scholarly journals Towards universal health coverage: lessons from 10 years of healthcare reform in China

2020 ◽  
Vol 5 (3) ◽  
pp. e002086 ◽  
Author(s):  
Wenjuan Tao ◽  
Zhi Zeng ◽  
Haixia Dang ◽  
Bingqing Lu ◽  
Linh Chuong ◽  
...  
Keyword(s):  
Universal Health Coverage ◽  
Healthcare Reform ◽  
Service System ◽  
National Policy ◽  
Health Financing ◽  
Universal Coverage ◽  
Political Support ◽  
Chinese Government ◽  
Health Coverage ◽  
Universal Health

Universal health coverage (UHC) is driving the global health agenda. Many countries have embarked on national policy reforms towards this goal, including China. In 2009, the Chinese government launched a new round of healthcare reform towards UHC, aiming to provide universal coverage of basic healthcare by the end of 2020. The year of 2019 marks the 10th anniversary of China’s most recent healthcare reform. Sharing China’s experience is especially timely for other countries pursuing reforms to achieve UHC. This study describes the social, economic and health context in China, and then reviews the overall progress of healthcare reform (1949 to present), with a focus on the most recent (2009) round of healthcare reform. The study comprehensively analyses key reform initiatives and major achievements according to four aspects: health insurance system, drug supply and security system, medical service system and public health service system. Lessons learnt from China may have important implications for other nations, including continued political support, increased health financing and a strong primary healthcare system as basis.

scholarly journals Towards universal health coverage: achievements and challenges of 10 years of healthcare reform in China

2020 ◽  
Vol 5 (3) ◽  
pp. e002087 ◽  
Author(s):  
Wenjuan Tao ◽  
Zhi Zeng ◽  
Haixia Dang ◽  
Peiyi Li ◽  
Linh Chuong ◽  
...  
Keyword(s):  
Universal Health Coverage ◽  
Healthcare Reform ◽  
Insurance Coverage ◽  
Secondary Data ◽  
Health Insurance Coverage ◽  
Chinese Government ◽  
Health Coverage ◽  
Average Life Expectancy ◽  
Live Births ◽  
Universal Health

Universal health coverage (UHC) has been identified as a priority for the global health agenda. In 2009, the Chinese government launched a new round of healthcare reform towards UHC, aiming to provide universal coverage of basic healthcare by the end of 2020. We conducted a secondary data analysis and combined it with a literature review, analysing the overview of UHC in China with regard to financial protection, coverage of health services and the reported coverage of the WHO and the World Bank UHC indicators. The results include the following: out-of-pocket expenditures as a percentage of current health expenditures in China have dropped dramatically from 60.13% in 2000 to 35.91% in 2016; the health insurance coverage of the total population jumped from 22.1% in 2003 to 95.1% in 2013; the average life expectancy increased from 72.0 to 76.4, maternal mortality dropped from 59 to 29 per 100 000 live births, the under-5 mortality rate dropped from 36.8 to 9.3 per 1000 live births, and neonatal mortality dropped from 21.4 to 4.7 per 1000 live births between 2000 and 2017; and so on. Our findings show that while China appears to be well on the path to UHC, there are identifiable gaps in service quality and a requirement for ongoing strengthening of financial protections. Some of the key challenges remain to be faced, such as the fragmented and inequitable health delivery system, and the increasing demand for high-quality and value-based service delivery. Given that China has committed to achieving UHC and ‘Healthy China 2030’, the evidence from this study can be suggestive of furthering on in the UHC journey and taking the policy steps necessary to secure change.

scholarly journals Employment based health financing does not support gender equity in universal health coverage

BMJ ◽  
2020 ◽  
pp. m3384 ◽  
Author(s):  
Lavanya Vijayasingham ◽  
Veloshnee Govender ◽  
Sophie Witter ◽  
Michelle Remme
Keyword(s):  
Gender Equity ◽  
Universal Health Coverage ◽  
Health Financing ◽  
Health Coverage ◽  
Universal Health

scholarly journals Universal Health Coverage in Bangladesh: Activities, Challenges, and Suggestions

2019 ◽  
Vol 2019 ◽  
pp. 1-12 ◽  
Author(s):  
Taufique Joarder ◽  
Tahrim Z. Chaudhury ◽  
Ishtiaq Mannan
Keyword(s):  
Health Insurance ◽  
Universal Health Coverage ◽  
Service Management ◽  
Service Providers ◽  
Health Financing ◽  
Community Empowerment ◽  
Health Coverage ◽  
Demand Side ◽  
Implementation Barriers ◽  
Universal Health

Catastrophic health expenditure forces 5.7 million Bangladeshis into poverty. Inequity is present in most of health indicators across social, economic, and demographic parameters. This study explores the existing health policy environment and current activities to further the progress towards Universal Health Coverage (UHC) and the challenges faced in these endeavors. This qualitative study involved document reviews (n=22) and key informant interviews (KII, n=15). Thematic analysis of texts (themes: activities around UHC, implementation barriers, suggestions) was done using the manual coding technique. We found that Bangladesh has a comprehensive set of policies for UHC, e.g., a health-financing strategy and staged recommendations for pooling of funds to create a national health insurance scheme and expand financial protection for health. Progress has been made in a number of areas including the roll out of the essential package of health services for all, expansion of access to primary health care services (support by donors), and the piloting of health insurance which has been piloted in three subdistricts. Political commitment for these areas is strong. However, there are barriers pertaining to the larger policy level which includes a rigid public financing structure dating from the colonial era. While others pertain to the health sector’s implementation shortfalls including issues of human resources, political interference, monitoring, and supervision, most key informants discussed demand-side barriers too, such as sociocultural disinclination, historical mistrust, and lack of empowerment. To overcome these, several policies have been recommended, e.g., redesigning the public finance structure, improving governance and regulatory mechanism, specifying code of conduct for service providers, introducing health-financing reform, and collaborating with different sectors. To address the implementation barriers, recommendations include improving service quality, strengthening overall health systems, improving health service management, and improving monitoring and supervision. Addressing demand-side barriers, such as patient education and community empowerment, is also needed. Research and advocacy are required to address crosscutting barriers such as the lack of common understanding of UHC.

scholarly journals Towards universal health coverage: governance and organisational change in ministries of health

2019 ◽  
Vol 4 (5) ◽  
pp. e001735 ◽  
Author(s):  
Peter Berman ◽  
Azrina Azhar ◽  
Elizabeth J Osborn
Keyword(s):  
Health System ◽  
Universal Health Coverage ◽  
Organisational Change ◽  
Health Financing ◽  
Comparative Case Study ◽  
Health Coverage ◽  
Political Commitment ◽  
Middle Income ◽  
High Level ◽  
Universal Health

Countries have implemented a range of reforms in health financing and provision to advance towards universal health coverage (UHC). These reforms often change the role of a ministry of health (MOH) in traditionally unitary national health service systems. An exploratory comparative case study of four upper middle-income and high-income countries provides insights into how these reforms in pursuit of UHC are likely to affect health governance and the organisational functioning of an MOH accustomed to controlling the financing and delivery of healthcare. These reforms often do not result in simple transfers of responsibility from MOH to other actors in the health system. The resulting configuration of responsibilities and organisational changes within a health system is specific to the capacities within the health system and the sociopolitical context. Formal prescriptions that accompany reform proposals often do not fully represent what actually takes place. An MOH may retain considerable influence in financing and delivery even when reforms appear to formally shift those powers to other organisational units. MOHs have limited ability to independently achieve fundamental system restructuring in health systems that are strongly subject to public sector rules and policies. Our comparative study shows that within these constraints, MOHs can drive organisational change through four mechanisms: establishing a high-level interministerial team to provide political commitment and reduce institutional barriers; establishing an MOH ‘change team’ to lead implementation of organisational change; securing key components of systemic change through legislation; and leveraging emerging political change windows of opportunity for the introduction of health reforms.

scholarly journals Pooling arrangements in health financing systems: a proposed classification

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Inke Mathauer ◽  
Priyanka Saksena ◽  
Joe Kutzin
Keyword(s):  
Health Insurance ◽  
Universal Health Coverage ◽  
Grey Literature ◽  
Health Spending ◽  
Health Financing ◽  
Policy Instrument ◽  
Health Coverage ◽  
Voluntary Health Insurance ◽  
Financing Policies ◽  
Universal Health

Abstract Objectives The function of pooling and the ways that countries organize this is critical for countries’ progress towards universal health coverage, but its potential as a policy instrument has not received much attention. We provide a simple classification of country pooling arrangements and discuss the specific ways that fragmentation manifests in each and the typical challenges with respect to universal health coverage objectives associated. This can help countries assess their pooling setup and contribute to identifying policy options to address fragmentation or mitigate its consequences. Methods The paper is based on a review of published and grey literature in PubMed, Google and Google Scholar and our information gathered from our professional work in countries on health financing policies. We examined the nature and structure of pooling in more than 100 countries across all income groups to develop the classification. Findings We propose eight broad types of pooling arrangements: (1.) a single pool; (2.) territorially distinct pools; (3.) territorially overlapping pools in terms of service and population coverage; (4.) different pools for different socio-economic groups with population segmentation; (5.) different pools for different population groups, with explicit coverage for all; (6.) multiple competing pools with risk adjustment across the pools; and in combination with types (1.)-(6.), (7.) fragmented systems with voluntary health insurance, duplicating publicly financed coverage; and (8.) complementary or supplementary voluntary health insurance. However, we recognize that any classification is a simplification of reality and does not substitute for a country-specific analysis of pooling arrangements. Conclusion Pooling arrangements set the potential for redistributive health spending. The extent to which the potential redistributive and efficiency gains established by a particular pooling arrangement are realized in practice depends on its interaction and alignment with the other health financing functions of revenue raising and purchasing, including the links between pools and the service benefits and populations they cover.

Universal Health Coverage for Undocumented Migrants. The Spanish Case

2018 ◽  
Vol 25 (2) ◽  
pp. 283-299
Author(s):  
María Dalli
Keyword(s):  
Health Care ◽  
Universal Health Coverage ◽  
Access To Health Care ◽  
Health Care Services ◽  
Universal Coverage ◽  
Right To Health ◽  
Undocumented Migrants ◽  
Health Coverage ◽  
The Right ◽  
Universal Health

Implementation of the universal right to health, along with the UN’s goal to achieve universal health coverage (UHC), face common challenges to ensuring universal health care entitlement. One of these difficulties is health care restrictions for undocumented migrants. A recent example is the Spanish health care regulation that places universal coverage at risk by restricting access to it by this group. The work herein examines the right to health and UHC’s regulations with the aim of determining if access to health care services for undocumented migrants is indeed recognized and if this recognition could therefore be valid to limit those kinds of measures. The UHC proposal does not sufficiently deal with this problem. Regarding the right to health, even though there are some limitations within international human rights laws regarding protection for this group, it can be concluded that the right to health is also applicable to undocumented migrants.

Universal Health Coverage

2021 ◽  
pp. 134-153
Author(s):  
Joia S. Mukherjee
Keyword(s):  
Health Systems ◽  
Universal Health Coverage ◽  
Quality Care ◽  
Universal Coverage ◽  
Health Coverage ◽  
Quality Health Care ◽  
The Sustainable Development ◽  
Quality Health ◽  
The Right ◽  
Universal Health

As part of the Sustainable Development Goals the right to health is captured under the rubric of universal health coverage (UHC). That is that all people should have access to the high quality care they need without suffering financial hardship. This chapter explores this seminal topic reviewing the theory of universal coverage and definitions that shape the current conversation about UHC. This chapter also highlights some important steps taken by countries to expand access to quality health care but challenges the rhetoric that financing care through insurance schemes, a common approach to UHC) is sufficient when the inputs into the health systems do not match the disease burden. Finally, the chapter investigates the theory and practice behind a morbidity-based approach to strengthening health systems and achieving UHC.

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