The four pillars to ensure inclusive Universal Health Coverage Feb 16, 2017

The four pillars to ensure inclusive Universal Health Coverage

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Last week, addressing a plenary at the Prince Mahidol Award Conference entitled ‘The Political Economy of Social Inclusion’, Elder, Ernesto Zedillo, drew on his experiences as President of Mexico and explained how to sustainably implement Universal Health Coverage.

Ernesto spoke of the interventions to reach the vulnerable: “In the quest for social inclusion, hardly any other institutional policy will be as powerful as the pursuit of universal health care. Consequently, achieving this noble and indispensable objective must be undertaken with a sound strategy to make it financially sustainable and unequivocally compatible with other important social development objectives. Success in this endeavour, let me insist, requires clarity of purpose, clarity of design, clarity of financing, and clarity of incentives.”

His speech emphasised the role of what he sees as the four indispensable pillars of effective social policies. Those pillars being, clarity of: purpose, design, financing, and incentives.

Clarity of purpose: Universal Health Care is Universal Health Care and the term ‘universal’ should not allow nuances that justify or give rise to social exclusion. Ernesto went on to state that, “There should be no question that UHC is about the entire population and the entire system.”

Furthermore a commitment to UHC is also a commitment to justice, rule of law and good governance. It is about justice because it is about fair equality of opportunity and treating all individuals as equals.

Clarity of design: This means that in determining the pathway towards UHC, the trade-offs must be acknowledged at the outset and confronted. Covering everyone with the most essential services, which must be clearly defined, should be the priority in most cases. The hard choices in deciding the modalities for delivery of health services must be admitted transparently.

Clarity of financing: Clarity of purpose and design would be worthless without clarity of financing. According to Ernesto, “Compulsory prepayments and risk pooling – in a pool as large as conceivably possible – must be the general approach to finance UHC. Compulsion and subsidisation must be the anchors for the viability and sustainability of a genuine UHC system.”

Not all compulsory payments are created equal. From theory and practice we know that general tax revenues should be the preferred best financing source.

Clarity of incentives: Key examples of objectives where the level and structure of incentives, positive and negative, play a decisive role include:

  • Transforming potential demand into real demand for health services
  • Preventing abuses of the system by its consumers and providers
  • Moderating cost inflation of health services
  • Enhancing productivity and promoting cost-effective innovation 

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