The Push for UHC — Comparison of HIC vs. LMIC

Universal Health Coverage (UHC) has become quite the buzzword in the global health community in the last decade, as 75% of countries are striving to provide this for their people through policy initiatives. What exactly is the argument for UHC in terms of health financing? Would it really affect what people are paying, especially in terms of out-of-pocket (OOP) expenditure? We can compare the revenue collections aspect of financing — I’ll be focusing on overall health expenditures — to compare the health equity of Bangladesh and the United States. Hopefully, I’ll shed some light on a few of these questions.

First off, what is UHC, and why the big push now? UHC as defined by the WHO is, “Universal health coverage means that all people have access to the health services they need, when and where they need them, without financial hardship. It includes the full range of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care (WHO, 2020).” The UN agreed to tackle UHC by 2030 in SDG 3.8, stating “Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all (UN Stats, 2020).”

Of the two countries I will be talking about, one supposedly already has UHC (Bangladesh) and one does not (USA). The WHO argues that the push for UHC is due to 100 million people worldwide being driven into poverty each year as a result of OOP spending and that 75% of the world’s population are either not covered by insurance or undercovered (WHO, 2020). This prevents access to needed healthcare, which would lead them to catastrophic OOP spending during a health emergency. UHC will become even harder to achieve as climate change worsens (Salas, 2019). Climate change could be the disaster that sends the worst hit and most uncovered places into economic despair, whilst struggling to stay alive.

The United States is a high-income country (HIC) and also spends the most on healthcare in accordance with GDP than any other HIC. 16.8% as of 2018, equaling $10,623 per capita (The World Bank Group, 2021). Out of Pocket (OOP) payments are also high, but on a downward trend in the last 20 years, currently sitting at 10.8% of current health expenditure as of 2018. However, OOP per capita in USD is increasing. In 2000, individuals were to spend $705, but as of 2018, it has increased to $1,148 per capita (The World Bank Group, 2021). This is due to rising costs in healthcare, but also the lack of insurance coverage with only 1 in 6 Americans being insured (Barnes, Rice, Rosenau, and Unruh, 2013). The US healthcare system is mainly privatized with a very limited government involvement, which creates catastrophic socioeconomic inequities throughout the system. Climate change will certainly play a role in American citizens needing more access to urgent and long-term care, however, in what exact locations and in what capacity, is still unknown.

Bangladesh is a lower-middle-income country (LMIC), and also one of the hardest-hit countries in terms of climate change, making healthcare more of a necessity (Ahmed et al., 2015). As of 2018, Bangladesh allocates 2.3% of its GDP towards healthcare, equaling $41 per capita (The World Bank Group, 2021). OOP expenses are high due to the lack of public funding put towards health care, equaling $30 US per capita, or 73.9% of current health expenditures (The World Bank Group, 2021). This is a regressing trend, increasing 12.8 points in the last two decades. Bangladesh healthcare inequity is rising, by forcing people at lower income levels to pay a higher percentage of their income towards OOP expenses. Bangladesh’s health system is theoretically Universal Health Coverage (UHC) but is largely regressive as they rely heavily on OOP payment to make up the majority of their health expenditure budget (Joarder, et al., 2019)(Ahmed et al., 2015).

In terms of healthcare equity, both systems are regressive. They create more inequity due to their emphasis on OOP, causing further inequities in terms of health outcomes. People will hesitate to seek healthcare due to it being such a large financial burden, creating more emergent problems long-term, costing them more money for more severe health issues. Bangladesh’s outcomes will be more significantly affected due to the quality of health care they have access to being lower overall than the US. Climate change will also play a role in this, with Bangladesh being known as the worst victim of the effects of global climate change (Ahmed et al., 2015). OOP in both nations is the highest both in their region as well as their GDP/GNI levels (Ahmed et al., 2015) (Barnes, Rice, Rosenau and Unruh, 2013). Both countries would benefit from moving towards a more equitable UHC model if they would like to maximize their health expenditures and improve the equity of their systems. As both country’s systems are currently regressive, Bangladesh would benefit from spending a higher percentage of public funds on healthcare in order to lower the OOP of individuals (Joarder, et al., 2019). The US could benefit from UHC in that it might spend less percentage of its overall GDP on healthcare if everyone was covered, creating more access, and allowing people to seek preventative care rather than emergent.

With the looming nature of climate change upon us, the more countries can do now to ensure people have access to care, the better. Preventive measures, like UHC, are going to cost the world, economically and otherwise, far less than if we wait for another disaster to strike.

References

Ahmed, S., Alam, B., Anwar, I., Begum, T., Huque, R., Khan, J., Nababan, H., and Osman, F., 2015. Bangladesh Health System Review. 5th ed. Manilla: Asia Pacific Observatory on Public Health Systems and Policies.

Barnes, A., Rice, T., Rosenau, P., and Unruh, L., 2013. United States Of America Health System Review. 15th ed. Copenhagen: European Observatory on Health Systems and Policies.

Data.worldbank.org. 2021. Current Health Expenditure — Bangladesh, United States | Data. [online] Available at: <https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS?end=2018&locations=BD-US&start=2000&view=chart> [Accessed 3 January 2021].

Joarder, T., Chaudhury, T. and Mannan, I., 2019. Universal Health Coverage in Bangladesh: Activities, Challenges, and Suggestions. Advances in Public Health, pp.1–12.

Salas Renee N, Jha Ashish K., 2019. Climate change threatens the achievement of effective universal healthcare. BMJ

UN Stats, 2020. SDG Indicators. Viewed January 11, 2021. <https://unstats.un.org/sdgs/metadata/?Text=&Goal=3&Target=3.8>

WHO, 2020. Universal Health Coverage. Viewed January 11, 2021. <https://www.who.int/health-topics/universal-health-coverage#tab=tab_1>