New WHO World Health Report Discusses Equity in Health Care Financing

This year’s World Health Report, Health Systems Financing: The Path to Universal Coverage, published this week by the World Health Organization (WHO), seeks to give governments practical guidance on financing health care in a way that ensures universal access.

From the press release: “Taking evidence from all over the world, [the report] shows how all countries, rich and poor, can adjust their health financing mechanisms so more people get the health care they need. […] ‘No one in need of health care should have to risk financial ruin as a result,’ said Dr Margaret Chan, Director-General of WHO.”

While regrettably ignoring the human right to health care framework, established in international law, the report does include some relevant observations, especially when it draws on the principle of equity to discuss approaches to health care financing.

Here are some excerpts:

"In this report, WHO outlines how countries can modify their financing systems to move more quickly towards universal coverage and to sustain those achievements."

"The path to universal coverage… is relatively simple – at least on paper. Countries must raise sufficient funds, reduce the reliance on direct payments to finance services, and improve efficiency and equity."

"Where fees are charged, everyone pays the same price regardless of their economic status. There is no formal expression of solidarity between the sick and the healthy, or between the rich and the poor. Such systems make it impossible to spread costs over the life-cycle: paying contributions when one is young and healthy and drawing on them in the event of illness later in life. Consequently, the risk of financial catastrophe and impoverishment is high, and achieving universal coverage impossible."

"The only way to reduce reliance on direct payments is for governments to encourage the risk-pooling, prepayment approach, the path chosen by most of the countries that have come closest to universal coverage. When a population has access to prepayment and pooling mechanisms, the goal of universal health coverage becomes more realistic."

"Third, pools that protect the health needs of a small number of people are not viable in the long run. A few episodes of expensive illness will wipe them out. Multiple pools, each with their own administrations and information systems, are also inefficient and make it difficult to achieve equity. Usually, one of the pools will provide high benefits to relatively wealthy people, who will not want to cross-subsidize the costs of poorer, less healthy people."

"[Governments] are… responsible for ensuring that everyone can obtain the services they need and that all are protected from the financial risks associated with using them. This can conflict with the drive towards efficiency, for the most efficient way of using resources is not always the most equitable. For example, it is usually more efficient to locate services in populated areas, but reaching the rural poor will require locating services closer to them."