With a High-Level Meeting on the topic at this year’s United Nations’ General Assembly and debate during the US presidential primaries and elsewhere, there can be little doubt that Universal Health Coverage – or UHC – has become a hot political topic.
Yet, despite all the hype, there are disagreements over whether UHC, which aims to ensure that all people receive the health services they need without financial hardship, is even achievable.
But new research sheds light on the experience of almost 50 countries that have attained UHC or made strides toward doing so. This research indicates that while there isn’t a one-size-fits-all approach, there are parallels – and opinions on what aids or prevents UHC are often misinformed.
1. “Only stable governments can aim for UHC”
It’s often thought that countries strive for UHC during periods of stability. But research shows that most major moves towards UHC are triggered by a change in circumstances that breaks a country’s usual pattern that has prevented healthcare reform.
Indeed, seven out of 10 countries progressed towards UHC while rebuilding in the aftermath of fragility, for example during post-war reconstruction (Belgium, UK), following civil strife (Thailand), or after military rule (Brazil). Fragile contexts tend to be periods of self-reflection during which countries decide what they want to be and where there is a need for unity. Combined, these forces can create political appetite for UHC.
It’s much more difficult to roll out UHC during fragile times – finances are often limited and subject to competing claims. But fragility appears to be a powerful motivation for UHC: disruption weakens powerbases that may oppose UHC and governments use healthcare to build legitimacy.
