Intricacies of Universal Health Care

What are some of the primary concerns of Universal Health and access to quality health care? Among researchers doing studies in this area, these concerns have raised new narratives and debates. The general debate over Universal Health Care has revealed that certain populations are at greater risk and certain aspects of this crisis are particularly difficult to grasp. The process for achieving Universal Health care is not an easy one. And, many countries that currently have universal coverage systems needed decades to implement it. There are several factors involved in this process and this article will discuss some of the more important ones.

A concern of major importance to countries is how their health care systems can provide adequate health care for all of it’s inhabitants at an affordable price. However, this concern involves two diverse coverage dimensions: health care coverage (adequate health care) and population coverage (health care for all) – which is the aim of universal coverage. Now, Social Health Insurance (SHI) has become one of the primary methods for implementing health financing and twenty-seven countries have established this as their principle method for universal coverage.

There are at least three options for developing a universal health care system – two that are clearly distinct and one that is a hybrid composed of a mixture of the first two. First, there is the health system whose main source of financing is derived from a general tax revenue. Usually, these services are provided by a network of public and privately contracted providers and is usually referred to as a national health service. Then, there is the Social Health Insurance system (SHI) that mandates compulsory membership among a country’s population. This system is maintained by contributions by government, workers, the self-employed and businesses paying into a social health insurance fund. Contributions by businesses and workers is usually accomplished through salary deductions while contributions by the self-employed are flat fee based or determined by estimated income. In the case of the unemployed, low-income, informally employed or those that just cannot pay, the government usually provides contributions. And finally, there are the mixed health financing systems that usually employ a combination of both methods – that is, coverage through a general tax revenue and those covered by specific health insurance. It should be mentioned that private health insurance can also provide a supplementary role.

Further, there are a number of factors that influence the success of achieving universal coverage through a Social Health Insurance system. And here is where it becomes complicated. First, there is the level of income consideration that is available to any specific country. Ideally, the greater amount of income per capita increases the capacity of workers and businesses to make contributions to a SHI. Also, as income increases, tax revenues usually increase thereby enhancing the disbursement of subsidies into the fund. Therefore, when a country experiences steady economic growth, this has the capacity to increase contributions to the fund. Next, there is the structure of a country’s economy. What is important here is the difference between those that are formally employed and those that are informally employed. Those countries considered emerging or developing may have administrative difficulties in assessing incomes and collecting contributions because many workers do not have a formal salary structure.  More important, this can cause problems in providing coverage for the informal sector especially within a system that depends heavily on household contributions.

Another factor is the administrative costs associated with the distribution of the population. Populations in urban areas, where there is assumed at least a minimum degree of communication and infrastructure and usually a higher population density, is generally easier to serve than a population that is rural based and widely dispersed. Also, there is the consideration of the country’s ability to administer such a plan. That is, the establishment of a SHI plan requires a large workforce skilled in bookkeeping, banking, and information processing requiring secondary and often times tertiary educational levels. In addition, skilled workers in financial services, insurance, and community health insurance planning is needed. Obviously, it becomes the burden of the government to insure that staff are well-trained and stay up-to-date with changes in policies. And finally, there is “solidarity” within a given society. This is defined as a society that is willing to help other individuals within their society. Studies indicate that a system of full financial protection requires “cross-subsidization” both from the rich to the poor and from low risks to high risks.  Each country must assess it’s level of solidarity. And although policymakers can impose solidarity, a sufficient degree of inherent solidarity is needed in order to implement and maintain cross-subsidization.

Thus, it should be clear that a universal health care system in any country depends to a large extent on the country’s specific economic and political structure. Also, policymakers need to be well informed and prepared to be realistic about setting and maintaining goals. As a result, universal coverage, that is secure access to basic health care for all at an affordable price should be the ultimate goal and a better understanding of what that involves helps to achieve that aim – for everyone.

Sources: Carrin, J. and Chris James. (2004).  Reaching universal coverage via social health insurance: key design features in the transition period. Geneva: World Health Organization. Rao, K., Petrosyan, V., Araujo, E., & McIntyre, D. (2014, March 10). Progress towards universal health coverage in BRICS: Translating economic growth into better health. December 17, 2015, http://dx.doi.org/10.2471/BLT.13.127951