The promise and peril of universal health care

Abstract

Universal health care (UHC) is garnering growing support throughout the world, a reflection of social and economic progress and of the recognition that population health is both an indicator and an instrument of national development. Substantial human and financial resources will be required to achieve UHC in any of the various ways it has been conceived and defined. Progress toward achieving UHC will be aided by new technologies, a willingness to shift medical tasks from highly trained to appropriately well-trained personnel, a judicious balance between the quantity and quality of health care services, and resource allocation decisions that acknowledge the important role of public health interventions and nonmedical influences on population health.

Bangkok, Thailand. A nurse keeps records of a blood donor at the Thai National Blood Centre on 14 June 2017.

Fig. 1

WHO–World Bank UHC index score versus the natural logarithm of GDP per capita. The plot captures absolute changes in UHC index scores (maximum of 80) relative to percentage changes in GDP per capita. Source: UHC index scores from World Bank (2017) (9) and GDP per capita from World Bank (2018) (15). R², coefficient of determination.

Fig. 2

Cascade of care for patients with any form of TB in India in 2013. Patient losses at each stage of care represent shortcomings in quality of care that undermine the effectiveness of TB services, despite a high level of population coverage. Source: Subbaraman et al. (47).