Universal Health Care for Sustainable Development

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Lizbeth Gilmore
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1 Universal Health Care for Sustainable Development Reinhard Busse, Prof. Dr. med. MPH Department of Health Care Management Berlin University of Technology (WHO CollaboratingCentreforHealth Systems Research and Management) & European Observatory on Health Systems and Policies

2 Instead of a formal introduction MEAND UNIVERSAL HEALTHCARE THESTORYSO FAR

3 Seoul: where it all began 20 years ago Represented: China Costa Rica Czech Republic Egypt Germany Indonesia Japan Morocco Republic of Korea South Africa Thailand Vietnam

4 Discussed: SHI only for up.-middle/ high income? No! Germany and Japan started with compulsory SHI when they were poor/ low-income countries (in today s terms)

5 10 years ago: how to visualize coverage?

6 The first Coverage Cube was born

7 picked up by WHO only a year later

8 and again in 2010

9 copied and modified elsewhere

10 Looking at the data UNIVERSAL HEALTHCARE HAVE WESEENPROGRESSSINCE2000?

11 Global health expenditure in $PPP 7.7% of GDP Private (16% VHI, 23% OOP) 56% Public (23% tax, 33% SHI) and in $PPP 8.6% of GDP Private (15% VHI, 22% OOP) 58% Public (23% tax, 34% SHI)

12 Low-income country health expenditure in $PPP 2.9% of GDP Private (1% VHI, 53% OOP) 38% Public (37% tax, 1% SHI) and in $PPP 5.1% of GDP Private (1% VHI, 47% OOP) 39% Public (38% tax, 1% SHI)

13 By 2012, budgetary spending on health had increased by 1% of GDP (39% of +2.2% of GDP)

Lower middle income countryhealth expenditure in 2000 108 $PPP 3.

14 Lower middle income countryhealth expenditure in $PPP 3.9% of GDP Private (2% VHI, 59% OOP) 34% Public (29% tax, 5% SHI) Private (2% VHI, 55% OOP) and in $PPP 4.1% of GDP 36% Public (31% tax, 5% SHI)

15 Upper middle income countryhealth expenditure in $PPP 5.3% of GDP Private (8% VHI, 43% OOP) 47% Public (27% tax, 19% SHI) and in $PPP 6.0% of GDP Private (7% VHI, 32% OOP) 56% Public (29% tax, 27% SHI)

16 High income country expenditure in $PPP 9.6% of GDP Private (16% VHI, 19% OOP) 60% Public (22% tax, 38% SHI) and in $PPP 11.6% of GDP Private (15% VHI, 19% OOP) 61% Public (21% tax, 40% SHI)

17 UsingtheCube tolookat a fewissuesin detail BUT WAS OURVIEWCOMPLETE?

18 1st issue: Who is(not) covered?

19 VHI SHI Not covered Coverage by access to tax-financed provision

20 Puttingthispre-UHC into thecube V H I SHI Tax RICHEST 1. WHO (sorted by income)? POOREST

21 need to extend coverage to missing middle by (1) extending tax-financed coverage or

22 (2) extending the SHI system

23 Looking at a few examples Thailand without a missing middle (but rich partly excluded) Vietnam as an example of missing middle Ghana as an example of an immature pro-rich system

24 2nd issue: What is(not) covered?

25 Puttingthisissueinto thecube Most would agree that essential services should be covered; but what is essential? UHC dominant <GDP/cap. Many agree that this will differ from one country to the next; but how do we advise policy-makers in countries? Scope to learn from economic evaluation which services to include: (1) monetary effects > costs ( dominant ) (2) costs per life year saved are < GDP/ capita (WHO-CHOICE)

26 Examples from a recent systematic review

27 A wider issue: coverageonlystep1 to3 ofaccess Need (by socio-economic status, ethnicity/ migration status etc.) Coverage Unmet need Realised access/ effective coverage Unmet need x Quality = Outcomes Performance of Health System

28 Are the efforts worth it? THE CONTRIBUTIONOF UNIVERSAL HEALTH CARE TO SUSTAINABLEDEVELOPMENT

29 For individuals: poverty in informal sector

30 For society: economic growth

31 UHC mayonlybeoneof17 SDGs, but ithasa centralroleforoverallgoalachievement! In spiteofnoticableprogressin thepast, many countries (esp. lower middle income) can speed-up. All should monitor progress closely.

Financing II: Pooling and (Re-)Allocation

Financing II: Pooling and (Re-)Allocation Managing and Researching Health Care Systems Reinhard Busse, Prof. Dr. med. MPH FFPH FG Management im Gesundheitswesen, Technische Universität Berlin (WHO Collaborating