Technological innovation, expansion of the use of frontline
personnel such as community health workers, and rapid increases in health care
financing are likely to be instrumental to achieving universal health care
(UHC) in countries around the world, according to a new analysis by researchers
at Harvard T.H. Chan School of Public Health and Tufts University School of
While the idea of universal healthcare is garnering
widespread support and is a central imperative for the World Health
Organization and the United Nations, the researchers emphasised that countries
must strike a balance between expanding healthcare coverage and ensuring the
quality of care that is being delivered. Medical errors, healthcare-acquired
infections, and poor retention of patients in care could undermine gains made
under UHC, they said.
“It’s difficult to think of an aspiration that both reflects
and contributes to human progress more than UHC. The challenge is delivery,
which will require sustained political and financial muscle in addition to
innovative technologies and institutions. Most importantly, it requires that we
avoid tunnel vision conceptions of UHC that focus predominantly on medical
interventions. We must not give short shrift to primary health care or to
interventions that promote disease prevention and early detection, social and
economic equity, and international cooperation,” said David Bloom, co-author
and Clarence James Gamble Professor of Economics and Demography at Harvard Chan
The analysis, which is a wide-ranging review of the
scientific evidence on UHC, is published online on August 23, 2018 in Science.
Forty years ago this September, world health leaders issued
the Alma-Ata Declaration, which raised global awareness of “health for all” as
a universal human right and emphasised the importance of primary healthcare.
The benefits of UHC are plentiful and extend beyond improving health. UHC may
lead to economic gains by increasing productivity, the researchers said, and it
can improve social and political stability while reducing health disparities
and economic and social inequalities. Additionally, countries in which the bulk
of healthcare spending is prepaid by government financing have lower rates of
the type of catastrophic health expenditures that can bankrupt families when
compared with countries that rely on private insurance schemes.
Since the Alma-Ata Declaration, high-income countries have
made significant strides toward UHC. Today, according to the researchers, the US
is the only high-income country in the world that does not explicitly provide
UHC to its citizens, despite spending significantly more on healthcare than
other economically advanced countries.
Progress toward UHC in low- and middle-income countries has
not been as swift, especially among countries located in sub-Saharan Africa and
South Asia, according to the analysis. Moreover, there are wide disparities in
care between countries with similar incomes. As an example, the researchers
noted that Vietnam scored 34 points higher than Nigeria on a World Health
Organization and World Bank index measuring UHC coverage, despite both
countries having a per capita GDP of around $2200. Vietnam outperformed Nigeria
in several key indicator areas, including infant vaccination coverage, births
attended by skilled professionals, and houses with access to basic sanitation.
Differences in economic inequality and political commitment to UHC may
contribute to these disparities in UHC coverage.
Among the biggest challenges is the need to rapidly increase
healthcare financing in low- and middle-income countries, where populations are
simultaneously growing in size and getting older. In the world’s less-developed
regions, the population is expected to grow by 1 billion people between 2018
and 2030 while the percentage of people over the age of 60 is expected to grow
from 10.6% to 14.2%, the researchers said.
Achieving UHC in low-resource settings will likely require a
radical transformation in the way health services are delivered, the authors
said. Shifting certain medical tasks from highly trained personnel to
appropriately well-trained personnel – such as community health workers – could
prove to be an important step. The researchers also said that adopting
innovative technologies such as electronic medical records, telemedicine, and
artificial intelligence for interpretation of x-rays and electrocardiograms,
may also help.
D, et al. The promise and peril of universal health care. Science. Published 24
August 2018. http://science.sciencemag.org/content/361/6404/eaat9644