Universal health coverage

Universal health coverage and universal access

David B Evans a, Justine Hsu a & Ties Boerma a

a. World Health Organization, 20 avenue Appia, CH-1211 Geneva 27, Switzerland.

Correspondence to David B Evans (e-mail: evansd@who.int).

Bulletin of the World Health Organization 2013;91:546-546A. doi:http://dx.doi.org/10.2471/BLT.13.125450 [PDF]

Universal health coverage has been set as a possible umbrella goal for health in the post-2015 development agenda.1 Whether it is a means to an end or an end in itself and whether it is measureable are subjects of heated debate.2 In this issue of the Bulletin, Kutzin argues that universal health coverage not only leads to better health and to financial protection for households, but that it is valuable for its own sake.3 More recently, attention has shifted to just what the goal should be: whether universal coverage or universal access. This editorial focuses on this question.

Universal health coverage is the goal that all people obtain the health services they need without risking financial hardship from unaffordable out-of-pocket payments.4It involves coverage with good health services – from health promotion to prevention, treatment, rehabilitation and palliation – as well as coverage with a form of financial risk protection. A third feature is universality – coverage should be for everyone. Although many countries are far from attaining universal health coverage, all countries can take steps in this direction.3,4 Improving access is one such step./.../

Health financing for universal coverage and health system performance: concepts and implications for policy

Joseph Kutzin a

a. Health Systems Financing, World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland.

Correspondence to Joseph Kutzin (e-mail: kutzinj@who.int).

(Submitted: 05 November 2012 – Revised version received: 12 May 2013 – Accepted: 30 May 2013 – Published online: 17 June 2013.)

Bulletin of the World Health Organization 2013;91:602-611. doi:http://dx.doi.org/10.2471/BLT.12.113985 [PDF]

Introduction

Since the publication of The world health report 2010,1 universal coverage (also often referred to as universal health coverage or UHC) has received increased attention. Like having a “sustainable health financing system”, it is something that sounds very good. But what does it mean, exactly, and why is it something worth pursuing?

The world health report 2010 contains the following definition of health financing for universal coverage: “Financing systems need to be specifically designed to: provide all people with access to needed health services (including prevention, promotion, treatment and rehabilitation) of sufficient quality to be effective; [and to] ensure that the use of these services does not expose the user to financial hardship.”1 Some of the debates around recent reform experiences, particularly those related to the interpretation of what is meant by “insurance”,2–5 suggest that there remains a lack of common understanding about the concept portrayed in The world health report 2010. This is not merely an academic debate; conceptual differences create operational differences in terms of the health financing policy choices made by countries, what they are advised to do, and how reforms are assessed. This paper aims to clarify what is meant by health financing for universal coverage; how UHC embodies specific health system goals and intermediate objectives, what is the appropriate unit of analysis for these, and, broadly, the ways in which health financing can influence progress towards UHC. An assessment of specific policy options or recommendations for reform is beyond the scope of the paper, although some illustrations are provided./.../