Editorial | Financing universal health coverage

The recent G20 Summit of major industrial countries held in Osaka, Japan, devoted most of its attention to the major issues of challenging the global economy, including trade, energy, and financial flows, as well as security and climate change.

A very significant event took place at the summit. Though it received very little coverage, it holds promise for ordinary people around the globe. This event was the first-ever joint meeting of ministers of health and ministers of finance from G20 countries focusing on how to ensure sustainable financing of universal health coverage (UHC) in developing countries.

Ensuring that all people receive the quality health services that they need without suffering financial hardship is a commitment that governments, including Jamaica’s, have given as part of the United Nations Sustainable Development Goals.

The leaders of the G20 countries were alarmed at the possibility that the majority of developing countries would fail to achieve the UHC target unless urgent and fundamental steps are taken to address health financing. They were informed by a new report launched by the World Bank, High-Performance Health Financing for Universal Health Coverage, showing the need for urgent action.

Insufficient and inefficient financing

The report shows that the insufficient and inefficient financing of health means that large numbers of poorer people in developing countries like Jamaica are paying on average US$80 per capita in out-of-pocket health expenses, pushing many into extreme poverty. Less than 20 per cent of the Jamaican population currently access health insurance. Further, in 2011, the World Bank reported that 32 per cent of Jamaicans were unable to access health care because of financial concerns.

The fee-less policy that was extended in 2008, beyond children and the elderly, means that all Jamaicans can access public hospitals and health facilities without having to pay directly. This policy has put tremendous strain on the already inadequate health facilities and staff. There is, as yet, no clear indication that the policy has led to significant improvements in health outcomes.

The need for more resources to meet current and future needs of the health sector was, it appears, significant in informing the Government’s push for a national health insurance scheme, announced by Minister Christopher Tufton in his May 2019 Budget Speech, along with the publication of a Green Paper to inform discussions on the subject.

The ambition of the Government to have universal coverage for every Jamaican resident will be tested by the demographic reality of an ageing population, woefully inadequate health infrastructure, insufficient financing, and a fragile economy, still with close to 100 per cent debt to GDP.

The gap between demands for health spending and available resources from the Budget will likely prolong the reliance on the inequitable out-of-pocket health expenditure by the poorest.

If the Government’s objective to meet its goals set out in Vision 2030, the United Nations Human Development Goals for universal health coverage, is to be realised, fundamental decisions need to be made – and soon.

A critical starting point is to view healthcare expenditure as largely investment, rather than consumption, that benefits the economy through building human capital, reducing poverty and inequality, and increasing the resiliency of the population.

Another important principle is the need for joint leadership of the ministers of health and finance in the development of successful health-financing policy solutions. As the World Bank points out, the Government can improve efficiency and equity of resource use by prioritising the financing of high-quality primary and community-health services.

These issues will need to be addressed in the promised public consultation and discussion of the Green Paper on health insurance.