Universal Health Coverage:

Financing Health Systems

James Fitzgerald
Director,
Health Systems and Services
Content
UHC: what it means to us.
Health Systems Challenges
in the Americas.
Financing Universal Health
Coverage.
UHC: a powerful conceptin evolution
UHC is to ensure all people have
access to needed services
(prevention, promotion, curative,
rehabilitation, and palliative care)
with sufficient quality to be
effective and without exposing
individuals to financial hardship.
UHC provides renewed focus on
access to the Social Determinants
of Health, and the engagement of
other sectors and civil society to
promote health and well-being
PRINCIPLES OF UHC

Universality
Equity
Right to health
Solidarity

Elements of the UHC Framework
Political Commitments on
the Right to Health and UHC
UHC Dimensions

Enabling Conditions and
Capacities

Legal Framework
Policies, Strategies,
Plans
Fiscal priority

Population coverage
Services coverage
Financial protection



Intersectoral approach
and SDH
Social dialogue and
participation
Regulatory capacity
Efficiency

What UHC is not?
UHC is not only about treatment
UHC is not only about financial protection
UHC is not a strategy which excludes priority health
programs
UHC is not about ensuring a minimum package of health
services
UHC is not about privatizing the health system
Challenges for Health Systems in
the Americas
Profound inequalities in income distribution
Inequalities in health in the Americas
Across countries
Disparities in health outcomes
The proportion of municipalities with
less than 80% DPT3 coverage varies
significantly between countries.
Inequalities in Health Care Access & Use

Within Countries Between populations
Important differences in population
health indicators exist between
Indigenous and non Indigenous
populations
UHC and the Right to Health
Policy and Legal frameworks;
Constitutions and health legislation;
Policies, Strategies and Plans;
Regulatory Capacity;

Social Dialogue and Inter-sectoral Action;
Effective participation of civil society;
Transparency, accountability framework;

Organization of PHC Based health systems
Progressive expansion of services
Integrated Health Service Delivery Networks
Quality
No yes
St Kitts&Nevis x
URU x
T&C x
TRT x
SUR x
PER x
PAN x
NIC x
COL x
COR x
BEL x
BOL x
CHI x
ECU x
BRA x
Do public health system users pay for medicine at the point of service delivery?
Source: Data from a random sampling of countries answers in WHO pharmaceutical profiles 2010-2011, PAHO/WHO
Financial Protection and Access to Medicines
Availability of Human Resources for Health
HRH per 10,000 inhabitants
0,0
10,0
20,0
30,0
40,0
50,0
60,0
59,0
37,0
32,7
23,8
22,5 19,5
17,4
8,9
25,0
Razn de RHS por 10.000 habitantes
Insufficiency
Inadequate
distribution
Poorly adapted to
challenges of UHC
(PHC, quality of care,
etc.)
HRH/10.000 inhabitants
EL SALVADOR Health Reform towards UHC
El Salvador
Health Reform Strategic Components
Integrated Health Service
Delivery
Medicines and Vaccines
National Medical Emergency
System
Unified Health Information
System
Social Participation
National Health Institute
Intersectoral action
People Centered Model of Care

Results of the health reform:
more preventive services and more integration among levels of care
Expanding Primary Health Care in Brazil
Brazil: 1,83 doctors/1,000 inhab.
22 Brazilian states are below the
national average
Impact
Brazils capacity to reduce inequities in access
to primary health care strengthened, as a
contribution to poverty reduction.

Outcome
Primary health care strengthened in priority
locations through qualification of health
professionals and international exchange of
knowledge.

Strategies
Changes in medical education system
Introduction of incentives to reach
underserved or remote regions
International exchange of knowledge
Financing Universal Health
Coverage
Health Financing Structure
Fuente: WB, 2012
37%
11%
3%
Future Impact of NCDs on Health Financing
Health systems challenges:
segmentation and fragmentation
SECTOR
SOURCES
FUNDS
PROVIDERS
USERS
Progressive and increased investment:
The case of Canada.
The Challenge in Financing Reform
towards UHC
The need for national health accounts to facilitate analysis and
decision making;

Targeting the use of health financing:
to reduce in so far as possible out of pocket of
expenditures, in particular at the point of service;
promote improved equity in access and Primary Health
Care based quality services.
Pooling resources and risk, promoting equity;
Address perverse incentives in the system (results based
financing);

A focus on efficiencies;

Efficiency as a Means to Promote Equity
According to the WHR 2010, between 30-40% of total health
spending is inefficient;

According to the OECD, a reduction of 50% in inefficient use of
finances would increase life expectancy by 1 year within
Member States.

Efficiencies in the Organization of services and delivery of care:
A focus on quality and people centered models of care
(PHC/RISS);
HTA, promotion of generic medicines;
Pricing transparency and referencing;

Efficiencies in the Financing System;
Integration of sub-systems, pooling of resources and risks.

LA has low rates
of taxation.
The actual tax
revenues
collected are far
from what they
should be based
on analysis of
national tax
codes.
Actual versus Potential Tax Revenues
in 2010 (%)
Soure: adapted from IMF, 2013
Countries Improving Health
Financing towards UHC
Argentina, Chile, Bolivia, Dominican Republic, Equator,
Mexico, Peru, Uruguay, USA, have recently introduced
(or are introducing) changes in pooling mechanisms

Many others are reviewing their financing structures to align better
with health objectives (Costa Rica, Chile, Brazil, Dominican Republic)

Some countries have increased their spending on primary care,
while others are implementing more comprehensive reforms.

Seeking efficiencies in medicines and health technologies
o Application of evidence, HTA, and economic evaluations , CPG, rational
use strategies to guide prioritization, incorporation and use of
medicines and health technologies in health systems
Each country needs to find its own way to
UHC based on its own particular historic,
social, and economic context, promoting a
larger social dialogue.
Every country can do something
to move towards UHC
Dr. C. F. Etienne, Jamaica, June 2013