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Building sustainable universal health coverage

The Council on Foreign Relations (CFR) hosted the second meeting of the Universal Health Coverage Roundtable Series, "Toward Sustainable Universal Health Coverage" in New York City on Thursday, February 9, 2012.

Moderated by Yanzhong Huang, senior fellow for Global Health at CFR, Michael Chen, associate professor at the National Chung-Cheng University and former Vice President and CFO of National Health Insurance Bureau in Taiwan, and Margaret E. Kruk, assistant professor of health policy and management at Columbia University Mailman School of Public Health examined the possibilities, challenges, and paths toward achieving Universal Health Coverage in different resource settings by exploring the methods for expanding and supporting coverage worldwide.

The roundtable discussion highlighted several key issues for building sustainable universal health coverage (UHC) schemes including:

  • Quality is the key to achieving “true” universal health coverage: Tanzania’s national health insurance scheme covers approximately 90 percent of their population. They have no user fees for vulnerable populations such as the elderly, women, and children and 90 percent of the population lives within 10 kilometers of a health facility. By most standards, Tanzania would be considered close to achieving universal health coverage. However, only 40 percent of Tanzanians utilize public health services. Is this considered universal health coverage? And if so, is this the kind of universal health coverage we want? Dr. Kruk explained that simply providing affordable health care is insufficient. The end goal of UHC should not only be to provide financial protection, but to provide quality health services at an affordable price. In her words, “We need to rethink the notion that low and middle income consumers will be grateful for any type and quality of service. They are active health consumers and this holds true in Tanzania, Ghana, and many other countries that are struggling to increase utilization.”

  • Benefit package design is critical to increasing utilization: The concept of defining a benefits package that is cost effective and meets expectations is an art. To create successful UHC schemes, there is a need to focus on quality and benefit-package design to expand coverage, increase utilization, and improve access. The explosion of non-communicable diseases in low and middle-income countries will dramatically affect how benefit packages should be designed in the future. Non-communicable diseases cannot be treated in silos like the vertical or specific diseases such as TB, HIV/AIDS, and Malaria. The only common denominator to addressing NCD’s is reinforcing the underlying health system. “We need to hit the happy spot between affordable and enough services that the consumer will actually find the services useful,” said Dr. Kruk.

The session concluded with a rich discussion including challenges like how emerging technologies will affect the cost of UHC, should there be a universal quality standard, and the role of health education in increasing utilization. Complete transcripts from the event can be found on the Council on Foreign Relations website here.

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