Free health care’ policies: Opportunities and risks for moving towards UHC

Overview

‘Free health care’ policies, or ‘politiques de gratuités des soins’ in French, have gained popularity over the past ten years, mostly in West Africa. They are being introduced by a number of low- and middle-income countries as a reaction to the situation where government funded and provided health services are in practice only accessible by paying user charges.

This policy brief outlines what is meant by free health care policies and why it is important to discuss these in relation to universal health coverage. It explores health financing policy issues related to free health care policies as well as the potential contributions to health financing system strengthening for progress towards UHC.

Evidence of free health care policies based on theory and practice is presented to show their impact on equitable utilisation, financial protection, service delivery as well as on system fragmentation. The policy brief concludes with a WHO perspective: An FHC design that focuses on specific services or easily identified population groups may be less pro-poor than a targeted user fee exemption or cash transfers based on income assessment or means testing, but in practice a FHC policy may be more feasible to implement. Particular attention needs to be given to replacing incentives for health workers when direct user charges are abolished. But provided they are formulated as part of a wider and phased strategic vision, FHC policies can be an effective instrument to broader UHC-oriented reforms.