The complex definitions and economics of universal health coverage

I indicated the kind of problems health systems specialists are grappling with.  Where does one begin? How does one define universal health coverage, the goal of the global health policy?

Ravi Rannan-Eliya, from the Institute of Health Policy, Sri Lanka,  points out that it is not sufficient to define it in terms of nominal or legal coverage – we all know universal coverage is not a reality anyway.

There is no easy definition of universal health coverage, says Ravi Rannan-Eliya. Credit: WHO

An operational definition of universal health coverage should include both access to health services and risk protection, he told delegates at the symposium, says Ranna-Eliya.

Several published studies show that protection against ‘catastrophic’ expenditures is feasible in low-income settings. Equal service use by the poor is also achievable at low-income settings. What’s needed is political will to implement health reforms.

What financing mechanisms could influence universal health coverage? They broadly fall into four categories – tax-funded integral services where tax payers in a country pay a tax that is used to fund health care for the poor; social health insurance, community health insurance and private or voluntary health insurance.

Two countries that are getting repeated mention at the symposium for the relative success of their national health insurance policies are Ghana and Mexico.

So where does science fit in here? As Julio Frenk, Mexico’s former health minister and dean of the Harvard School of Public Health, said, reforms open up new research opportunities,  such as how “implementation research” can be put into practice and scaled up; whether and how reforms are actually working; and comparative analyses from different countries.

Research is the core of the new era of global health, says Frenk. “Any time a country tries out an innovation, this is a learning opportunity for the rest of the world.”

T. V. Padma, South Asia Regional Coordinator, SciDev.Net

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