The WHO defines Universal Health Coverage as “access to health services, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship”. UHC is a “concept that is deeply rooted in its 1946 Constitution, which declares health to be a fundamental human right”.
UHC is designed as a three-dimensional system that progressively moves towards:
i) the coverage of the entire population by a package of services,
ii) inclusion of an increasing range of services, and
iii) a rising share of pooled funds as the main source of funding for healthcare, and thereby a decrease in co-payments.
This model is gaining in popularity and the current discourse on UHC is dominating the majority of inter- national discussions on health care. UHC is presented as the response to urgent needs in health in low and medium income countries. Some enthusiastic backers have named it the “third great transition” in health, by changing the way in which services and the organisation of systems are financed.
Since 2010, over 80 countries have requested technical assistance from the WHO in their attempts to achieve this goal. The emerging economies of Brazil, Russia, India, China and South Africa (the “BRICS”, representing almost half of the global population) have all undertaken UHC measures. UHC is a key target (target 3.8) in achieving the third global goal: “ensure healthy lives and promote well-being for all at all ages”. This is all good news. We do, however, see a danger in the dominant interpretation of the UHC concept. Does UHC mean universal health insurance coverage? Or does it mean providing high quality health care for all? What role should the State play? Should we count on the private sector? On the international stage, in the first instance, the focus was placed on “sustainable financing” for UHC22. UHC is not primarily focused on the way in which health care services have to be provided, but on the way in which these services have to be financed. The fundamental principle seems to indicate that if the finances are guaranteed, the health care services could well be provided by a variety of combinations involving both the public and private sectors.
The overarching concept of UHC seems to recommend a pooling of finances for health; the same is not suggested for the provision of services. In other words, there is no proposal for a unified system of public provision. The importance of reinforcing public health care services is not part of the dominant discourse. And we believe that it should be.
UHC is designed as a three-dimensional system that progressively moves towards:
i) the coverage of the entire population by a package of services,
ii) inclusion of an increasing range of services, and
iii) a rising share of pooled funds as the main source of funding for healthcare, and thereby a decrease in co-payments.
This model is gaining in popularity and the current discourse on UHC is dominating the majority of inter- national discussions on health care. UHC is presented as the response to urgent needs in health in low and medium income countries. Some enthusiastic backers have named it the “third great transition” in health, by changing the way in which services and the organisation of systems are financed.
Since 2010, over 80 countries have requested technical assistance from the WHO in their attempts to achieve this goal. The emerging economies of Brazil, Russia, India, China and South Africa (the “BRICS”, representing almost half of the global population) have all undertaken UHC measures. UHC is a key target (target 3.8) in achieving the third global goal: “ensure healthy lives and promote well-being for all at all ages”. This is all good news. We do, however, see a danger in the dominant interpretation of the UHC concept. Does UHC mean universal health insurance coverage? Or does it mean providing high quality health care for all? What role should the State play? Should we count on the private sector? On the international stage, in the first instance, the focus was placed on “sustainable financing” for UHC22. UHC is not primarily focused on the way in which health care services have to be provided, but on the way in which these services have to be financed. The fundamental principle seems to indicate that if the finances are guaranteed, the health care services could well be provided by a variety of combinations involving both the public and private sectors.
The overarching concept of UHC seems to recommend a pooling of finances for health; the same is not suggested for the provision of services. In other words, there is no proposal for a unified system of public provision. The importance of reinforcing public health care services is not part of the dominant discourse. And we believe that it should be.
Extract from dossier Health, a commodity, by Campaign of Social Protection for all
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