The World Health Organization’s Member States have set themselves the target of developing their health financing systems to ensure universal health coverage for all people.
In its report, Health Systems Financing: The Path to Universal Coverage, published today, the WHO maps out what countries can do to modify their financing systems so they can move towards this goal.
The report identifies an overreliance on direct payments at the time people need care, as the biggest barrier to universal coverage. Direct payments include over-the-counter payments for medicines and fees for consultations and procedures. “The obligation to pay directly for services at the moment of need – whether that payment is made on a formal or informal (under the table) basis – prevents millions of people receiving health care when they need it. For those who do seek treatment, it can result in severe financial hardship, even impoverishment,” the report states.
The only way to reduce reliance on direct payments, it explains, is for governments to encourage the risk-pooling, prepayment approach, the path chosen by most of the countries that have come closest to universal coverage.
Dr Margaret Chan, director general of the WHO, said: “Concerning the path to universal coverage, the report identifies continued reliance on direct payments, including user fees, as by far the greatest obstacle to progress. Abundant evidence shows that raising funds through required prepayment is the most efficient and equitable base for increasing population coverage. In effect, such mechanisms mean that the rich subsidise the poor, and the healthy subsidise the sick. Experience shows this approach works best when prepayment comes from a large number of people, with subsequent pooling of funds to cover everyone’s health-care costs.
“No one in need of health care, whether curative or preventive, should risk financial ruin as a result.”
Overall, the report provides an action agenda for countries at all stages of development and proposes ways that the international community can better support efforts in low income countries to achieve universal coverage and improve health outcomes.
Included in its recommendations is the statement that all countries have scope to raise more money for health domestically by increasing the efficiency of revenue collection and by reprioritising government budgets.
The report also calls for a reduction in inefficiency – estimating that from 20% to 40% of all health spending is currently wasted through inefficiency.