To make progress towards UHC, Ministries of Health should aim to move towards a predominant reliance on public funding for health, given the evidence that this is a pre-requisite to make progress towards UHC.
Efficient spending is also central. Ensuring a stable and transparent flow of funds to health purchasing agencies and service providers is also an important part of revenue raising policy.
Free health care (FHC) policies – or politiques de gratuité – are about removing formal user fees either fully or partially. The removal may apply either to all health services, to the primary care level, to selected population groups, to selected services for everyone, or to selected services for specific population groups.
However, to date, evidence about the impact of FHC policies in terms of financial protection and health service utilization is mixed. If well designed and implemented, FHC can be a way to expand coverage in countries with few resources and can therefore be part of a strategy and a catalyst to move towards Universal Health Coverage.
Tracking the sources and uses of financial resources in the health sector has taken place for over 20 years, using Health Accounts (see below) and other mechanisms. As countries strive to make progress towards universal health coverage (UHC), aligning the classification of revenues and expenditures to the health- financing policy framework of revenue raising, pooling and purchasing becomes increasingly important. This ensures more relevant information for the development of policy at country level. Tools include the System of Health Accounts 2011, Public Expenditure Tracking Surveys (PETS) and Public Expenditure Reviews (PERs).
Progress towards universal health coverage (UHC) requires not just more money for health but more value for money. All health systems suffer from inefficiency in terms of the types of services and technologies funded, and the way in which their delivery is organised.
Health financing policy can help to improve efficiency, for example the ways in which revenues are pooled and used to purchase services included in the benefit package. Moving towards strategic purchasing is one way to make significant efficiency gains and savings across health systems.