Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
The World Health Organization’s (WHO’s) World Health Report 2010, “Health systems financing, the path to universal coverage,” promoted universal health coverage (UHC) as an aspirational objective for country health systems. Yet, in addition to the dimensions of services and coverage, distribution of coverage in the population, and financial risk protection highlighted by the report, the consideration of the budget constraint should be further strengthened in the ensuing debate on resource allocation toward UHC. Beyond the substantial financial constraints faced by low- and middle-income countries, additional considerations, such as the geographical context, the underlying country infrastructure, and the architecture of health systems, determine the feasibility, effectiveness, quality and cost of healthcare delivery. Therefore, increased production and use of local evidence tied to the criteria of health benefits, equity, financial risk protection, and costs accompanying health delivery are needed so that to highlight pathways and acceptable trade-offs toward UHC.
Norheim OF. Ethical perspective: five unacceptable trade-offs on the path to universal health coverage. Int J Health Policy Manag. 2015;4(11):711-714. doi:10.15171/ijhpm.2015.184
Schmidt H, Gostin LO, Emanuel EJ. Public health, universal health coverage, and sustainable development goals: can they coexist? Lancet. 2015;386:928-930. doi:10.1016/s0140-6736(15)60244-6
Hanratty B, Zhang T, Whitehead M. How close have universal health systems come to achieving equity in use of curative services? A systematic review. Int J Health Serv. 2007;37:89-109. doi:10.2190/ttx2-3572-ul81-62w7
World Health Organization (WHO). Making fair choices on the path to universal health coverage. Final report of the WHO Consultative Group on Equity and Universal Health Coverage. Geneva: WHO; 2014.
Verguet S, Laxminarayan R, Jamison DT. Universal of public finance of tuberculosis treatment in India: an extended cost-effectiveness analysis. Health Econ. 2015;24:318-332. doi:10.1002/hec.3019
Verguet S, Olson ZD, Babigumira JB, et al. Health gains and financial risk protection afforded by public financing of selected interventions in Ethiopia: an extended cost-effectiveness analysis. Lancet Global Health. 2015;3(5):e288-e296. doi:10.1016/s2214-109x(14)70346-8