Research and country experience demonstrate that better ways of paying for health services are now feasible where once they were not. Instead of concentrating the cost burden on the sick and the poor, more modern approaches share health costs more equitably across the population. These efforts represent an emerging global movement to pursue and achieve universal health coverage (UHC).
UHC can be achieved – even in low and middle-income countries – by reorganizing domestic health expenditures to be used more efficiently, rather than relying on development assistance to fund health expenditures on a sustained basis.
Experiments with various models for moving towards UHC in a number of low and middle-income countries suggest that movements towards UHC are possible. Such efforts are underway in a growing number of countries – middle income (e.g., Thailand, Mexico, and Colombia) as well as lower-middle income (e.g., India, China, Indonesia, Vietnam) and low income (e.g., Rwanda, Ghana, Kenya, Nigeria).
While these countries’ reforms are imperfect and require continuous improvements, these efforts are showing promise in increasing access to health services and reducing out-of-pocket payments by poor and vulnerable populations.