Universal health coverage: just what is being promised and to whom?
The policy slogan of 'universal health coverage' promises unversal access to an 'essential' package of services and protection against medical impoverishment. In this extended analysis (current draft here) the promises of UHC are sharply interrogated.
For the strategists of transnational capitalism UHC promises opening of new markets for health commodities and market opportunities for consumer goods more generally. UHC will contribute to the relegitimation of the global neoliberal regime, demonstrating that it is not so heartless after all.
For national politicians, officials and civil society activists concerned about health development UHC promises a pathway to health system strengthening but there are grounds for caution. UHC as currently promoted will lock in two tiered health funding and two tiered service delivery. Under the model on offer the controls over quality, efficiency and equity are weak, particularly in the private sector. Weak cost control in the private sector is likely to lead to premium inflation and political pressure to subsidise private insurance and widen access to insurance rather than expanding the basic package. There appears to be no capacity in the model on offer for intersectoral collaboration and action on the social determinants of health, particularly at the primary care level.
For poor people facing financial barriers to care and the risk of medical impoverishment UHC promises financial protection but there are grounds for caution here also. Widening inequality and two tiered health funding compromise solidarity and revenue mobilisation and the prospect of widening the benefits package. Barriers to access and medical impoverishment are a reflection of widening economic inequality associated with the global crisis of overproduction. The UHC narrative offers no suggestions for reform here, indeed it is part of the neoliberal program which is perpetuating that crisis.
The challenges for the Health for All movement include: integrating a technical policy analysis with a political economy analysis; working in community on the specific and immediate health issues but in ways which also address the larger structural issues which reproduce those needs; promoting a vision of what a decent health system would look like; working in ways which deepen solidarity across difference in building a better world.
25 Sept 2021