Health financing for universal coverage

Universal health coverage choices facing purchasers

The universal health coverage (UHC) cube, used in the World health report 2010, reflects three dimensions of coverage; population coverage, service coverage, and financial coverage or financial protection. Service quality is an important dimension not reflected in the cube, but is also critical for coverage to be effective. In many cases, choices about which services to include in the benefit package combine all three dimensions; for example, the provision of priority services with no co-payment for the entire population, or for priority population groups.

Trade-offs frequently arise in benefit package decisions. For example, is the priority to provide cost-effective services to those living in relatively well-served urban areas? Or is the priority to provide less cost-effective services to those in underserved remote areas? Equity considerations in some cases may take priority over efficiency concerns.

WHO convened a Consultative Group between 2012-2014 to look at questions of how best to address fairness and equity in benefit package decisions, as countries move towards UHC. The questions this group used to guide its work were:

  • Which services to include first/next?
  • Which people to include first/next?
  • How to shift from out-of-pocket payments (OOPs) to prepayment?

The Consultative Group proposed a three-part strategy:

  • Categorize services into priority classes. Relevant criteria include services which are most cost-effective, those which benefit the poorest, and those which offer financial protection to the patient. Each country will do this slightly differently.
  • Expand coverage for high-priority services (as defined by the country) to everyone. This includes eliminating patient co-payments while increasing mandatory, progressive prepayments and greater pooling of funds.
  • Ensure that disadvantaged groups are not left behind in terms of actually accessing entitlements. For example, low-income groups and rural populations often face many barriers to accessing healthcare, beyond patient co-payments.

For further details see: