Emerging challenges in implementing universal health coverage in Asia.
As countries in Asia converge on the goal of universal health coverage (UHC), some common challenges are emerging. One is how to ensure coverage of the informal sector so as to make UHC truly universal; a second is how to design a benefit package that is responsive and appropriate to current health challenges, yet fiscally sustainable; and a third is how to ensure "supply-side readiness", i.e. the availability and quality of services, which is a necessary condition for translating coverage into improvements in health outcomes. Using examples from the Asia region, this paper discusses these three challenges and how they are being addressed. On the first challenge, two promising approaches emerge: using general revenues to fully cover the informal sector, or employing a combination of tax subsidies, non-financial incentives and contributory requirements. The former can produce fast results, but places pressure on government budgets and may induce informality, while the latter will require a strong administrative mandate and systems to track the ability-to-pay. With respect to benefit packages, we find considerable variation in the nature and rigor of processes underlying the selection and updating of the services included. Also, in general, packages do not yet focus sufficiently on non-communicable diseases (NCDs) and related preventive outpatient care. Finally, there are large variations and inequities in the supply-side readiness, in terms of availability of infrastructure, equipment, essential drugs and staffing, to deliver on the promises of UHC. Health worker competencies are also a constraint. While the UHC challenges are common, experience in overcoming these challenges is varied and many of the successes appear to be highly context-specific. This implies that researchers and policymakers need to rigorously, and regularly, assess different approaches, and share these findings across countries in Asia - and across the world.
World Bank Group, USA. Electronic address: cbredenkamp@worldbank.org.
Caryn
C
Bredenkamp
World Bank Group, USA.
Timothy
T
Evans
Philippines Health Insurance Corporation, Philippines.
Leizel
L
Lagrada
Bill and Melinda Gates Foundation, USA.
John
J
Langenbrunner
University of California, San Francisco, USA.
Stefan
S
Nachuk
World Bank Group, USA.
Toomas
T
Palu
D001208:Asia; D004651:Employment / Q000191:economics; D006297:Health Services Accessibility / Q000191:economics; D006301:Health Services Needs and Demand / Q000458:organization & administration; D006801:Humans; D007183:Income Tax / Q000191:economics; D007348:Insurance, Health / Q000458:organization & administration*; D011787:Quality of Health Care; D019472:Universal Health Insurance / Q000191:economics / Q000458:organization & administration*
Asia; Benefit package; Health care; Health financing; Health insurance; Informal sector; Quality; UHC; Universal health coverage