Universal Health Coverage (UHC) is a concept gaining increasing global attention, but Should Our Country Have A Universal Health Care Program? Around the world, nations are grappling with the complexities of healthcare systems, striving to ensure that all citizens have access to the medical services they need without facing financial ruin. The push for UHC stems from a fundamental belief: healthcare is a human right, not a privilege.
What is Universal Health Coverage?
Universal Health Coverage, often abbreviated as UHC, is more than just health insurance. It signifies a system where all people, regardless of their socioeconomic status, have access to a full spectrum of quality health services. These services span from essential health promotion and disease prevention to treatment, rehabilitation, and even palliative care, covering all stages of life. UHC aims to provide these services “when and where” people need them, ensuring timely and appropriate care.
The backbone of UHC relies on a well-supported healthcare workforce. This includes skilled health and care workers distributed equitably across all levels of the health system. They must have access to quality medical products and work in decent conditions to effectively deliver the necessary services.
A crucial element of UHC is financial protection. It aims to shield individuals from the potentially devastating financial consequences of seeking healthcare. Without UHC, out-of-pocket payments can force families to deplete savings, sell assets, or fall into debt, perpetuating cycles of poverty across generations.
The Global Imperative for UHC
The pursuit of Universal Health Coverage is not merely a national aspiration; it is a globally recognized target. In 2015, the United Nations Sustainable Development Goals (SDGs) were adopted, with UHC firmly embedded as a key objective (SDG target 3.8). This commitment was further reinforced at the 2019 UN General Assembly High Level Meeting on UHC, where nations reaffirmed health as both a precondition for and an outcome of sustainable development.
The World Health Organization (WHO) has placed UHC at the forefront of its global health agenda. The WHO’s Thirteenth General Programme of Work includes an ambitious goal: to have one billion more people benefit from UHC by 2025. This is part of a broader strategy to improve global health security and well-being, alongside protecting populations from health emergencies and promoting healthier lives.
Progress and Stagnation: A Global Reality Check
While the vision of UHC is compelling, the reality on the ground reveals a mixed picture of progress and persistent challenges. Prior to the COVID-19 pandemic, the world had witnessed encouraging advancements in expanding health service coverage. However, this momentum has faltered in recent years.
The UHC service coverage index, a key metric for tracking progress (SDG indicator 3.8.1), shows a concerning trend. While it increased significantly between 2000 and 2015, progress has slowed considerably since. By 2019, the index had only risen marginally, and it stagnated at this level through 2021. This stagnation means that, as of 2021, an estimated 4.5 billion people globally were still not fully covered by essential health services.
Financial hardship related to healthcare is also on the rise. The proportion of the population facing catastrophic out-of-pocket health spending (SDG 3.8.2) has steadily increased. By 2019, this affected over one billion people. Furthermore, in the same year, healthcare costs pushed an estimated 344 million people into extreme poverty and 1.3 billion into relative poverty. In total, around 2 billion people experienced some form of financial hardship due to health expenses in 2019.
This concerning trend of slowing service coverage improvement coupled with rising financial hardship is not limited to specific regions or income levels. It is a global pattern observed across various regions, income groups, and the majority of countries, highlighting the widespread challenges in achieving true universal health coverage.
The Case for Universal Health Care
The data paints a stark picture, underscoring the urgent need to revitalize the global push for UHC. The WHO strongly advocates for reorienting health systems towards a primary health care (PHC) approach as the foundation for achieving UHC.
Primary health care is considered the most inclusive, equitable, cost-effective, and efficient pathway to strengthen health systems and improve population health. PHC emphasizes providing integrated access to a comprehensive range of health services within people’s communities. This approach not only improves health service coverage and financial protection but also promotes preventative care and health education.
Studies indicate that a PHC-oriented approach can deliver approximately 90% of essential UHC interventions. The potential impact is substantial: strengthening PHC globally could save an estimated 60 million lives and increase average global life expectancy by 3.7 years by 2030. Investing in universal health care, therefore, is not just a matter of social justice; it is a strategic investment in human capital and sustainable development.
Measuring UHC Success
A critical aspect of ensuring effective UHC programs is the ability to measure progress and outcomes. The SDG framework provides two key indicators for tracking UHC:
- Coverage of essential health services (SDG 3.8.1): This indicator assesses the proportion of people receiving essential health services, reflecting the service delivery aspect of UHC.
- Catastrophic health spending (and related indicators) (SDG 3.8.2): This indicator measures the extent to which people face financial hardship due to out-of-pocket health expenses, reflecting the financial protection aspect of UHC.
Regular monitoring and reporting using these indicators are crucial for holding countries accountable, identifying areas needing improvement, and ensuring that UHC initiatives are genuinely reaching those in need and reducing health-related financial burdens.
Conclusion: The Path Towards Health for All
The question of “should our country have a universal health care program?” is not just a policy debate; it is a question about societal values and priorities. The global data reveals both the progress made and the significant challenges remaining in achieving health for all. The concept of Universal Health Coverage, grounded in primary health care, offers a viable and ethical path forward.
Adopting UHC is a commitment to ensuring that every citizen has the opportunity to live a healthy and productive life, free from the fear of financial ruin due to healthcare costs. It is an investment in a more equitable, resilient, and prosperous future for all nations. As the world strives to achieve the Sustainable Development Goals, the pursuit of Universal Health Coverage remains a central and indispensable pillar of progress.
