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April 18, 2016
In the last few years, the topic of universal health coverage has gained significant traction on the world stage. Universal health coverage is where all people in the world can access quality health services without suffering from financial burdens. The World Health Organisation back in 2010 called for universal health coverage and in 2012, the United Nations supported this act as a priority for sustainable development. As well as guaranteeing every human’s right to healthcare, universal health coverage investment has a significant and positive economic pay off. The Ebola virus in West Africa has been a painful reminder of the costs of neglecting health systems especially when it is estimated that every dollar invested in health systems today will generate benefits between U$D9-U$D20 by 2035. It is no longer the case of deciding whether or not to seek universal health coverage but how to pursue it and Latin America is a prime example of how to expand access to health.
One of the biggest errors made by governments when looking to expand health coverage is that they create separate pools and health coverage schemes dependent on their social class. In many countries within Latin America the populations have been separated not only by class but their employment status creating further inequalities instead of addressing them. It is typically the employed and wealthier population that will be assigned social security agencies that have been provided with better health services and higher levels of investment. On the opposite side of the spectrum, the poorer population is often covered by underfunded Ministry of Health and therefore receives a lower level of care at a higher out-of-pocket cost. As seen in many Latin American countries, this has trapped the most vulnerable in a cycle of poverty. This in turn acts against one of the core principles of universal health coverage which is for equality and prioritisation for the poorer population.
In order to reach the ultimate goal of universal health coverage there needs to be solidarity based financing models. Today, Brazil, Costa Rica and Mexico are all prime examples of this as they all rely heavily on their capability to increase public expenditure and reduce out-of-pocket spending. These solidarity-based models integrate a number of different sources of health sector financing such as social-security contributions and private spending. The level of integration obtained has perhaps become the main determinant of universal health coverage in Latin America.
With the lessons learnt from Latin America, it is important for governments to focus on safeguarding health within the system of wider social protection. Health systems and policies should therefore actively seek to address social determinants of health which could include anything from age and gender to socioeconomic status. Even today, we are faced with the problem of inequality which can dramatically lower a person’s chance at leading a healthy life, freely and without discrimination. Those health systems that focus solely on specific diseases and not on the majority of the marginalised population fall short of their full potential. This is as those left on the edge continue to suffer with their disease. Countries must instead recognise the basic human right to health access without discrimination or other difficulties in order to advance universal health coverage into a broader social context. For example, in Brazilian households that bring in less than U$D30 per person have access to employment opportunities, income transfers and public services included health. By implementing this policy, the number of people living below the poverty line has fallen dramatically in Brazil and has also led to a more general and significant gain in the level of health.
If the pre-World Cup riots on the streets of Brazil have taught us anything it is that there needs to be transparency, accountability and more importantly social participation. These key elements are essential if universal health coverage is to be achieved. In Latin America, social participation has been central to moving towards universal health coverage especially in antiretrovirals and in the reforms that led to the Sistema Único de Saúde or universal health system in Brazil.
The 12th December 2014 will mark the first year anniversary of the UN resolution on universal health coverage and the first Universal Health Coverage Day. Governments will be urged to prioritise an extension of health services and whilst there is no one-size-fits-all approach, there are today enough examples and experiences to draw out the successes of universal health coverage policies. Instead of waiting for a comprehensive universal health coverage formula, governments need to be proactive in their approach and work towards making universal health coverage attainable. With Universal Health Coverage Day approaching and with the outbreak of Ebola, there is surely no better time for governments to act than now.
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