Volume 16, Issue 1, Supplement, January–February 2013, Pages S39–S45
Universal Health Coverage: A Quest for All Countries But under Threat in Some
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Open Archive
Abstract
Over
the past 50 years, health care has been making a growing contribution
to population health in many countries. Yet its benefits are still
denied to many people worldwide. This article describes how many
countries, both developed and developing, have pursued the quest to
achieve universal health care. This has been an explicitly political
process. In Europe, it emerged from a belief in solidarity, a fear of
revolution, and a changing view of the role of the state. In developing
countries, progress was more erratic, characterized by debates about the
affordability of universal health care, until it was realized that
functioning health systems were essential to deliver development goals.
Throughout, the United States has been an exception. An analysis of
progress toward universal health care, combining a review of existing
theories and new empirical analysis, identifies five factors as
important: the strength of organized labor and left-wing parties,
adequate economic resources, absence of societal divisions, weakness of
institutions that might oppose it (such as organized medicine), and
windows of opportunity. Having noted the substantial benefits accruing
from universal health care, the article concludes with an analysis of
how universal health care is under threat in some European countries and
a warning about the risks posed by current radical austerity policies.
Keywords
- global health;
- health systems;
- universal coverage
Introduction
Health
care is viewed by some as a fundamental right but by others as a
tradable commodity. In the course of just over a century, universal
health care (UHC) has gone from being an aspiration to a reality in most
industrialized countries, but not yet all. Yet for many, especially in
the developing world, it remains no more than a dream. For those who
have it, never before has it been so insecure.
Before
proceeding further, it is necessary to clarify what is meant by UHC. A
previous systematic review of the literature found that UHC and
universal health care were often conflated, but the former was invoked
more frequently when discussing developing countries [1].
Each term, as used by researchers, was found to express five main
themes: access to care, coverage, point of entry to the health system, a
rights-based approach, and social and economic risk protection. The
definition set out by the World Health Organization (WHO) integrates
these themes:
Universal coverage is defined as access to key promotive, preventive, curative and rehabilitative health interventions for all at an affordable cost, thereby achieving equity in access. The principle of financial-risk protection ensures that the cost of care does not put people at risk of financial catastrophe. A related objective of health-financing policy is equity in financing: households contribute to the health system on the basis of ability to pay. Universal coverage is consistent with WHO’s concepts of Health for All and Primary Health Care.
It
identifies the health system as a widely agreed upon means (e.g.,
affordability) for achieving desired ends (e.g., financial risk
protection).
This article
aims to assess the future of UHC in Europe. Our analysis proceeds as
follows: in the first section, we first review a chronological history
of how UHC came (or did not) to be. In the second section, we assess the
global prevalence of UHC and leading theories that can account for its
presence. Finally, having evaluated the social, political, and economic
drivers of UHC, we evaluate the implications of changes to these forces
over time, particularly in light of the recent global economic crisis,
to assess challenges and threats to UHC in developing countries and
Europe.
