Moving towards universal health coverage

WHO/J. Holmes

A major illness is traumatic in its own right, but for many people it is the start of an even bigger nightmare: catastrophic health-care costs that lead to hardship, poverty and even financial ruin. Universal health coverage protects people—especially a country’s most vulnerable groups—from such devastating consequences of ill-health and ensures that everyone has access to quality health care.

Across the World Health Organization (WHO) Western Pacific Region, universal health coverage is gaining momentum. No matter where it lies on this road, each country advances at its own pace and in its own manner and can move towards universal health coverage step-by-step with WHO's commitment of support.

Strong commitment

“Ensuring access to quality health care for all demands policy-level commitment and resources, including integrated infrastructure for health services delivery, essential medicines and medical technologies, human resources, information systems and strong management,” says Dr Shin Young-soo, WHO Regional Director for the Western Pacific. “Most of all, it needs a funding system that is sustainable and fair.”

WHO has identified six priority countries in the Region to support as they strive for universal health coverage: Cambodia, China, the Lao People’s Democratic Republic, Mongolia, the Philippines and Viet Nam.

Expand population coverage, improve benefits

How to create a health-care funding system that is both equitable and sustainable is a major challenge and entails determining not just the extent of coverage and level of services, but also being clear about who pays.

Viet Nam, for example, has a social health insurance system with government-subsidized health insurance premiums for vulnerable groups. Coverage extends to 64% of the population so far.

The health insurance benefit package has brought outpatient and inpatient care within the grasp of 57 million Vietnamese. This is an improvement since the 1990s, when 80% of medical expenditure was paid out-of-pocket by individuals. Even now, however, 50% of health expenditure is still paid by individuals.

WHO helped Viet Nam by facilitating high-level policy dialogue and providing technical support for the revision of its national health insurance law.

There are also many other challenges ahead, said Prof Nguyen Thi Kim Tien, Viet Nam’s Health Minister, at a side event about universal health coverage during the 63rd Session of the WHO Regional Committee for the Western Pacific in September in Hanoi. “The first challenge is expanding coverage to the remaining 36% of the population of which many are employed in the informal sector,” she said. “A further challenge is to improve access to affordable quality health care services, through a package of services…developed on cost-effectiveness based evidence.”

Learning from others

Viet Nam is also looking at the experience of other countries in the Region, such as Japan and the Republic of Korea, which have well-developed social health insurance systems, and China, which began a major reform of its health system in 2008.

China’s first step was to increase population coverage, and it has since expanded medical insurance to cover more than 95% of the population via three different social health insurance schemes.

Speaking at the same event, Dr Ren Minghui, Director-General for International Cooperation of China’s Ministry of Health, explained how China has progressed to expand the benefit package and increase reimbursement levels. Governments at all levels have been gradually increasing the subsidy for essential medical insurance, and at the same time primary health care has been strengthened, he said.

"We’ve deployed 10 000 doctors every year to the rural areas to improve primary health-care services so that the grassroots-level health institutions can be a good gatekeeper for health," Dr Ren said.

Beyond 2015

As the desire for universal health coverage gathers momentum, so do calls for its inclusion in the new development agenda that will emerge to replace the Millennium Development Goals in 2015. This would help sustain the political commitment, backed by financial support and investment to ensure genuine access to health care for all.

For more information, please contact:

Dr Ke Xu
Team Leader, Health Care Financing
Telephone: +632 5289808
E-mail: xuk@wpro.who.int

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