What the pandemic taught us about Universal Health Coverage

Proper access to health services has undoubtedly become an incontrovertible right of every human being. Moreover, the responsibility falls upon the government to ensure that this access to healthcare is equitable. Similarly, it is also the government's responsibility to ensure that availing health services put no inexorable financial burden on the recipients. This is the dream of Universal Health Coverage.  

But, then again, this very promise of equal access and practically free healthcare services for all raise questions on whether UHC will ever be realistically achievable. In addition to the constant privatisation of medical services and resistance created by these industries, as shown in the US, the dream of UHC currently remains unattainable. The opponents of UHC also point to the possibility of unwanted government intrusion into private life rendering freedom useless. And all this eventually results in people paying higher out-of-pocket (OOP) expenses, which sometimes can become a lifelong burden for the lower and middle class. 

This issue is further exacerbated by the fact that the health services market is one of the most asymmetrical markets in terms of equitable information disbursement. Patients will never know more about their required medical services than their doctors. Consequently, the private medical service providers have an unfair advantage over their service recipients. Overall, the argument leans more towards UHC being economically detrimental than helpful.

To counter the naysayers regarding UHC, there are multiple examples of UHC being deployed, both on a small and large scale, in multiple countries, such as South Korea, Taiwan, Singapore with high success rates and even in relatively poorer countries like Thailand, India, Brazil, and Mexico. The case of UHC deployment in Kerala is exemplary of the development potential of derelict states in terms of economic growth and healthcare. 

Kerala, as one of the worst-off states in India, had no hopes of recovery from its stagnant economic growth and prevalent high mortality rates. So, when UHC was deployed there was virtually no hope of success. But the state of Kerala was able to surmount all those obstacles and now boasts one of the lowest mortality rates in the country with productivity and economic growth at an all-time high. 

The success of the poorer countries in UHC adaptation completely negates the trite objection that providing basic health care to all is inherently highly expensive, especially for developing and under-developed countries. But the argument forgets to account for the fact that health care provision is only as expensive as the labour behind it. 

The wage rate in these countries is comparatively lower than that of developed countries, thus rendering UHC implementation relatively cheaper. UHC also bolsters the quality of health care provided. 

Less than 1 percent of the entire population has a health coverage scheme resulting in 64 percent of total health expenditure coming from out-of-pocket expenses. PHOTO: Mumit M

The Lancet Global Health Commission has cited that poor-quality care is a large barrier to reducing the mortality rate and it estimates that almost 60 percent of deaths are caused due to poor quality care and non-utilisation of the health system. Easily available public health care prompts private medical services to better their service provision and offer more competitive prices to draw customers from the public sector.

Thus, assessing the benefits of UHC, in consideration of its costs, Bangladesh has taken certain steps towards UHC in the last decades. Bangladesh has taken steps in providing UHC both at the central and district level. The government has built Community Clinics all over the country and initiated the financing of the health scheme Shasthyo Suroksha Karmasuchi (SSK) in certain upazilas. 

The government aims to provide these services to the part of the population living below the poverty line by paying their premium. The government also aims to extend the coverage of this scheme to people above the poverty line as well. Additionally, Bangladesh has also provided vaccination programs like the Expanded Program on Immunisation (EPI) as preventive measures. 

Moreover, these efforts NGOs along with various donors such as the World Health Organization (WHO) are constantly working towards providing accessible and affordable health care to all in Bangladesh. Despite the best efforts of the government, less than 1 percent of the entire population has a health coverage scheme resulting in 64 percent of total health expenditure coming from out-of-pocket expenses, a figure that is high even compared to Bangladesh's neighbours. This high OOP has pushed 3.8 percent of people under the poverty line.

While the need for and implementation of UHC was gradually being recognised, the onset of a global pandemic has derailed all the progress for it. One the implicit prerequisite for public health care has always been stable economic growth for a country. 

Covid-19 has put the entire world into lockdown thereby shrinking the global economy by 4.3 percent. The dreams of universal health care have remained unfulfilled in this regard. The financial crunch created by the pandemic in the global economy has also raised costs for all businesses and services and therefore has raised the cost of implementing UHC even in the relatively poorer countries. 

The mass layoffs forced upon the global economy and the resultant short staffing can also be a disrupting factor in UHC implementation as the glut of workers, both health professionals and others is a necessity.  Moreover, with countries scrambling to secure vaccines for the population and combat the virus, it seems like implementation of UHC will have to wait. However, delaying the implementation of UHC would be an unwise step in a post-pandemic world.

While the dream for free health care has hit a massive obstacle in the form of a pandemic, it has further exposed the inefficacies of traditional healthcare systems and underlined the need for UHC. The pandemic has once again shown the need for preventive measures than reactive ones. And once again equality in service provision has been disputed in the form of discrepancies in health care service provision. Rwanda is exemplary in the case of tackling the pandemic with the help of UHC. Rwanda recorded one of the fewest COVID-19 cases relative to its population size because Universal Health Care emphasises primary health care for all which limits the spread of contagious diseases in the first place. And this is further aided by the fact that bare minimum health care is accessible for all citizens and easily affordable. The pandemic has shown the importance of preventive healthcare which happens to be one of the cornerstones of UHC. Finally, a heightened sense of one's health and general medical awareness should be a major takeaway from this global calamity that can properly be facilitated with the help of Universal Health Care.

The author is an undergraduate business student currently studying in Bangladesh University of Professionals (BUP).

Disclaimer: The views and opinions expressed in this article are those of the authors and do not necessarily reflect the opinions and views of The Business Standard.