Universal health coverage can transform more lives than any UN anti-poverty scheme

Kai Hong Phua is a professor of health and social policy at the Lee Kuan Yew School of Public Policy in Singapore. ILLUSTRATION | JOHN NYAGAH |  NATION MEDIA GROUP

By KAI HONG PHUA

In Summary

• Achieving universal health coverage globally is therefore a noble ambition that could transform more lives than any of the anti-poverty schemes yet promoted by the UN.
• Instead of thinking the task ends with instituting politically popular but unrealistic universal health insurance, governments need to think carefully about how limited public sector resources can best be deployed.inShare

This week, the World Health Organisation (WHO) meets in Geneva to discuss its agenda for ................................
the year ahead. In addition to pressing topics such as Ebola, officials will discuss the Sustainable Development Goals – the replacement for the UN’s Millennium Development Goals, due to expire this year.

There is increasing consensus that developing countries should commit to “universal health coverage” – that is, reforming health systems so that everyone can access care without suffering crippling financial costs.

While the majority of people in developed countries take it for granted that a hospital stay will not result in a catastrophic bill, people in developing countries are less fortunate. Some 150 million people each year in these countries suffer financial catastrophe as a result of having to pay for healthcare, forcing people to choose between healthcare and housing, education, and even food.

Achieving universal health coverage globally is therefore a noble ambition that could transform more lives than any of the anti-poverty schemes yet promoted by the UN.

Sadly, the signs are that the WHO’s campaign will end up over-promising and under-delivering, just like WHO’s past populist battle cries such as the 1980’s “Health for all by the year 2000.”

This is because many of today’s proponents of universal health coverage tend to conflate it with universal health insurance, in which all citizens subscribe to a single government-controlled insurance fund, topped up with tax revenues. Such funds exist from the Philippines to Belize, and are the dominant model among countries moving towards universal health coverage.

Universal health insurance is seen by many ideological groups as a magic bullet to address the woes of the healthcare system, by ensuring equality of access for all people, regardless of wealth, while mobilising extra money for hospitals and doctors.

If only it were this easy. Free healthcare is certainly politically alluring, but too many countries are jumping on this bandwagon without first undertaking difficult but vital reforms of health infrastructure.

Giving people free access to care is useless if hospitals are decaying, quality is low, and there are too few doctors and nurses.

This is the unfortunate reality in most developing countries, a situation compounded by poor governance. It is well known, for instance, that many doctors in China’s public hospitals routinely require illegal payments from patients.

Capacity problems are exacerbated if a seemingly “free” national health programme unleashes a tidal wave of new demand without accompanying health sector reform. This is what happened in Indonesia in 2014 when it implemented its new national health insurance scheme without looking at the supply side.

That is not to say that universal health coverage is an impossible dream for developing countries. But instead of thinking the task ends with instituting politically popular but unrealistic universal health insurance, governments need to think carefully about how limited public sector resources can best be deployed.

One answer would be for governments to increase their spending on public health measures, such as improving sanitation and vaccination. This would be of enormous benefit to the poorest, who suffer a disproportionate burden of preventable infectious diseases.

Governments should also focus limited resources on supplying essential services to the poor, instead of trying to offer everything for free to everyone.

The private and non-profit sectors have an important role, but sadly many proponents of universal health insurance tend to downplay their importance. In Africa, nearly 50 per cent of patients currently use private or non-state providers, as do three quarters of the poorest children in Asia.