Syndicate content

Add new comment

Submitted by Emre Ozaltin on
An excellent distillation of key UHC components. To me, this reinforces the case for continued work by the Bank and global actors on this topic, to make expertise, studies and tools such as UNICO and UNICAT available to countries trying to expand coverage, to help them think through key issues such as costing, provider payment, benefit packages, financial protection, harmonizing existing schemes and so on. A more pertinent question is whether UHC should be part of the post-MDG agenda. I submit that any candidate for inclusion should satisfy two minimum criteria: (1) be concrete and easy to explainable to policy makers; and (2) have clear, readily measurable targets. At present, UHC comes up short on both counts. For the first, while I think this post does an excellent job of reframing UHC, we are still left with a concept that is soft, diffuse and difficult to explain without several parentheses. With its subtleties, misnomers, qualifications and cubes UHC, as currently conceptualized, is not easily understood by a non-technical audience, which will limit its usefulness in inflaming passions and serving as a rallying cry. Second, and more important, the components outlined – particularly coverage and clinical quality – do not lend to straightforward quantification. As discussed in the post, all populations are covered by some health care, whether it be public, private, non-medical or of low accessibility. The issue of what is covered is even more elusive; how do we quantify or rank different packages (depth) in different setting? The concept of “effective coverage” – the proportion of the population in need of an intervention who receives an effective intervention – best gets at the both. But, while at a macro level the intersection between burden and service mix may serve a useful indicator, getting at effective coverage at the individual level if difficult. In addition to clinical quality, responsiveness is another dimension not mentioned but that should be part of UHC. Quantifying gaps between theoretical coverage and utilization, and the barriers thereto is challenging. While catastrophic spending is an excellent indicator, out-of-pocket expenditure is regressive and it is unclear if zero OOP is the right target in every context. This is not to say that these conceptualizations and quantifications cannot be done, but that important work remains. Finally, as has been often pointed out, UHC is a means rather than an end. As such, it may lead to a focus on process rather than the outcomes we ultimately care about. The effectiveness of expanding the depth and breadth of effective coverage on improving health outcomes remains an incomplete area of research. Moreover we have been moving, in the right direction in my opinion, towards multisectoral interventions – UHC, perhaps unwittingly, reinforces the outdated notion that the solutions to improving population health lie exclusively in the health sector.