Achieving Effective Universal Health Coverage And Diagonal Approaches To Care For Chronic Illnesses.
Health systems in low- and middle-income countries were designed to provide episodic care for acute conditions. However, the burden of disease has shifted to be overwhelmingly dominated by chronic conditions and illnesses that require health systems to function in an integrated manner across a spectrum of disease stages from prevention to palliation. Low- and middle-income countries are also aiming to ensure health care access for all through universal health coverage. This article proposes a framework of effective universal health coverage intended to meet the challenge of chronic illnesses. It outlines strategies to strengthen health systems through a "diagonal approach." We argue that the core challenge to health systems is chronicity of illness that requires ongoing and long-term health care. The example of breast cancer within the broader context of health system reform in Mexico is presented to illustrate effective universal health coverage along the chronic disease continuum and across health systems functions. The article concludes with recommendations to strengthen health systems in order to achieve effective universal health coverage.
Felicia Marie Knaul (fknaul@gmail.com) is director of the Miami Institute for the Americas and professor at the Miller School of Medicine, University of Miami, in Florida. At the time this research was conducted, she was director of the Harvard Global Equity Initiative, in Boston, Massachusetts.
Felicia Marie
FM
Knaul
Afsan Bhadelia is a research associate at the Harvard Global Equity Initiative.
Afsan
A
Bhadelia
Rifat Atun is a professor of global health systems in the Department of Global Health and Population at the Harvard School of Public Health.
Rifat
R
Atun
Julio Frenk is president of the University of Miami, in Florida. At the time this research was conducted, he was dean of the Harvard School of Public Health.
Julio
J
Frenk
D001943:Breast Neoplasms / Q000191:economics / Q000628:therapy; D002908:Chronic Disease / Q000191:economics* / Q000628:therapy*; D003695:Delivery of Health Care / Q000191:economics* / Q000458:organization & administration; D003906:Developing Countries; D005260:Female; D018166:Health Care Reform / Q000458:organization & administration; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D008297:Male; D008800:Mexico; D059408:Pain Management / Q000191:economics / Q000379:methods; D010166:Palliative Care / Q000458:organization & administration; D019472:Universal Health Insurance / Q000191:economics / Q000458:organization & administration*
Chronic Care, Long-Term Care; Developing World < International/Global Health Studies; Disparities; Public Health