Date Published: November 22, 2010
Publisher: Public Library of Science
Author(s): Sara Bennett, Sachiko Ozawa, Krishna D. Rao
Partial Text: From the US to China, South Africa to India, governments and citizens are engaged in an active debate about how best to protect people from catastrophic health care costs while ensuring access to health care of adequate quality. While it is widely known that in the US there are 50 million uninsured, it is perhaps less well known that across the world 100 million people are pushed into poverty each year because of health care expenditures. This is an avoidable tragedy.
The report structures its arguments around three main themes: (i) raising sufficient resources for health, (ii) reducing financial risks and barriers to care, and (iii) increasing efficient use of resources. On the first point, all countries face constant demands to increase their health spending. The report argues that there are multiple ways to do this through leveraging greater domestic resources, notably through exploring an increasing menu of innovative mechanisms to increase funds available to health. However, it also recognizes that most low-income countries need external assistance to achieve universal coverage.
The report makes many sensible and balanced suggestions and provides an excellent overview of recent evidence. But will it make a difference to the 100 million people potentially facing poverty because of health care costs, or the many other millions without adequate access to care? On this question, our response is nuanced: we believe that the report provides a vision of a good health financing system that is sufficiently flexible for many states to adopt. It also provides a compass and an overview of possible routes to achieve that vision. However, the report falls short in identifying important milestones along the route or providing detailed guidance on the implementation process to achieve universal coverage.
There is an explosion of interest in universal health coverage with many countries experimenting with and adopting new health financing strategies. The World Health Organization and other concerned agencies need to ensure that countries can receive support along the path to universal coverage if they seek it. All countries, regardless of their stage of development, face the challenge to increase domestic funds for health care and reduce inefficiencies. Facilitating the sharing of experiences between countries in terms of the challenges faced and how they have been managed is essential. The indicators for monitoring universal coverage presented in the report can help track progress and allow countries to learn which strategies are effective.