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Commonwealth Health Partnerships 2015

Universal health coverage and the elderly: Basic principles Commonwealth Health Partnerships 2015 107 S. Arulrhaj, R. V. Asokan and R. Hewapathirana Universal health coverage (UHC) implies that all people receive the health services they need without suffering financial hardship when paying for them. The full spectrum of essential, quality health services should be covered, including health promotion, prevention and treatment, rehabilitation and palliative care. Nations that are planning to attain UHC need to consider the social, economic and political contexts of their countries to develop sustainable approaches. There are two key principles for financing for UHC: insurance premiums and tax revenues. However, if people have to pay most of the cost out of their own pockets, the poor will be unable to obtain many of the services they need and even the wealthy will be exposed to financial hardship in the event of severe or long-term illness. Hence, many of the countries that have successfully implemented UHC collect insurance premiums only from those in formal salaried employment and pool these where possible with tax revenues to finance health coverage for the entire population (Oxfam, 2013). Forms of financial risk protection that pool funds (through tax, other government revenues and/or insurance contributions) to spread the financial risks of illness across the population, and allow for cross subsidy from rich to poor and from healthy to ill, increase access to both needed services and financial risk protection. Background Globally, the agenda of UHC is taking centre stage in health policy. Governments, as well as civil society, in developed and developing countries are engaged in active debates over how best to achieve it. The concept of UHC, however, has a long history. Article 25.1 of the 1948 Universal Declaration of Human Rights states: ‘Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services.’ In 1966 member states of the International Covenant on Economic, Social and Cultural Rights recognised ‘the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’.1 The 1978 Alma-Ata declaration stands out as a landmark in the modern history of public health by promoting the vision of health for all. Current scenario State-led implementation of UHC dates back even further. With the 1883 Health Insurance Bill, Germany became the first country to make nationwide health insurance mandatory. The bill laid the foundations for Germany’s generous social health insurance scheme, which covers 88 per cent of its population today.2 Great Britain followed Germany in 1911 with the enactment of the National Insurance Act and the National Health Service (NHS) in 1948, which caters to all legal residents of Great Britain with supplementation from private insurance providers. Today, most high-income countries (HICs) have some system of UHC. Public demand, economic feasibility and political leadership have combined to encourage many low- and middle-income countries (LMICs) to adopt UHC as a realistic goal. Countries like Kenya and India are in the process of introducing UHC, joining the ranks of Brazil, Thailand, Sri Lanka and Taiwan – countries with two to three decades of experience on the path to UHC. Whatever the approach is, the World Health Organization (WHO) has been explicit that countries should prioritise four key actions to finance UHC. These include reducing direct payments, maximising mandatory prepayment, establishing large risk pools and using general government revenue to cover those who cannot afford to contribute (Oxfam, 2013). Definition Ensuring equitable access for all citizens, resident in any part of the country, regardless of income level, social status, gender, creed or religion, to affordable, accountable, appropriate health services of assured quality (promotive, preventive, curative and rehabilitative) as well as public health services addressing the wider determinants of health delivered to individuals and populations, with the government being the guarantor and enabler, although not necessarily the only provider, of health and related services. Figure 1 Universal health coverage Entitlement Universal health entitlement to every citizen National health package Guaranteed access to essential health package (including cashless inpatient and outpatient care provided free): • Primary care • Secondary care • Tertiary care Choice of facilities People free to choose between: • Public sector facilities • Contracted-in private providers > >


Commonwealth Health Partnerships 2015
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