Health Systems

SDG 3.8 Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

The World Health Organisation has defined UHC as "ensuring that all people can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship."

"Universal health coverage (UHC) aims to ensure that everyone, everywhere, can access quality health services without facing financial hardship as a result. Every year 100 million people are pushed into poverty and 150 million people globally suffer financial catastrophe annually because of out-of-pocket expenditure on health services. Financial protection is at the core of UHC and improving financial protection is a central focus of health financing policy."

Schmidt and colleagues however, caution "The global move towards UHC by ensuring affordable access to essential health benefits is urgent and long overdue. The current enthusiasm and momentum is encouraging. However, the ultimate challenge for policy makers is not merely to improve clinical services, but to achieve equitable health outcome improvements through genuine integration of individual and population-level health promotion and preventative efforts with curative services."

This is echoed by a comment in the Lancet Public Health Universal Health Coverage: realistic and achievable? "Financing is an essential, and often forgotten, component of UHC. But progress toward UHC also requires coordinated actions across the different pillars of a health system— the health workforce in particular, but also health service delivery platforms and governance. Importantly, efforts also need to draw on in-country capacity and local context."

The same journal, a comment Universal Health Coverage and public health: a truly sustainable approach says "Universal Health Coverage (UHC) is driving the global health agenda" and "Crucially, as UHC continues to be championed and rolled out globally, all people working in global health need to reinforce the importance of including the full scope of public health in health system reforms; only then can the full potential of UHC be realised—a true reduction in health inequities."

A report in Lancet Global Health, seen in full here Implementing pro-poor universal health coverage - summarises as follows: "Universal health coverage (UHC)—the availability of quality, affordable health services for all when needed without financial impoverishment—can be a vehicle for improving equity, health outcomes, and financial wellbeing. It can also contribute to economic development. In its Global Health 2035 report, the Lancet Commission on Investing in Health (CIH) set forth an ambitious investment framework for transforming global health through UHC. The CIH endorsed pro-poor pathways to UHC that provide access to services and financial protection to poor people from the beginning and that include people with low income in the design and development of UHC health financing and service provision mechanisms."

The World Bank has produced nine volumes of Disease Control Priorities, 3rd edition (DCP3), and the key messages can be found in Universal health coverage and intersectoral action for health:key messages from Disease Control Priorities, 3rd edition This is a long paper, and for our purposes here let's look at this part of the summary: "DCP3 defines a model concept of essential universal health coverage (EUHC) with 218 interventions that provides a starting point for country-specific analysis of priorities. Assuming steady-state implementation by 2030, EUHC in lower-middle-income countries would reduce premature deaths by an estimated 4·2 million per year. Estimated total costs prove substantial: about 9·1% of (current) gross national income (GNI) in low-income countries and 5·2% of GNI in lower-middle-income countries. Financing provision of continuing intervention against chronic conditions accounts for about half of estimated incremental costs. For lower-middle-income countries, the mortality reduction from implementing the EUHC can only reach about half the mortality reduction in non-communicable diseases called for by the Sustainable Development Goals. Full achievement will require increased investment or sustained intersectoral action, and actions by finance ministries to tax smoking and polluting emissions and to reduce or eliminate (often large) subsidies on fossil fuels appear of central importance."

Sources of revenue

The Lancet Commission’s Global health 2035: a world converging within a generation is too large to explore in depth here, but it nicely identifies potential sources of revenue:

The revenue source for health services may be from public funds, private funds, donor funds, or from a combination of sources.
1. Public funds, or funding that comes from the government, may be increased through

a. Economic growth

b. New taxes on tobacco, or on natural resource production (extractive industry)

c. Removal of subsidies currently given

d. Finding efficiencies

e. Support through development assistance

2. Private funds, or funding that comes from the individual seeking care must be carefully considered, to ensure that there is no risk of financial hardship associated with seeking health services

3. Donor funds are likely necessary for low-income countries, but it is important to avoid relying completely on outside sources of funding. Over time, donor funding should be reduced and eventually removed.