Universal health care in middle-income countries: Lessons from four countries

Abstract

Faced with illness, disability and death, people throughout history, at all income levelsrich or poor -and from all cultural backgrounds have in the past and continue today to aspire to overcome their ailments and restore good health.Systems-wide changes, that allow affordable access to needed health care at the time of illness, has been a major theme for health care reform throughout the 20 th century.Most countries that are members of the Organization for Economic Cooperation and Development (OECD), with the exception of Background In this paper, we review lessons learned about Universal Health Coverage (UHC) in middle-income countries, with specific reference to achievements and challenges observed during recent years in four middle-income to upper-middle-income countries -Mexico, Turkey, The Republic of Korea and Ukraine.Three of these countries -Mexico, the Republic of Korea, Turkey are members of the Organization for Economic Cooperation and Development (OECD).Ukraine has aspired to join Western institutions like the OECD since its independence in 1991 MethodsThe research included a combination of cross-sectional and longitudinal reviews of both statistical and contextual data, available from both published sources and available "grey literature" reports. ResultsBased on the research, we conclude the following.First, reaching UHC is achievable in middle-income and upper-middle-income countries.It is not an unattainable goal reserved for upper income countries.Second, successes and failures are evident both in the case of countries that pursue a contributory health insurance path to UHC and those that pursue a core government funding path.Third, the devil is often in the detail.De jure constitutional guarantees and national health legislation are often a necessary but do not constitute a guaranteed path to success without accompanying institutional measure to secure sustainability (political and economic) and supply and demand constraints in service provision and consumer/patient behavior.De facto, in most countries expansion in health insurance coverage does not happen "with the stroke of a pen" but require years of commitment and efforts to change the supply and demand after critical legislation has been enacted.Fourth, two major approaches dominate: incremental and "big bang" health system reforms. ConclusionsWe caution against the pitfalls of over-attribution from drawing too strong conclusion from individual longitudinal country experiences ("over-determinism") and over-generalization from broad sweeping cross-sectional statistical analysis ("reductionism").Every country is different and needs to find its own path towards UHC considering their contextual specificities, learning from the achievements and failures of others, but not try to copy their experiences.Preker et al.

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