Background

Transforming Health Systems for Universal Health Care

Universal health coverage (UHC) is an important way to expand access to effective health-care services, reduce financial hardship during illness, and improve health outcomes. In addition to legal provisions, which provide entitlements and mandate access to necessary health services, UHC requires a well-functioning health system that provides high quality, affordable, accessible, and efficient health services. As well as enabling countries to realize UHC, well-functioning health systems provide social protection, respond to legitimate expectations of citizens, contribute to economic growth and welfare of nations and underpin universal health coverage.

High income inequalities create barriers to UHC, whereas political stability, committed leadership, sustained economic growth and a comprehensive health system transformation that improves governance, financing and healthcare services are critical for achieving UHC.

Recent experience from middle-income countries, including Brazil, China, Mexico, Thailand and Turkey, provides new evidence on the approaches used to address inequalities in access to health care and in health outcomes through UHC by combining pre-pooled health insurance schemes or tax financing with health system strengthening.

In addition to middle-income countries such as Indonesia, the Philippines, and South Africa, no less than 30 low-income and middle-income countries are actively pursuing policies to achieve UHC.  Hence, the experience and evidence from different settings is crucially important to build the knowledge base on the effective strategies used to introduce UHC in order to expand health service access, provide financial protection, improve health outcomes and enhance user satisfaction.

The experience of Thailand in introducing her Universal Coverage Scheme (UCS) is particularly valuable as it showcases a comprehensive and inclusive approach underpinned by strong political and financial commitments, locally developed technical capacity, engagement of civil society organizations and health system strengthening. Thailand has carefully drawn on international and locally generated evidence to design and implement the USC and used economic growth to create the necessary fiscal space for its expansion.