The Global Movement Towards
Universal Health Coverage
National Workshop on Universal Health Coverage (UHC)
Ruposhi Bangla Hotel, Dhaka, Bangladesh
18th February 2014
Rob Yates
Senior Health Economist
World Health Organisation
What is Universal Health Coverage?
A simple definition on UHC:
All people receive the quality
health services they need
without suffering financial
hardship
UHC is already a global priority
• “We must be the generation that delivers
Universal Health Coverage”
Dr Jim Kim, President of the World Bank, 21/05/2013
• “Universal coverage is the single most
powerful concept that public health has to
offer”
Dr Margaret Chan, DG of WHO, 23/05/2012
The Three Dimensions of UHC
Economics

Politics
Health
UHC is fundamentally about EQUITY
• Universal = Everybody. Nobody left behind
• Health services allocated according to NEED
• Health financing contributions according to
one’s ability to pay
• Healthy-wealthy cross-subsidise the sick and
the poor
• Not just curative services: preventive,
rehabilitative, palliative too
• Services must be good quality to be effective
UHC is achieved through PUBLIC Financing
• Market-driven privately financed health
systems do not result in UHC
• The state must force the healthy-wealthy to
cross subsidise the sick and the poor
• The state must be heavily involved in all
three main financing functions of raising
revenues, pooling and purchasing services
• Hence public financing is the key to UHC
• This doesn’t rule out private sector
administration or provision of services
Emerging consensus on health financing for
UHC
• User fees are “unjust and unnecessary”
Jim Kim, President World Bank , May 2013
• Private voluntary insurance including
community based insurance is ineffective,
inefficient and inequitable
• Public financing (tax financing and social
insurance) is the key to UHC
• All countries need to use tax financing to
cover those not in formal employment
A key difference between WDR 1993 and the new
Lancet Commission is the latter's emphasis on
universal health coverage (UHC) and its stance
towards private voluntary insurance—the market
forces of WDR 1993 now rejected in the 2013
Commission. “We are much more explicit about UHC
in the 2013 report”, Jamison says. “The path to UHC
cannot work with reliance on voluntary private
insurance”.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)62613-6/fulltext?rss%3Dyes
Rapid Scale Up Towards UHC Using Public (Mostly Tax) Funding to Cover
the Untargeted Informal Sector
Households from poorest to richest
120
100
Social health
insurance
contributions collected
from those in formal
employment
80
More efficient
and equitable if
these risk
pools can be
merged
60
40
20
0
Shift to universal
entitlement to publicly
funded services using
predominantly tax
financing
Bottom line: where government spends more on
health, people spend less out-of-pocket
90
80
India
OOPS as % total health spending
70
Armenia
Georgia
60
Egypt
KyrgyzstanAlbania
Iran Bosnia & Herzegovina
50
Philippines
Moldova
Kazakhstan
40
Romania
30
Thailand
Hungary
Serbia & Montenegro
20
Bhutan
USA
10
R2 = 0.66
0
0
1
2
3
4
5
6
Public spending on health % GDP
7
8
9
Source: WHO estimates for 2004, excluding countries with population < 600,000
10
Lessons from UHC successes
• Have prioritised population coverage
• Recognised failings of private voluntary
mechanisms including community insurance
• Heavy reliance on compulsory public
(especially tax) financing with some SHI
• Cover the informal sector as one group tend not to target the poor
• If they take premium contributions from the
informal sector these are very small
• No user fees or only very small co-payments
The Global Campaign for UHC
• Global UHC Campaign being driven by
political leaders, governments and civil
society, not technical agencies
• Especially MICs that have recently made
big progress towards UHC
• WHA Resolutions in 2005, 2008 and 2011
on UHC. World Health Report 2010
• UN General Assembly Resolution Dec 2012
– co-sponsored by the US!
Concluding thoughts
• UHC is good for population health
• UHC is easy to understand
• UHC is popular with people and politicians
across the world – it brings politics into
health systems
• Governments are the driving force behind
UHC and for it to become a post-2015 Goal
• Development agencies should embrace
UHC and be prepared to engage in the
politics of extending coverage