The Global Politics of Universal Health Care

This guest post is from Yanzhong Huang, senior fellow for Global Health at the Council on Foreign Relations, and CFR Research Associate Jay T. Chittooran.

Global momentum is building for universal health care (UHC). In January 2012, health ministers from around the world gathered in Bangkok and committed themselves to raising “universal health coverage on the national, regional and global agendas.” Within a year, the United Nations General Assembly adopted a resolution on UHC, encouraging national governments worldwide to “plan or pursue the transition towards universal access to affordable and quality health-care services.” Since then, the World Health Organization and the World Bank have worked together to encourage global action on instituting UHC. Over seventy countries have enacted UHC or similar programs within their borders.

But even with growing political commitment, difficult decisions remain regarding what health services will be covered by UHC, given that resources for health are finite and demand is seemingly limitless. This is especially true in low- and middle-income countries (LMICs), which typically face tough budget constraints. In setting priorities about what to cover, policymakers have to address some thorny questions, such as: how can evidence and social values be systematically incorporated into the design of health plans?  How do you ensure a proper balance between promotive and preventive care on the one hand, and curative and rehabilitative care on the other? Which types of patients receive what interventions, when, and at what cost? Very often, the selection of services and technologies to be covered is based on cost effectiveness with respect to health outcomes. But any UHC plan should also take equity, financial protection, and social values into account.

Unfortunately, health care coverage in many LMICs is associated with general inefficiency, wasted money, and needless illness and death. For example, in India, even though only 44 percent of children under two years old are fully vaccinated, open-heart surgery is subsidized in national public hospitals. Similarly, in Colombia, only 58 percent of children are fully vaccinated, but public monies are used to subsidize a breast cancer treatment considered ineffective and unsafe in the United States. In both cases, expensive and potentially wasteful services are prioritized over cost effective and equity-enhancing health interventions.

In order to correct this problem, countries should ensure that they have an adequate amount of certain affordable drugs that satisfy the health care needs of their population, consult health insurance priority lists, and incorporate technology-related policy-making in health care to encourage the use of cost-effective health care tools. This requires building capacities to produce quality data and developing evidence-based decision-making. Fortunately, in many LMICs, data, methods, and evidence on the costs, effectiveness, and equity of health interventions are increasingly available. But health care resources and interventions remain skewed in favor of the privileged and politically-connected.

As UHC generates more demand for better health care, in turn putting financial pressure on governments, public spending will respond even more to interest groups and wealthy populations. This makes it imperative that countries invest in independent institutions to overcome the inherent biases of participatory politics, which tends to favor the loudest, best connected, and most articulate, but not always those most in need of care.