Prashant Sharma, Managing Director, Charnock Hospital highlights the benefits of UHC, current challenges and road ahead
Universal health coverage (UHC) is a state-sponsored health policy that will ensure that all people get the quality health services they deserve, without experiencing financial hardship. UHC is a pivotal element in achieving progress on Sustainable Development and Growth for any economy. Generally, UHC has two magnitudes – access to the common mass where accessing quality healthcare is a challenge, and the next dimension is financial protection. The Regional average for the UHC essential health services index is 64 per cent in 2022 compared with 46 per cent in 2010. On the other hand, over 65 million people are pushed into poverty because of out-of-pocket health expenditures.
UHC is an ecosystem sponsored by the state that all people obtain the health services they need without risking financial hardship from unaffordable out-of-pocket payments. On the contrary, health insurance is operated by public and private organisations where the quantum and extent of medical expenses will be covered in accordance with the premium paid.
Benefits of UHC
- A state-sponsored health policy that will ensure that all the people get the quality health services they deserve
- General public will not experience financial hardship from unaffordable out-of-pocket payments
- It covers the full continuum of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative
Thailand is among the few countries in the Southeast Asia region or among middle-income countries worldwide, that has a Universal Health Care (UHC) system covering 98 per cent of its population through publicly funded healthcare without co-payments. Managed by the National Health Security Office, it includes 953 hospitals and 9,765 health centers, significantly improving health indicators since its initiation in 2001-2011, including increased life expectancy and reduced infant mortality. Thailand’s UHC covers the entire population of 66.3 million people, merging previously separate schemes to achieve this comprehensive coverage. The model’s success is attributed to dedicated government agencies and equitable healthcare access.
In Japan, health care is universally available and free for citizens, expatriates, and foreigners. The system is accessible through enrollment with an employer, with insurance contributions deducted from salaries. Self-employed and unemployed individuals must join the National Health Insurance plan, paying taxes based on income. The Japanese system covers screenings, disease control, and prenatal care. Patients bear 30 per cent of medical costs, while the government covers the remaining 70 per cent.
Almost all South Koreans (97 per cent) are covered by the National Health Insurance Service (NHIS) and pay NHIS premiums according to their income levels or property values. The remaining 3 per cent are Medical Aid recipients, fully covered by the government. Both NHIS and MA include outpatient, inpatient, testing, and drug expenses, with out-of-pocket costs usually ranging from 0 to 20 per cent. During the pandemic, South Korea eliminated out-of-pocket expenses for COVID-19 health services.
In 1995, Taiwan established a government-administered national health insurance system, featuring single-payer healthcare. It offers accessible, comprehensive coverage, short waiting times, and a health insurance databank. Funding sources include employees, employers, and national and local government, with special programs for subsidies benefiting low-income populations and disadvantaged groups.
Ayushman Bharat (PMJAY) was launched in India as a step towards Universal Health Coverage (UHC). The concept covers three key elements — access, quality, and financial protection. India is committed to achieving Universal Health care for all by 2030, which now has achieved Sustainable Development Goals of 3.8. There were similar initiatives from the various state governments. All the district of West Bengal is covered under the ‘’Swasthya Sathi” scheme and 45 Lakhs of families covering nearly 2.5 Crore population benefitted from the scheme. Similarly, the Karnataka government has rolled out “Arogya Bhagya’ where 1.4 Crore households will get cashless treatment up to 1.5 lacs in government and private hospitals. All these schemes cover a vast volume of the population, because of prevailing low rates and prices implementing such schemes are very difficult in private hospitals.
Challenges and the way forward
Myanmar, despite efforts, faces challenges in achieving UHC due to chronic underfunding of the healthcare sector. Public spending on health remains low, constituting only around 1 per cent of GDP. Bangladesh’s healthcare system grapples with a double burden of diseases, inadequate service coverage, and a lack of effective financial risk protection mechanisms.
In Asia, notable strides have been made in UHC, especially in China, Japan, Singapore, Thailand, and South Korea, where health coverage rates exceed 95 per cent. India and Indonesia are also advancing their UHC programs. Addressing regional variations in service coverage and out-of-pocket expenditure remains a key challenge.
UHC stands as a vital aspiration for Asian nations. Learning from the successes of Thailand, Japan, South Korea, and others, countries can forge a path toward equitable, accessible, and financially secure healthcare for their citizens. While challenges persist, the journey toward UHC holds the promise of improved health and prosperity for all.