Universal Health Coverage

Srinath Reddy, Yasmine Rouai, Jeffrey L. Sturchio, Cicely Thomas, Tana Wuliji, Snow Yang, Pascal Zurn

Vaccinate children against deadly pneumococcal disease, or pay for cardiac patients to undergo lifesaving surgery? Cover the costs of dialysis for kidney patients, or channel the money toward preventing the conditions that lead to renal failure in the first place? Policymakers dealing with the realities of limited health care budgets face tough decisions like these regularly. And for many individuals, their personal health care choices are equally stark: paying for medical treatment could push them into poverty. Many low- and middle-income countries now aspire to universal health coverage, where governments ensure that all people have access to the quality health services they need without risk of impoverishment. But for universal health coverage to become reality, the health services offered must be consistent with the funds available—and this implies tough everyday choices for policymakers that could be the difference between life and death for those affected by any given condition or disease. The situation is particularly acute in low- and middle income countries where public spending on health is on the rise but still extremely low, and where demand for expanded services is growing rapidly. What’s In, What’s Out: Designing Benefits for Universal Health Coverage argues that the creation of an explicit health benefits plan—a defined list of services that are and are not available—is an essential element in creating a sustainable system of universal health coverage. With contributions from leading health economists and policy experts, the book considers the many dimensions of governance, institutions, methods, political economy, and ethics that are needed to decide what’s in and what’s out in a way that is fair, evidence-based, and sustainable over time.

Universal health coverage (UHC) has been recognized by the World Health Organization as a key element in reducing social inequality and a critical component of sustainable development and poverty reduction. In most of the world UHC is sought through a combination of public and private-sector health care systems. In most low- and middle-income countries health systems are evolving to increasingly rely on the private sector because the public sector lacks the infrastructure and staff to meet all health care needs. With growing individual assets available for private-sector expenditure, patients often seek better access to technology, staff, and medicines. However, in low-income countries nearly 50 percent of health care financing is out-of-pocket. With the expected increase in the overall fraction of care provided through the private sector, these expenditures can be financially catastrophic for individuals in the informal workforce. In the global workforce of approximately 3 billion people, only 10 to 15 percent are estimated to have some type of access to occupational health services. The informal workforce is growing worldwide, and the degree to which its occupational health needs are satisfied depends on the capabilities of the general health care system. In July 2014, the Institute of Medicine held a workshop on approaches to universal health coverage and occupational health and safety for informal sector workers in developing countries. This report summarizes the presentations and discussions from this workshop. Approaches to Universal Health Coverage and Occupational Health and Safety for the Informal Workforce in Developing Countries identifies best practices and lessons learned for the informal workforce in developing countries in the financing of health care with respect to health care delivery models that are especially suitable to meeting a population's needs for a variety of occupational health issues, including the prevention of or mitigation of hazardous risks and the costs of providing medical and rehabilitation services and other benefits to various types of workers within this population. These experiences and lessons learned may be useful for stakeholders in moving the discussions, policies, and mechanisms forward to increase equitable access to quality health services without financial hardship for the informal workforce.

"The World Health Report: research for universal health coverage" focuses on the importance of research in advancing progress towards universal health coverage. In addition, it identifies the benefits of increased investment in health research by low- and middle-income countries using case studies from around the world, and proposes ways to further strengthen this type of research.

As the culminating volume in the DCP3 series, volume 9 will provide an overview of DCP3 findings and methods, a summary of messages and substantive lessons to be taken from DCP3, and a further discussion of cross-cutting and synthesizing topics across the first eight volumes. The introductory chapters (1-3) in this volume take as their starting point the elements of the Essential Packages presented in the overview chapters of each volume. First, the chapter on intersectoral policy priorities for health includes fiscal and intersectoral policies and assembles a subset of the population policies and applies strict criteria for a low-income setting in order to propose a "highest-priority" essential package. Second, the chapter on packages of care and delivery platforms for universal health coverage (UHC) includes health sector interventions, primarily clinical and public health services, and uses the same approach to propose a highest priority package of interventions and policies that meet similar criteria, provides cost estimates, and describes a pathway to UHC.

This accessibly written book explains universal healthcare; the many forms it can take; and the issues, debates, and historical context underpinning the continued struggle for its implementation in the United States. Universal healthcare may be defined as any healthcare system that ensures at least basic coverage to most, if not all, citizens of a country. Although it may be implemented in many ways, universal healthcare has been widely accepted by international humanitarian organizations such as the World Health Organization (WHO) as the best way to ensure the universal human right to health. So why is the United States the only industrialized country without universal healthcare? What are the political, social, and economic factors that have prevented its successful introduction? Universal Healthcare explores what universal healthcare is, the many forms it can take—using examples from countries around the world—and the tumultuous history of attempts to implement a system of universal healthcare in the United States. Part II delves into the contentious issues and debates surrounding adoption of universal healthcare in the United States. Lastly, Part III provides a variety of useful materials, including case studies, a timeline of critical events, a glossary, and a directory of resources.

This report describes the current situation with regard to universal health coverage and global quality of care, and outlines the steps governments, health services and their workers, together with citizens and patients need to urgently take.

This book is about 24 developing countries that have embarked on the journey towards universal health coverage (UHC) following a bottom-up approach, with a special focus on the poor and vulnerable, through a systematic data collection that provides practical insights to policymakers and practitioners. Each of the UHC programs analyzed in this book is seeking to overcome the legacy of inequality by tackling both a “financing gap†? and a “provision gap†?: the financing gap (or lower per capita spending on the poor) by spending additional resources in a pro-poor way; the provision gap (or underperformance of service delivery for the poor) by expanding supply and changing incentives in a variety of ways. The prevailing view seems to indicate that UHC require not just more money, but also a focus on changing the rules of the game for spending health system resources. The book does not attempt to identify best practices, but rather aims to help policy makers understand the options they face, and help develop a new operational research agenda. The main chapters are focused on providing a granular understanding of policy design, while the appendixes offer a systematic review of the literature attempting to evaluate UHC program impact on access to services, on financial protection, and on health outcomes.