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“UHC [Universal Health Coverage] means that all individuals and communities receive the health services they need without suffering financial hardship. It includes the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care.
“UHC enables everyone to access the services that address the most significant causes of disease and death, and ensures that the quality of those services is good enough to improve the health of the people who receive them.
“Protecting people from the financial consequences of paying for health services out of their own pockets reduces the risk that people will be pushed into poverty because unexpected illness requires them to use up their life savings, sell assets, or borrow – destroying their futures and often those of their children.
“Achieving UHC is one of the targets the nations of the world set when adopting the Sustainable Development Goals in 2015. Countries that progress towards UHC will make progress towards the other health-related targets, and towards the other goals. Good health allows children to learn and adults to earn, helps people escape from poverty, and provides the basis for long-term economic development.”
Source: World Health Organization. Factsheet: Universal Health Coverage (UHC). January 24, 2019. Last accessed Jan. 13, 2020. https://www.who.int/en/news-room/fact-sheets/detail/universal-health-coverage-(uhc)
“There are many things that are not included in the scope of UHC:
- “UHC does not mean free coverage for all possible health interventions, regardless of the cost, as no country can provide all services free of charge on a sustainable basis.
- “UHC is not just about health financing. It encompasses all components of the health system: health service delivery systems, the health workforce, health facilities and communications networks, health technologies, information systems, quality assurance mechanisms, and governance and legislation.
- “UHC is not only about ensuring a minimum package of health services, but also about ensuring a progressive expansion of coverage of health services and financial protection as more resources become available.
- “UHC is not only about individual treatment services, but also includes population-based services such as public health campaigns, adding fluoride to water, controlling mosquito breeding grounds, and so on.
- “UHC is comprised of much more than just health; taking steps towards UHC means steps towards equity, development priorities, and social inclusion and cohesion.”
Source: World Health Organization. Factsheet: Universal Health Coverage (UHC). January 24, 2019. Last accessed Jan. 13, 2020. https://www.who.int/en/news-room/fact-sheets/detail/universal-health-coverage-(uhc)
“More recent economic work suggests a more nuanced account of insurance. In a range of clinical situations, Baicker, Mullainnathan, and Schwartzstein note that patients seem to forgo highly efficient healthcare. [15] Even when healthcare is deeply subsidized or free, some diabetics do not adhere to their insulin regimens and some patients with heart disease do not take their beta blockers, for examples. The authors suggest that in these special situations where individuals may be biased against consumption, optimal copays should sometimes be zero, or perhaps negative. They coin a term, ‘negative behavioral hazard,’ to describe the tendency of individuals to under-consume valuable health care interventions, in contrast to ‘positive behavioral hazard,’ which is the tendency of individuals to over-consume interventions lacking value.
“In this same vein, Brot-Goldberg and associates recently studied a change to greater cost-sharing exposure among a group of highly-paid employees, and found that, while it reduced spending, the intervention did not cause greater price-shopping. [16] In other work, high-deductible healthcare plans have been shown to reduce health spending, but also reduce appropriate preventative care and medication adherence. [17] Recent research suggests that providers may drive spending choices to a much greater degree than patients. [18,19]”
Source: Robertson CT, Yuan A, Zhang W, Joiner K. (2020). Distinguishing moral hazard from access for high-cost healthcare under insurance. PLoS ONE 15(4): e0231768. doi.org/10.1371/journal.pone.0231768.
“We were consistently unable to find a significant effect of moral hazard waste, and the upper ranges of our confidence intervals help rule out the hypothesis that the problem is substantial in the experimental sample. In contrast, we consistently found a substantial effect of insurance to provide access to expensive healthcare. These suggest that moral hazard in the healthcare sector may not be large, but the benefit of insurance providing access to expensive healthcare could be substantial.
“This research project sheds light on moral hazard, which has preoccupied health economics and U.S. health policy for half a century. By testing a novel counterfactual of indemnity insurance, we distinguished the access function of health insurance from waste, and thus informed longstanding debates about how fulsome health insurance coverage should be.
“Importantly, we focus on expensive interventions, associated with serious illness, which drives aggregate health spending. [21] Our data suggest that in these circumstances, moral hazard waste is not substantial, since the vast majority of spending stimulated by insurance would happen with fungible insurance, which preserves a price signal for consumers. We make no claim that these findings can or should be extrapolated directly to more routine care decisions.
“Healthcare is far from an ideal market: it is rife with wasteful spending and infected by all sorts of market failures, including the misaligned incentives of healthcare providers. Our data show what we know obtains in the real world: healthcare consumers are often willing to consume low-value care, when their physicians recommend it. Yet, our data show that the problem exists regardless of whether patients have a traditional insurance policy that occludes the price of care or an indemnity policy that makes the price salient along with the opportunity costs of consumption. Thus, our data helps to pinpoint the problem, and helps us understand where future policymaking should focus. For example, our study suggests that it will be more effective to align incentives of providers with health and thrift, rather than placing more risk on patients.”
Source: Robertson CT, Yuan A, Zhang W, Joiner K. (2020). Distinguishing moral hazard from access for high-cost healthcare under insurance. PLoS ONE 15(4): e0231768. doi.org/10.1371/journal.pone.0231768.
Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and sixteen other nations.
Page last updated Sept. 14, 2022 by Doug McVay, Editor.
