UNIVERSAL HEALTH COVERAGE: Providing a continuum of care for all population groups

Michael Palmer

UHC Forum, Bonn 26-28 August 2013

Universal Health Coverage (UHC)

“The challenge, it seems to me, is not to cover everyone. Or even to give everyone the same cover. Rather, the … challenge … is really about narrowing inequalities in coverage.”

Wagstaff (2010), Beyond Universal Coverage I

Results from Vietnam

Formal Retired Merit Disabled Ethnic Poor Farmer Self-emp Student

Inpat vis 0.078 0.201 0.110 0.235 0.075 0.085 0.091 0.082 0.037

Inpat exp p/v 97.783 239.960 100.244 425.557 43.265 99.303 71.910 144.331 34.725

Outpat vis 0.111 0.322 0.176 0.360 0.109 0.143 0.157 0.165 0.077

Outpat exp p/v 12.435 37.134 17.965 47.547 6.903 10.146 14.549 11.867 5.840

Self-treat vis 0.100 0.235 0.137 0.251 0.072 0.111 0.117 0.159 0.072

Self-treat exp 8.863 40.005 9.192 31.799 4.001 7.879 9.163 11.585 3.176

Catastrophic exp 0.069 0.192 0.161 0.276 0.102 0.202 0.147 0.138 0.096

Poverty net 0.023 0.171 0.288 0.286 0.536 0.546 0.413 0.129 0.157

N 2741 1093 2159 680 4844 4385 5571 1605 7889

15% of the world’s population (1 billion people)

Ageing populations and rise in non-communicable diseases

Higher prevalence of disability among the poor

Disability reduces income and earning capability and increased costs

Health care is particularly burdensome

Poverty rates increase significantly when the extra costs of disability are taken into account (e.g. Mont & Nguyen 2011)

People with Disabilities (PWDs)

Potentially powerful policy

Current programs poorly targeted in eligibility and benefits

Physical, acupuncture, acupressure rehabilitation services (no orthopedic, speech and occupational services)

90% of people requiring assistive devices are unable to attain them

Capped benefits

Physical and attitudinal barriers

UHC & PWDs

Inclusion of rehabilitation and assistive devices

Universal coverage of services and medication

Coverage of catastrophic expenditures

Travel costs

Supplementary benefit package

Systematic determination of disability

Improve accessibility and training of health staff

The way forwards

UHC is arguably the most important policy to change the lives of persons with disabilities and their families

So let’s do it well!

Last word…