Project:

Symposium: Universal Coverage: Can We Guarantee Health for All?

Symposium Overview:

The aim of a health system that claims universal coverage is to ensure that all people have access to a full spectrum of quality health services without suffering undue financial hardship in order to pay for it. Incorporated in this definition of universal coverage are two distinct notions.  The first relates to full access to the spectrum of quality services – from prevention through to palliative and rehabilitative services. The second relates to access to the available healthcare; both financial and structural (geographical location, social position, etc.).

The argument for universal coverage recognises the importance of health as a public good. As such, to achieve universal coverage, investments in health services will need to exceed the expectation of a reasonable financial return. However, the investment can be expected to return value to the community as a whole, beyond benefits to the individual. Underpinning universal coverage therefore are the basic human values of equity and social justice.

A stark reality, often at odds with the values argument, is the financing of health services within a universal coverage health system to mitigate the potential financial hardship of the end user. Where governments are unable or unwilling to shoulder the costs from the public purse there have been a range of options that include various models of insurance. There is also a rapidly growing private sector involved both in the delivery of health services and in private insurance schemes. In broad terms, the private sector in health is based on a model of health services as a commodity that can be distributed efficiently by a free market. The question of whether considerations of equity and free market distribution are mutually exclusive remains an open debate.

How then can governments, particularly in lower and middle income countries, with significant budget deficits, often limited capacity and with populations with multiple disease burdens, achieve universal coverage; and what evidence do they need to support their approach? This topic was the focus of the World Health Report 2010. However, in spite of some opportunities for dialogue between the public and private health sectors, it remains largely unclear how the roles of both can be integrated towards a coherent functional, efficient and equitable health system. These are key challenges particularly within the context of the urgent need for health systems strengthening and health sector reforms in lower and middle income countries.

Using a combination of case studies and panel discussions, this symposium will bring together policy makers, practitioners, academics, consumers and experts from the public and private health care sectors to explore these issues from their unique perspectives. The symposium will provide the opportunity to discuss effective mechanisms and measures adopted by states to control cost escalation in implementing universal coverage. Papers and case studies will be presented from a range of lower and middle income countries and from the private health sector, with the explicit purpose of enabling discussion of approaches to making universal coverage affordable.

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