Experience of Achieving Universal Coverage: A Review of Health Care Financing in Four Organization for Economic Cooperation Development (OECD) Countries (Canada, the Republic of Korea, Mexico and the United Kingdom)

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Background: The World Health Assembly Resolution in 2005 urges Member States to introduce and/or strengthen universal coverage policies to facilitate financial risk protection (FRP) to households in order to avoid catastrophic health expenditures and impoverishment from seeking care. The other goal of universal coverage is to ensure equitable access to healthcare based on relative need, irrespective of ability to make health payments, social status or geographical location. The two prepaid financing mechanisms that promote universal coverage are mandatory health insurance and general tax revenue. Aim: To undertake a comparative analysis of selected OECD countries with universal coverage to derive lessons that could inform the development of universal coverage policy in low-to-middle income (LMICs) countries. Methods: Empirical evidence on the selected OECD countries was sourced through an extensive review of published literature from print and electronic sources. Countries were selected from different continents to include health systems with a long history as universal systems. Most universal systems are in OECD countries. OECD countries were selected because of availability of high quality credible data. The data for the analysis is sourced from OECD Health Data 2008 dataset. Kutzin’s conceptual framework is the analytical tool for the critical analysis of empirical evidence in terms of the equity, sustainability, efficiency and feasibility of each health system. Results: Findings from the analysis show that publicly funded (primarily tax -funded) systems have lower out-of-pocket expenditures and offer greater financial risk protection. Systems with a single risk pool and a single payer tend to be administratively efficient. Allocating health resources based on a needs-based allocation formula is more equitable than historical budgeting. Capitation provider payment promotes greater efficiency than fee-for-service. A purchaser-provider split also improves efficiency.