Catalyzing Change:
The System Reform Costs of Universal Health Coverage
Rockefeller Foundation - November 15, 2010
Available online PDF [98p.] at: http://bit.ly/9O6vst
“….A global movement for universal health coverage (UHC) is under way, as illustrated by an increasing number of nations working toward achieving UHC. Endorsed by the World Health Assembly through a resolution in 2005, UHC is defined as access for all to appropriate health services at an affordable cost. Universal coverage is associated with better health and equity, as well as financial protection.
This new report aims to call health leaders’ attention to the importance and enhanced feasibility of establishing the systems and institutions needed to pursue UHC. It also seeks to quantify the transition costs associated with reforming a health system away from one that relies on out-of-pocket payments and towards one in which health expenditures are more evenly distributed….”
“………Every year health expenses create severe financial hardship for 150 million people and force 25 million households into poverty. This is due largely to the fact that more than three billion people—many of whom are found in the poorest half of the world’s population—pay out of pocket for health services. They are forced to choose between impoverishing fees or foregoing needed services, leaving them at risk of falling into a downward spiral of sickness and poverty.
Yet, paradoxically, in most countries around the world, the total amount of domestic resources devoted to health is increasing at an historically unprecedented rate, in parallel with growing national economies. While large amounts of time and resources have been spent on improving the health of people in low- and middle-income countries, not enough work has been done to help strengthen their health systems and provide access for all to appropriate health services at an affordable cost.
Many countries are beginning to embrace universal health coverage (UHC)— defined by the World Health Organization (WHO) as
“access to key promotive, preventive, curative and rehabilitative health interventions for all at an affordable cost, thereby achieving equity in access”—as a viable financing mechanism. Although models for UHC vary by country, governments are reorganizing national health systems to share health costs more equitably across the population and its life cycle, instead of concentrating the burden on the few who face catastrophic illness in any given year.
This timely report addresses a specific question: how much does it cost to shift a health system from being predominantly financed out of pocket toward one that is financed using schemes of universal coverage? Using examples from four countries that have made tremendous strides toward achieving universal coverage, the report puts an approximate price tag on these investments. The conclusions indicate that relatively small early investments can set countries on the path toward universal health coverage.
This information should be useful to those involved in planning reform, as well as the development partners that support them…..”
Content
Foreword
Executive summary
CHAPTER 1 Where the World Stands Today: The Feasibility of Universal Health Coverage
CHAPTER 2 Framework for Planning the Transition
CHAPTER 3 Case Studies: Andhra Pradesh (
CHAPTER 4 Conclusions
ANNEX
Additional Case Studies:
Notes
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