By: Dave Ross, ScD, President and CEO
In February, we met with World Health Organization Director-General Dr. Tedros Adhanom Ghebreyesus, and among the topics that came up was Universal Health Coverage, a subject that is close to our collective hearts at The Task Force. To my mind, UHC, as many in public health refer to it, is necessary and inevitable. But it’s a slow march as there’s not an infinite supply of doctors and nurses. We need to be smart about growing the health workforce to keep pace with promising access to services for all.
Achieving UHC requires continued economic prosperity across all countries coupled with focused attention on growing the number of health care professionals and smart approaches to preventive health strategies, such as having a sufficient workforce of field epidemiologists and an informative surveillance systems infrastructure. There is no doubt we can make significant progress within current contexts. For instance, one of our programs in Kenya has revolutionized access to good care by establishing electronic health workforce information systems that provide accurate and real-time data for policy, health program planning and management of the country’s healthcare personnel. And the best part is that this is a completely replicable and financially self-sustaining model. You can read about its transformative impact here.
However, it’s becoming increasingly evident that a thoughtful restructuring of countries’ health systems – including the United States – is essential to maximize the benefits of task shifting such as having nurses do some of the tasks previously done only by physicians, and community health workers being trained to perform specific tasks usually done by nurses, for example, administering medications. Countries need to develop primary care facilities and make them more robust so patients don’t need to seek tertiary care for non-emergencies.
Even in this most developed country, we struggle to get essential health services to all persons who need them. When we debate Universal Health Coverage, we are really boiling it down to two issues: Cost and Values. Is affordable access to essential health care a human rights issue or is it an economic issue? Which dominates the other? If having access to healthcare is viewed primarily like any other commercial financial transaction, then the consequence to this approach is equivalent to saying, ‘we are willing to let you die because you can’t pay what the providers of health care want.’ On the other hand, if we take a values driven approach we begin by asking society how best to minimize cost while assuring access for all. Taking the values driven approach requires very broad social consensus that health is a human right.
In many countries, in fact, most countries around the world, when confronted with those two choices, most people land on the idea that everyone has a right to some sort of healthcare service. In the United States, we have yet to reach social consensus around the notion that health is a human right.
What should start the Universal Health Coverage conversation – valuing life for all or economic efficiency? Where and how values come into this conversation is critical for guiding us to policies that everyone can embrace, support, and fund. There will inevitably be more demand than supply. Therefore, how do we ration care – who needs the care most or who can pay most?
We must segregate the philosophy that guides a nation’s approach towards Universal Health Coverage from focusing on how it’s delivered to the actual provision of care. I don’t believe that deciding everyone should have access to a basic suite of services necessarily eliminates a private health care approach nor a privately managed insurance scheme.
Around the world we see multiple models in play – some based on private insurance schemes, some based on nationalized service delivery. Experience shows that there are effective low-cost ways to operate, and we as a global health community can map out scalable solutions and learn from one another’s approaches.
But before we debate how to deliver care, let’s first agree on why we’re giving care. Is it because I can pay or because I am in need?