While Washington continues to tussle over health coverage expansion for Americans, much of the rest of the world is deliberately and actively pursuing the same goal. Although achieving affordable universal health care will not be quick or easy, there is an increasing global consensus that it is critical to ensuring social and economic stability.
Global movement toward universal health coverage—defined as access to health services for all without suffering financial hardship as result—is a century old, but the pace has accelerated in recent years. China and India, for example, are now implementing ambitious coverage expansions and increasing their investments in health systems.
As each country forges its own pathway toward expanding coverage based on existing health resources and political circumstances, specific trends are emerging in the way each country is approaching the issue. Many are combining smaller, population-specific coverage plans into broader programs that will address the entire country, according to Gina Lagomarsino of the Results for Development Institute. Countries are also are devising independent health purchasing agencies that can buy products and services from both the private and public sectors.
New ways to generate revenues are being considered, too. Ghana, for example, recently created a new value-added tax to support national health insurance. But universal health coverage is not only about financing—it also requires adequate infrastructure and human resources, including doctors, community health workers, and nurses. Personnel also have to be in the right places and not overly concentrated in urban areas. Systems need proper governance and regulatory structures.
There are other challenges as well. China invested $371 billion in health reform between 2009 and 2013, with a special emphasis on rural populations, according to Yanzhong Huang, senior fellow for global health at the Council on Foreign Relations. But services offered are basic, and do not cover services like outpatient care for diabetes, which is a major health problem in China. And many of those seeking care report that it’s more difficult to see a doctor than it was before the reforms. In addition, many developing countries grapple with large populations that aren’t connected to the official economy and aren’t contributing taxes to support programs, which makes it more difficult to gauge if everyone is receiving services.
Ensuring quality of care is another critical issue. Margaret Kruk, assistant professor in health policy and management at Columbia University, says that while quality of care involves competent doctors and adequate medical supplies, it also entails respectful treatment of patients. She advocates for a specific, global, quality of care standard for all health care systems.
While national and local governments are expected to be the major drivers in health coverage expansion, the movement is also expected to offer major new opportunities for the private sector. For example, the global drug market is expected to rise to more than a trillion dollars this year. But countries will struggle with how to regulate the market to ensure services provided are cost effective and of adequate quality.
Integrating the private sector into developing coverage schemes is a top priority for private sector companies. “The private sector is not limited merely to providing products and services,” according to Ashoke Bhattacharjya, executive director for global health systems and innovation policy at Johnson & Johnson. “There is a clear and direct interest in the architecture of the health care system,” including system financing, Bhattacharjya said.
The private sector is also bringing to market health care products that are suited to particular environments in terms of cost and capacity of the infrastructure. In addition, it is playing a role in medical professionals and staff training.
The World Bank and World Health Organization are among the organizations joining the fight for universal health care. WHO is developing tools to help countries determine which services to offer while the World Bank is cataloging different approaches to universal health coverage and generating funding for health systems improvement. Both are working together to develop specific measurements to judge progress on universal health coverage, starting with the recent announcement of two ambitious goals:
- By 2020, reduce from 100 million to 50 million the number of people impoverished as a result of out-of-pocket health expenses; further reduce the figure to zero by 2030.
- By 2030, double from 40 to 80 percent the proportion of poor in developing countries who have access to basic health services.
Countries are also aiding each other. Nine developing countries currently participate in the Joint Learning Network for Universal Health Coverage, which provides a forum for countries to share challenges and solutions in approaching coverage expansion. More countries are expected to join the initiative this year.
The global movement toward universal health coverage provides a unique opportunity to focus attention on longstanding health systems issues and create more effective markets for health care services. With its special emphasis on disease prevention and reaching vulnerable populations, universal health coverage could improve health everywhere, allowing all citizens to more fully participate in economic activity and contributing further to poverty reduction and global economic development.
Nellie Bristol is Senior Fellow in the Global Health Policy Center at the Center for Strategic and International Studies. Her latest report is, “Global Action toward Universal Health Coverage.”