Health financing

Universal health coverage day 2017

Date: 12 December 2017

As part of UHC Day events, WHO is releasing a series of regional health financing reports, based on the latest evidence, and highlighting key policy issues facing countries as they make progress towards UHC. Each report focuses on a specific theme relevant to the countries in their region, for example the current situation in terms of financial protection in South-East Asia, and the transition to greater domestic financing for public health services in the Western Pacific region. A number of common challenges and policy issues are evident across the reports, including:

  • The need for a greater reliance on public spending from domestic sources to make progress towards UHC.
  • The transition to greater domestic financing and integration of service delivery is a key challenge facing a growing number of countries.
  • The need to address fragmentation in health financing arrangements (both across health coverage schemes and across types of health services) to drive efficiency and value for money;
  • Coverage policies: the way in which benefits are designed can explain significant differences in financial hardship across countries.
  • Monitoring financial protection is vital to ensure continued progress towards UHC. The way financial protection is defined and measured has important policy consequences.

WHO Regional Office for Europe

Financial protection in high-income countries: a comparison of the Czech Republic, Estonia and Latvia


Financial protection is central to universal health coverage and a core dimension of health system performance. The WHO Regional Office for Europe is generating evidence on financial protection using a new method of measuring catastrophic and impoverishing health spending. The aim is to monitor financial protection in a way that produces actionable evidence for policy; promotes pro-poor policies to break the link between ill health and poverty; and is relevant to all Member States in the WHO European Region.

This report illustrates the nature of the Regional Office’s work on financial protection and its relevance for policy by comparing financial protection across three high-income countries: the Czech Republic, Estonia and Latvia. The three countries are broadly similar in many ways but experience markedly different levels of financial hardship. The incidence of catastrophic and impoverishing out-of-pocket payments is very low in the Czech Republic, much higher in Estonia and among the highest in the European Region in Latvia. This analysis finds that differences in financial hardship are partly explained by variations in health spending across the countries, especially variation in the priority given to health when allocating government spending. Coverage policy is an equally important explanatory factor, however. It is the primary mechanism through which households are exposed to out-of-pocket payments, and the design of coverage policy determines how out-of-pocket payments are distributed across income groups.

Pan American Health Organization/ WHO Regional Office for the Americas

Health Financing and Financial Protection in the Americas


Despite progress in addressing health in the Americas, exclusion and lack of access to quality services persist for large sectors of the population. An estimated 30% of the population has no access to health care for financial reasons, and 21% is kept from seeking care by geographic barriers.

The prevailing models of care, based more on hospital care for episodes of acute illness than on comprehensive health care, including disease prevention and health promotion, often with excessive use of technologies, weak primary care services, and poor distribution of human resources (physicians, nurses, and others), do not necessarily meet the health needs of people and communities.

Lack of universality and equity in access to quality services and appropriate coverage, entails a substantial social cost and increases the risk of impoverishment of population groups in highest conditions of vulnerability. The evidence shows that when there are access barriers to services (whether economic, geographic, cultural, demographic, gender, ethnic or age related, or other), deterioration in health implies not only greater expenditure but a loss of income as well. The absence of mechanisms to protect against the financial risk of ill health creates and perpetuates a vicious cycle of disease and poverty.

Countries in the Region of the Americas have not remained indifferent to the challenges they face and have adopted different policies to address them. The report describes health financing systems in the Americas, examining trends by country in public expenditures on health and out-of-pocket spending. It then discusses three main challenges facing the countries,: (a) increasing public spending on health, (b) decreasing fragmentation in health financing arrangements, and (c) improving efficiency in the organization of services through the adoption of people- and community-centered models of care.

WHO Regional Office for South-East Asia

Financial protection in the South-East Asia region: determinants and policy implications


The South East Asia Region (SEAR) continues to have the highest health out-of-pocket share of total health expenditure amongst all WHO regions. As described in the report, on average, 38% of health care is paid directly by households at the time that they use services. Low public spending on health certainly contributes to this situation. The combination of low government revenues and low allocation to health results in amongst the lowest public spending on health observed across all regions. This situation affects the poorest segment of society in particular, preventing many from accessing services due to financial barriers or leading to impoverishment.

SEAR countries are taking action. Most have embarked on the journey of pursuing UHC through a series of health reforms, with a particular concern for the poor. Many of these countries have been able to increase dramatically the number of enrolees in various types of insurance programs. However, the report argues that while these efforts are admirable, health insurance “population coverage” should not be taken as equivalent to UHC. The potential enrolment barriers (financial and non-financial), supply side capacity constraints, as well as insufficiency of fund and their poor management, can all be the bottlenecks to translating entitlements on paper into effective service coverage.

The monitoring of progress towards financial protection should go beyond a simple documentation of numbers of enrollees of national insurance programs over time, or how citizens’ rights are defined in constitutions. Instead, in order to better assess the actual effect of all the well intentioned policies, this paper presents empirical evidence from appropriate national household surveys. With the findings, the paper also intends to stimulate discussions on how health policies can be better designed to enhance financial protection of vulnerable populations, which is the stepping stone towards UHC.

WHO Regional Office for the Western Pacific

Transitioning to integrated financing and service delivery of priority public health services


Strengthening essential public health functions is relevant for all health systems as they underpin priority public health services in all countries. A resilient health system requires the capacity to adapt to change, including in the areas of public health preparedness, community engagement in disease prevention and emergency preparedness and response, and an ability to withstand economic shocks. The need to secure essential public health functions is relevant for countries undergoing service delivery and budgeting reforms and particularly critical to countries facing reduced external funding, such as global health initiatives. While global health initiatives have brought about massive immediate cash and in-kind support to countries, they have also enlarged core programme elements, and distorted and fragmented systems that support essential public health functions.

To transition from a vertically-funded to whole-of-system approach, countries are to map existing elements in disease control programmes and how they are arranged to support broader public health functions, then coordinate and integrate those functions into the general health system. This requires changing the way of work and enables countries to do more with available resources and achieve efficiencies at the health system level in addition to mobilizing domestic resources. Given each donor may have its own transition plan and systems, partners and government are to coordinate and collaborate together to smooth the overall transition in countries. Government leadership is critical to establishing the vision for health sector development, ensuring active participation of stakeholders, sustaining health gains, and driving the entire transition process.