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Submitted by Por Ir on
Hi Adam, Thank you very much for sharing this very concise post on UHC and its historical development. I have no doubt to agree with your analysis and description. I would just like to share a few ideas which you on this topic. As UHC can mean many things, it is crucial to make sure that individual country adopts a right UHC policy ("quality" wine), which "increases access and financial protection without deteriorating equity." Some countries may tend to shift from implicit coverage (government subsidized service provision) to explicit coverage (insurance-like schemes), which may not necessarily yield better results, but worse if the current state subsidized primary health care system is functioning reasonably well, e.g. Cambodian people seem to enjoy access to subsidized (mostly free) preventive services (RMCH services) provided by large coverage of health centers, and efforts to increase explicit coverage may undermine this core function of the Cambodian health system. We all agree that for all countries the bottle is not empty and competing the bottle is not an overnight action. For any country adopting/readopting UHC, a sound and clear pathway (road map) toward the ultimate goal of full coverage is necessary. Three points should be considered for this: (1) Depending on the country context and where the country is on the pathway, the UHC models currently implemented in countries already achieved UHC may not be relevant to a country being still on the way to UHC. For the latter, the past historical development in full UHC countries can be more useful; (2) Although all country health systems aim to improving health (as reflected by core health indicators) and financial protection (as reflected by health expenditures, mainly out-of-pocket payments, their level of achievement for these two health system objectives may be quite different, e.g. Vietnam has relatively good health indicators, but still high out-of-pocket payments. Particular emphasis on one of these two objectives, may requires different approaches to UHC. This is even more challenging if the countries take equity objective into consideration; (3) How to measure the progress toward UHC is also necessary (how the bottle is properly filled in over time). As a researcher, this is crucial for building a right path toward UHC. So far, we do not have clear consensus on how to measure the three dimensions of the cube yet. For breadth of coverage, it is rather straightforward for the insurance-like model, but not for state-subsidized service provision, which relies on physical coverage rather membership. It is even more challenging for measuring depth of coverage. Benefit package or package of services provided can only tell one part of it The quality of the services is another critical one. How about height of coverage, is out-of-pocket payment as a proxy enough? For all the three dimensions, the average is not enough, but also poor-rich, urban-rural, and gender difference (equity analysis) needs to be looked at carefully. Please let me know if I am going off track...