Lecture 1 - Universal Health Coverage Flashcards
What are the 2 goals of UHC?
1) Service coverage - people can use all of the services they need and they are of sufficient quality and quantity
2) Financial protection: ensuring use of these services does not expose individuals to economic hardship
What is the value at which point OOP are “catastrophic”
Greater than 10% of income
What is sustainable development goal 3.8?
1) financial risk protection
2) access to quality and essential healthcare services
3) access to safe, effective, quality and affordable vaccines
Kydland et al (2013)
The economic benefits of investing in UHC are estimated to be 10x greater than the costs
What are the 2 elements of UHC funding? Explain them.
1) Financial risk pooling: most people in society contribute and it is redistributed across the population so financial risk is spread
2) Mandatory public pre-payments: everyone must contribute regulary regardless of health status. More effective than OOP, voluntary premiums, taxes on employers/employees
Ji and Chen (2016)
3 benefits of financial risk pooling:
1) reduce unnecessary mortality/morbidity
2) ensure patient satisfaction
3) prevent financial impoversihment from catastrophic costs
Chan (2016)
Path to UHC
1) Exclude ineffective services, expand priority services as budget grows
2) Include more people, focusing first on disadvantaged, low income, and rural populations
3) Reduce OOP
What should you not do when trying to achieve UHC?
- expand coverage for low priorities before medium and high
- prioritise costly services with low health benefit
- expand coverage for well-off before worse-off
- include employed before informal workers and poor
How did China roll out medical insurance?
Covered formal before informal workers which is what you should NOT do when trying to achieve UHC but it did improve access to care (more people went to the doctor and hospital) and reduced financial burden.
- 1991 Urban Employee Basic Medical Insurance
- 2002 New Rural Cooperative Medical Scheme
- 2007 Urban Resident Basic Medical Insurance
Healthy India ‘Modicare’
- India is in the process of implementing UHC
- Modicare went live in Sept 2018
- health insurance for the poorest 40% of the population
- poorest 8% receive annual family-level cover
- covers most secondary and tertiary care
- no exclusions for pre-existing conditions
- includes transport allowance
- covers all public hospitals and empanelled private hospitals
- developing health and wellness centres
- national scheme but implemented at the state level; federal funding matches state funding, variation in implementation across states (experiment with what works)
What is the UHC index?
Weighs service coverage with financial protection
This is NOT UHC, it is the degree of coverage; according to this metric the US has UHC but India does not
Compare SHI vs tax-based systems based on the following: countries
SHI: Switzerland, Germany, France, Japan
Tax: UK, Spain, Canada, Denmark
Compare SHI vs tax-based systems based on the following: architect
SHI: Bismarck
Tax: Beveridge
Compare SHI vs tax-based systems based on the following: main aim
SHI: keep workers healthy and improve productivity
Tax: health as a human right
Compare SHI vs tax-based systems based on the following: entitlement
SHI: contributions
Tax: citizenship/residency
