I posted the comments below on the difference between universal health access and universal health coverage on the website of a student, Amitha Prasad, in my class on Emerging Trends in Global Health at USC to help clarify the need to understand the distinction between the two concepts...
Gurinder Shahi
---------------------
On the difference between universal access and universal coverage...
Universal access, as I see it, means that everyone get access to healthcare and services whenever they need it - if you have a healthcare problem or issue that needs to be addressed, there are no barriers to your gaining access to at least a minimum level and quality of care. One could well have different classes of service or care in a universal access system where, for example, you could, if you needed hospitalization, choose to stay in a general ward with 40 of your closest friends, or you could choose to stay in a private room - depending on your ability to pay. The key thing in a universal access system is that no one is turned away - everyone has a right to receive care and service.
When one speaks of universal coverage, one generally assumes insurance-based financing of healthcare when insurance is just one of many possible mechanisms to finance universal access to healthcare. Other possible mechanisms for financing access to healthcare include:
- out-of-pocket payments for access, as has historically been the case in countries like India (where, surprisingly for those who are not aware of the system, over 80% of healthcare services are paid for out-of-pocket) and, to a lesser extent, most countries in the developing world
- charitable or donation-based access to healthcare as is provided by many religious or charitable organizations where services and medication are provided free or at minimal cost - typically to those who could not otherwise afford to pay.
- socialized medicine or taxation-based financing of access to healthcare, as has been the case in countries like France (reputed to have among the best healthcare system in the world in terms of equity of access and quality of care), the United Kingdom, Scandinavia, etc
- dedicated medical savings plans as a mechanism to finance access to healthcare and services, as is the healthcare financing mechanism used in countries like Singapore. Typically, such medical savings plans are backed up by catastrophic illness insurance that kick in if the individual finds herself/himself having to deal with financially catastrophic illness such as chronic renal failure or cancer to ensure that the direct financial burden on the individual or her/his family is minimized
While insurance-based healthcare is the generally accepted approach to covering the cost of access to healthcare in the United States, comparative assessment has show that it is the most expensive way to provide healthcare and is fraught with the so-call "moral hazard" of insurance where people demand to use everything they feel they are entitled to when they need to use healthcare services - which results in a vicious cycle of rapidly escalating costs...as we have seen in this country. On top of this, there is the risk of people being denied service if they do not have the right form of coverage or if they have utilized more than a maximum level set by insurance providers and/or the law...which is why we see so many healthcare-related bankruptcies in this country.
The reason I spoke in class of being aware of the difference between universal access and universal coverage, and suggested that it is a far greater priority to ensure universal access rather than universal coverage is simply that universal coverage represents just one of many mechanisms of covering the cost of access to health services (and a pretty flawed one at that!), and that we would all be much better served if we focused on how to ensure and cover the cost of universal access, and are open to thinking out of the box to develop the fairest and most equitable mechanisms of financing access that could consist of any combination of some or all of the mechanisms identified above that would be most appropriate and responsive to meeting the healthcare needs and concerns in a given country.
Hope this clarifies the distinction I was trying to make between universal access and universal coverage.
No comments:
Post a Comment