The world is currently facing a significant challenge in achieving universal health coverage (UHC) by 2030, a key target within the Sustainable Development Goals (SDGs). Recent data reveals a concerning stagnation in improvements to health service coverage since 2015. Simultaneously, an increasing proportion of the global population is burdened by catastrophic levels of out-of-pocket health spending. This concerning trend spans across all regions and the majority of nations, prompting a critical question: Should Our Country Have A Universal Health Care Program?
Universal health coverage is founded on the principle that everyone, regardless of their socioeconomic status, should have access to a full spectrum of quality health services. These services should be available when and where people need them, without causing financial hardship. UHC encompasses the entire continuum of essential health services, from proactive health promotion and disease prevention to treatment, rehabilitation, and palliative care, throughout all stages of life. This necessitates a robust health workforce comprising skilled health and care professionals at every level of the health system. These workers must be fairly distributed, adequately resourced with quality medical products, and afforded decent working conditions.
The Stalling Progress of Universal Health Coverage
While the UHC service coverage index saw a substantial increase from 45 to 68 between 2000 and 2021, the pace of improvement has significantly slowed in recent years. Progress in expanding coverage has decelerated since 2015, with a mere 3 index point increase between 2015 and 2021 and no discernible change since 2019. This indicates a worrying trend of stagnation, leaving a vast portion of the world’s population without adequate access to essential health services. Specifically, in 2021, approximately 4.5 billion people remained not fully covered by the health services they critically needed.
Furthermore, the financial burden associated with healthcare is escalating. The proportion of individuals facing catastrophic out-of-pocket health expenditures has been on a continuous rise since 2000. Currently, around 2 billion people globally are experiencing financial hardship due to health costs. This includes a staggering 1 billion individuals facing catastrophic out-of-pocket health spending and 344 million people being pushed into deeper poverty as a direct consequence of health expenses. This financial strain underscores the urgent need for systems that protect individuals from the economic repercussions of seeking necessary medical care.
The COVID-19 pandemic further exacerbated the fragility of global health systems. At the peak of the pandemic in 2021, essential health services were disrupted in a staggering 92% of countries. Even in 2022, a substantial 84% of countries continued to report ongoing disruptions. This widespread disruption has had a devastating impact on access to routine care, preventative services, and timely treatment, further highlighting the vulnerabilities in current healthcare systems.
The Case for a Universal Health Care Program
The concept of a universal health care program offers a compelling solution to address these critical issues and ensure that all citizens have access to essential health services without facing financial ruin. Implementing a UHC program can bring about numerous benefits for a country and its population:
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Improved Population Health Outcomes: UHC ensures that everyone has access to preventive care, early diagnosis, and treatment, leading to better overall health outcomes and increased life expectancy. By removing financial barriers, people are more likely to seek timely medical attention, preventing conditions from worsening and reducing the burden of chronic diseases.
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Reduced Financial Hardship and Poverty: A cornerstone of UHC is protecting individuals from the financial devastation of healthcare costs. By providing comprehensive coverage, UHC minimizes out-of-pocket expenses, preventing individuals and families from being plunged into poverty due to medical bills. This financial security contributes to overall economic stability and well-being.
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Increased Economic Productivity: A healthy population is a productive population. UHC contributes to a healthier workforce by ensuring access to healthcare, reducing absenteeism due to illness, and improving overall well-being. This, in turn, boosts economic productivity and fosters national development.
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Greater Health Equity and Social Justice: UHC promotes equity by ensuring that healthcare access is not determined by income, social status, or geographic location. It upholds the principle that healthcare is a fundamental human right, not a privilege, and strives to reduce health disparities across different segments of society.
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Strengthened Public Health Infrastructure: Implementing UHC often necessitates strengthening primary health care systems and public health infrastructure. This investment not only improves routine care but also enhances a country’s capacity to respond effectively to public health emergencies, such as pandemics.
Navigating the Challenges of Universal Health Care
While the benefits of UHC are substantial, implementing such a program is not without its challenges. Countries considering UHC must carefully consider and address potential hurdles:
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Cost and Funding: One of the primary concerns surrounding UHC is the cost. Establishing and sustaining a comprehensive healthcare system requires significant financial investment. Governments need to explore various funding mechanisms, such as taxes, social insurance contributions, or a combination thereof, to ensure the long-term financial viability of the program.
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Potential for Increased Wait Times: In some UHC systems, there can be concerns about longer wait times for certain specialist appointments or elective procedures due to increased demand. Efficient management, resource allocation, and strategic investment in healthcare infrastructure are crucial to mitigate this potential issue and ensure timely access to care.
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Bureaucracy and Administration: Implementing a large-scale UHC program can introduce administrative complexities and bureaucracy. Streamlined processes, efficient management systems, and leveraging technology are essential to minimize administrative burdens and ensure smooth operation.
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Maintaining Quality and Choice: It is crucial to ensure that UHC programs maintain high standards of healthcare quality and offer patients reasonable choices in terms of providers and treatment options. Mechanisms for quality assurance, patient feedback, and provider accountability are necessary to maintain and improve the quality of care within a UHC system.
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Political Feasibility and Public Support: Implementing UHC is a significant policy undertaking that requires political will and broad public support. Engaging stakeholders, addressing concerns, and building consensus are vital for successful implementation and long-term sustainability.
Primary Health Care: The Foundation of Universal Health Coverage
The World Health Organization (WHO) strongly recommends reorienting health systems towards a primary health care (PHC) approach as the cornerstone of achieving UHC. PHC is recognized as the most inclusive, equitable, cost-effective, and efficient pathway to enhance people’s physical and mental health and overall social well-being. It emphasizes providing universal, integrated access to health services that are as close as possible to people’s everyday environments.
A PHC-oriented approach can deliver the vast majority (90%) of essential UHC interventions. By strengthening primary care systems, countries can achieve significant cost efficiencies, improve health outcomes, and make substantial progress towards UHC goals. It is estimated that embracing PHC could potentially save 60 million lives and increase global average life expectancy by 3.7 years by 2030.
Conclusion: Investing in a Healthier Future
The evidence is clear: universal health coverage is not just a moral imperative but also a strategic investment in a nation’s future. By ensuring that all citizens have access to quality health services without financial hardship, countries can unlock a healthier, more productive, and more equitable society. While challenges exist in implementing UHC, they are surmountable with careful planning, strategic resource allocation, and a commitment to prioritizing the health and well-being of all citizens. As we strive towards a more sustainable and just world, the question is not whether we can afford universal health care, but rather, can we afford to be without it?
For further information, please refer to the WHO’s resources on universal health coverage:
