastrophic spending on health care.
“No person should have to choose between whether to seek life-saving care or feed their family,” said Dr Zsuzsanna Jakab, WHO Acting Regional Director for the Western Pacific. “To achieve universal health coverage for all people in the Region and reduce catastrophic health spending, it is critical that governments prioritize investments in health, and implement effective policies to protect the poorest and most vulnerable.”
Inequalities in financial hardship in the Region
High out-of-pocket expenses can prevent people − especially vulnerable populations − from seeking health care, and when the cost to the household is relatively high compared to their ability to pay, health expenses can push families into financial hardship.
The report finds that catastrophic health spending is mostly affecting people living in Asian countries and areas in the Region. Evidence for countries and areas in the Pacific was limited. It also found that financial hardship from health spending is highest among those who live in households that are poorer, have older members or are in rural areas. Left unchecked, this situation can exacerbate health and socioeconomic inequalities in the Region.
Policy gaps in ensuring affordable access to medicines
For households in the Western Pacific Region, medicines are the biggest drivers of out-of-pocket health spending, followed by outpatient care (that is, health services that do not involve staying overnight in a hospital). The report finds that in several countries, medicines account for more than half of households’ out-of-pocket spending on health. Other recent studies have found that medicines account for a higher share of out-of-pocket expenses for poorer households compared to those that are better off.
“The evidence is alarming in this Region,” said Lluis Vinals Torres, WHO Director of Health Systems and Services for the Western Pacific. “Not only does paying for surgeries or complex care in hospital lead to financial hardship, so does paying for medicines. When governments do not cover the cost of outpatient medicines, make quality medicines available through the public sector, or regulate medicine prices, it forces families into financial hardship. This is particularly true for patients with chronic conditions who need daily medications. There is an urgent need to enact policies to address this.”
With rapidly ageing populations and increasing rates of noncommunicable diseases like heart disease, diabetes and cancer in the Western Pacific, the burden of paying for medicines is expected to rise in the years to come if bold actions are not taken to address the existing policy gaps.
Financial protection policies required for universal health coverage
UHC is a crucial goal of the 2030 Agenda for Sustainable Development, and essential for realizing the WHO’s For the Future vision to make the Western Pacific the world’s safest and healthiest region. However, without strong and effective financial protection measures, access to quality, affordable and accessible health care for all will not be achieved.
Financial protection means removing financial barriers to accessing health services. Having financial protection makes it more likely for people to seek care when they need it, rather than foregoing care that they need but cannot afford, and it protects those who access care from catastrophic spending.
While Member States in the Western Pacific Region are implementing policies aimed at reducing financial hardship on the path towards UHC, faster progress is needed. Strengthening financial protection requires policymakers to increase public funding for health, implement strategies to allocate resources efficiently, prioritize the poorest and most vulnerable groups, reduce out-of-pocket expenses on medicines, and improve data collection on financial hardship and financial barriers to accessing services.
Note to editors:
The report, Progress Towards Universal Health Coverage: Monitoring financial protection in the Western Pacific Region, presents data on the status and trends of financial hardship for 13 countries in the Western Pacific Region from 2000 to 2017, which were the most recent data available at the time of writing. The report includes data from Australia, Cambodia, China, Fiji, Japan, Kiribati, the Lao People’s Democratic Republic, Malaysia, Mongolia, the Philippines, the Republic of Korea, Singapore and Viet Nam.
For the latest data on health service coverage and financial hardship by country, please consult WHO’s Global Health Observatory.
On Tuesday, 12 December 2023, 12:30–13:30 Manila time, WHO will host a webinar to share findings from the report and discuss progress towards UHC in the Western Pacific Region. Speakers will include: Lluis Vinals Torres, Director, Division of Health Systems and Services for the WHO Western Pacific Region; Ding Wang, Health Economist, WHO Western Pacific Region; Rozita Halina binti Tun Hussein, former Director of the Planning Division, Ministry of Health, Malaysia; Idrish Khan, Head of Finance and Asset Management, Ministry of Health and Medical Services, Fiji; and Soonman Kwon, Professor and former Dean of the School of Public Health, Seoul National University.
Journalists and others can join the webinar by registering here.