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Unit 9 Reading & Listening Practice - Reading Text
World Health Organisation 2010, The world health report, accessed 8 March 2019,
<https://www.who.int/whr/2010/10_summary_en.pdf>.
Report
According to the World Health Organisation (WHO), universal healthcare (also called universal
health coverage, universal coverage, or universal care) is a health care system that provides
health care and financial protection to all citizens of a particular country or region. It is
organised around providing a specified package of benefits to all members of a society with the
end goal of providing financial risk protection, improved access to health services, and improved
health outcomes.
1. Universal Health Coverage (UHC) exists when all people receive the quality health services, they
need without suffering financial hardship. Universal Health Coverage combines two key
elements, the first relating to people’s use of the health services they need and the second to
the economic consequences of doing so. The first objective is that everybody should be able to
access a full range of health services including promotion, prevention, treatment, rehabilitation
and palliative care. These services should be of good quality. It is of no use having access to a
scanner that is poorly calibrated or run by an untrained health worker. Because the emphasis
here is on everybody getting the treatment they need, the objective includes an important
equity dimension. The second objective is to ensure protection from the financial risk associated
with seeking care. The need to pay for care at the point of use (whether through explicit policies
on user fees or informal payments) discourages people from using services and can cause
financial hardship for those that do seek care. The best way around this is to expand coverage
with compulsory prepayment of some type – e.g., taxes and other government charges, social
insurance premiums – that are subsequently pooled to spread risks. Contributions should reflect
people’s ability to pay which means that there will always need to be subsidies for the poor and
vulnerable.
2. Promoting and protecting health is essential to human welfare and sustained economic and
social development. This was recognized more than 30 years ago by the Alma‐Ata Declaration
signatories, who noted that Health for All would contribute both to a better quality of life and
also to global peace and security. Not surprisingly, people also rate health as one of their
highest priorities, in most countries behind only economic concerns, such as unemployment,
low wages and a high cost of living. Recognizing this, Member States of the World Health
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Organization (WHO) committed in 2005 to develop their health financing systems so that all
people have access to services and do not suffer financial hardship paying for them. This goal
was defined as universal coverage, sometimes called universal health coverage.
3. The beneficial effect of increasing coverage with good quality health services is well
documented. One recent study of statistical trends from 153 countries published in The Lancet
found that broader health coverage generally leads to better access to necessary care and
improved population health, with the largest gains accruing to poorer people. These findings are
borne out by recent experiences in scaling up service coverage with financial risk protection in
countries with markedly different income levels. There are also many examples of countries that
have had significant improvements in population health as a result of initiatives designed to
expand or improve coverage, though it is important to note that in each case the countries
continue to struggle with coverage issues of one kind or another.
4. How health services are paid for is a key aspect of health system performance, but it also has
profound implications for the broader economy. One of the most common forms of payment
for health is out‐of‐pocket payment for medicines and health services at the time of need, and it
is the poorer countries that rely on it most. An estimated 150 million people suffer financially
crippling health payments because of this annually, while 100 million people are pushed below
the poverty line simply because they need to use health services but must pay out‐of‐pocket for
them. One recent study showed that in the Indian state of Gujarat, 88% of households falling
below the poverty line believed this was due to health care costs. The problem is by no means
limited to developing countries, however, as evidenced by the United States, where it is
estimated that over half of personal bankruptcies are due to expenses for medical care, a
situation that will hopefully change as a result of the implementation of the Affordable Care Act.
At the individual or household level, people can be protected from high out‐of‐pocket health
expenditures through the extension of pre‐paid pooled funds which have the potential to
reduce or eliminate the financial risk associated with sudden, unpredictable health costs.
Families who benefit from such protection are not only healthier in financial terms, but they
also have less need to save for future health events, which often allows them to spend more on
other things, boosting cash flow in the broader economy. Worries about health care bills have
been the main cause of excessively high savings rates in some countries, notable among which is
China, where it has had a negative impact on domestic consumption and perhaps even the
world economy.
5. There is a growing recognition that reforms to promote progress towards UHC can also deliver
political benefits. Financed sustainably and implemented well, such reforms can be a vote
winner. It is perhaps not surprising then that many major UHC initiatives have come from
political leaders in the run‐up to elections and immediately following a transition of power. It is
worth noting that many of the political leaders that have led these processes derived substantial
political benefits in subsequent elections. Indeed, some political pioneers of UHC have become
national heroes. For example, in 2004 the Canadian public voted in a national poll for greatest
Canadian and chose the architect of their UHC reforms, Tommy Douglas. Douglas fought to
establish UHC in Saskatchewan province where it proved successful and was adopted as
national policy. However, it is also important to note that initiating reforms to move towards
UHC need to be planned very carefully in advance, notably in regard to their ultimate
sustainability in the face of inevitable increases in demand for health care. Making promises
that cannot be kept is worse than making no promises at all.
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6. The World Health Assembly resolution 58.33 from 2005 declares that everyone in the world
should be able to access health services and not be subject to financial hardship in doing so. On
both counts, we are still a long way from universal coverage. On the service coverage side, the
proportion of births attended by a skilled health worker can be as low as 10% in some countries,
for example, while it is close to 100% for countries with the lowest rates of maternal mortality.
Within countries, similar variations exist. Rich women generally obtain similar levels of
coverage, wherever they live, but the poor miss out. Women in the richest 20% of the
population are up to 20 times more likely to have a birth attended by a skilled health worker
than a poor woman. Closing this coverage gap between rich and poor in 49 low‐income
countries would save the lives of more than 700 000 women between now and 2015.
7. Three fundamental, interrelated problems restrict countries from moving closer to universal
coverage. The first is the availability of resources. No country, no matter how rich, has been able
to ensure that everyone has immediate access to every technology and intervention that may
improve their health or prolong their lives. The second barrier to universal coverage is an
overreliance on direct payments at the time people need care. These include over‐the‐counter
payments for medicines and fees for consultations and procedures. Even if people have some
form of health insurance, they may need to contribute in the form of co‐payments, co‐
insurance or deductibles. The third impediment to a more rapid movement towards universal
coverage is the inefficient and inequitable use of resources. At a conservative estimate, 20– 40%
of health resources are being wasted. Reducing this waste would greatly improve the ability of
health systems to provide quality services and improve health. Improved efficiency often makes
it easier for ministries of health to make a case for obtaining additional funding from ministries
of finance. The path to universal coverage, then, is relatively simple – at least on paper.
Countries must raise sufficient funds, reduce the reliance on direct payments to finance
services, and improve efficiency and equity.
8. Although domestic financial support for universal coverage will be crucial to its sustainability, it
is unrealistic to expect most low‐income countries to achieve universal coverage without help in
the short term. The international community will need to financially support domestic efforts in
the poorest countries to rapidly expand access to services. For this to happen, it is important to
know the likely cost. Recent estimates of the money needed to reach the health Millennium
Development Goals (MDGs) and to ensure access to critical interventions, including for non‐
communicable diseases in 49 low‐income countries, suggest that, on average (unweighted),
these countries will need to spend a little more than US$ 60 per capita by 2015, considerably
more than the US$ 32 they are currently spending. This 2015 figure includes the cost of
expanding the health system so that they can deliver the specified mix of interventions. The first
step to universal coverage, therefore, is to ensure that the poorest countries have these funds,
and that funding increases consistently over the coming years to enable the necessary scale‐up.
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