Abstract
Globally, countries have agreed to pursue the progressive realization of universal health coverage (UHC) and there is now a high level of political commitment to providing universal coverage of essential health services while ensuring that individuals are financially protected against high health spending. The aim of this paper is to help policy-makers think through the progressive realization of UHC. First, the pitfalls of applying global normative expenditure targets in estimating the national revenue required for UHC are discussed. Then, several recommendations on estimating national revenue are made by moving beyond the question of how much UHC will cost and focusing instead on the national health-care reforms and policy choices needed to progress towards UHC. In particular, costing exercises are recommended as a tool for comparing different service delivery options and investment in data infrastructure is recommended for improving the information needed to identify the best policies. These recommendations are intended to assist health policy-makers and international and national agencies who are developing country plans for the progressive realization of UHC.
Highlights
In 2015, United Nations’ Member States agreed to pursue the progressive realization of universal health coverage (UHC) as part of their commitment to the sustainable development goals
The World Health Organization (WHO) defines UHC as providing all people and communities with the promotive, preventive, curative, rehabilitative and palliative health services they need, of a sufficient quality, while ensuring that use of these services does not result in financial hardship.[1]
To help policy-makers think through this question for their own countries, we first discuss the importance of reframing the question such that the focus is less on global normative expenditure targets and more on the national policy choices and reforms needed to expand coverage and provide financial protection to all
Summary
In 2015, United Nations’ Member States agreed to pursue the progressive realization of universal health coverage (UHC) as part of their commitment to the sustainable development goals. Costing exercises can help identify the investments in infrastructure, resources and payment mechanisms needed to change the service delivery model such that care shifts from hospitals to primary care facilities This approach may be useful in evaluating reforms of the health-care workforce, which is a key constraint in many settings. In Kyrgyzstan, the approach of costing individual elements of health-care reform contributed to the development of a case-based hospital payment system that drove restructuring and efficiency gains.[17] The approach resulted in policies that allowed facilities to retain savings, matched payments to the services provided and enabled better data collection for the Kyrgyz single-payer system In this way, cost accounting was used to evaluate specific policy options on the sequencing of reforms. A comparison with expenditure levels and reforms in other countries with similar income levels or in the same region may be helpful in discussions with policy-makers
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