Take, for example, Universal Health Coverage (UHC). How does it Work?

Under Universal Health Coverage, everybody should be able to get health care without financial restrictions. Healthcare must be inexpensive across the board, including financing health-care programs, offering preventive measures, ensuring treatment, providing rehabilitation, and providing palliative care.

Poor people frequently sell their assets and use the proceeds to pay for medical care. While this may help them ensure their immediate future, it also puts them at danger of future crises. People will have better access to high-quality health care, improving their overall health and quality of life. Its purpose is to safeguard people from the harmful repercussions of excessive health-care spending.

People who have access to high-quality healthcare should be conscious of the fact that half of the world's population does not, and they should campaign for universal access to high-quality healthcare. By enlightening legislators about the essentials of effective health care, health-care workers may be able to play a significant role in this endeavor. Policymakers can then take actions to ensure Universal Health Coverage and satisfy the targets set forth in the Sustainable Development Goals.

What are the criteria for evaluating Universal Health Coverage?

Because different countries face different challenges, Universal Health Coverage can be assessed in accordance with their needs. The campaign's progress will be measured using the following two points, however, because some standardization is required:

1. The percentage of the population with access to high-quality health care
2. The percentage of the population that spends a significant portion of their income on health care.

Case Review Studies from Around the World on Universal Health Coverage

The United States

The health-care system in the United States is a mix of public and private insurers, as well as for-profit and nonprofit health-care providers. The federal government funds several programs for veterans and low-income people, including Medicaid and the Children's Health Insurance Program, as well as the national Medicare program for persons 65 and older and some people with disabilities.

Aspects of local coverage and the safety net are managed and paid for by states. Employers are the primary providers of private insurance, which is the most common type of coverage. The uninsured rate has dropped to 8.5 percent of the population, down from 16 percent in 2010, the year the Affordable Care Act was signed into law. Within federal and state laws, public and commercial insurers design their own benefit packages and cost-sharing structures.

How does universal health coverage work in the US?

There is no universal health insurance coverage in the United States. In 2018, about 92 percent of the population was anticipated to be covered, leaving 27.5 million people (or 8.5 percent) without coverage. 1 The progress toward establishing the right to health care has been slow.?

Employer-sponsored health insurance first became available in the 1920s. It became popular after World War II, when the government enforced wage limits and proclaimed fringe benefits like health insurance to be tax-free. Employer-sponsored insurance covered roughly 55 percent of the population in 2018.

The Social Security Act of 1965 established the first public insurance systems, Medicare and Medicaid, and others followed.

Medicare.?Medicare ensures that all people over the age of 65 have access to health care. The number of people who are eligible and the spectrum of benefits that are covered have gradually grown. Individuals under the age of 65 who have long-term impairments or end-stage renal disease have been eligible since 1972.

Traditional Medicare, a fee-for-service program that includes hospital insurance (Part A) and medical insurance (Part B), is available to all beneficiaries (Part B). Since 1973, Medicare beneficiaries have been able to choose between regular Medicare and Medicare Advantage (Part C), which allows them to join a commercial health maintenance organization (HMO) or managed care organization.

Part D, a private-sector voluntary outpatient prescription drug coverage alternative, was added to Medicare coverage in 2003.

Medicaid.?Medicaid was the first program to give states the option of receiving federal matching funds for providing health care to low-income families, the blind, and people with disabilities. Coverage for low-income pregnant women and babies was gradually made mandatory, and later for children up to the age of 18.

Medicaid now covers 17.9% of the population in the United States. Because it is a state-run, means-tested program, eligibility requirements differ per state. Individuals must apply for Medicaid coverage and re-enroll and recertify their eligibility every year. More than two-thirds of Medicaid recipients were enrolled in managed care organizations as of 2019.

Children’s Health Insurance Program.?The Children's Health Insurance Program, or CHIP, was established in 1997 as a public, state-run program for low-income children whose families earn too much to qualify for Medicaid yet are unlikely to be able to afford private insurance. The program now reaches 9.6 million children. It is a separate program in certain states, while it is an extension of Medicaid in others.

Affordable Care Act.?The Patient Protection and Affordable Care Act, or ACA, was passed in 2010, marking the most significant increase of the government's role in financing and regulating health care to date. Parts of the law's key coverage increases went into effect in 2014, included:

1. requiring most Americans to obtain health insurance or pay a penalty (the penalty was later removed)
2. extending coverage for young people by allowing them to remain on their parents’ private plans until age 26
3. opening health insurance marketplaces, or exchanges, which offer premium subsidies to lower- and middle-income individuals
4. expanding Medicaid eligibility with the help of federal subsidies (in states that chose this option).

The Affordable Care Act (ACA) helped an estimated 20 million people acquire insurance, lowering the percentage of uninsured adults aged 19 to 64 from 20% in 2010 to 12% in 2018.

England

The National Health Service provides free public health care to all English residents, including hospital, physician, and mental health services. The majority of the National Health Service's budget comes from ordinary taxation. NHS England is a government institution that oversees and funds 191 Clinical Commissioning Groups, which govern and pay for care delivery on a local level. Approximately 10.5 percent of the population in the United Kingdom has voluntary supplemental insurance in order to have faster access to elective care.

In England, how does universal health coverage work?

Since the National Health Service (NHS) was established in 1948, health coverage in England has been universal. The National Health Service was established in 1946, based on the recommendations of Sir William Beveridge's 1942 report to Parliament. Free health care was detailed in the Beveridge Report as one component of broader welfare reform aimed at eliminating unemployment, poverty, and illness, as well as improving education. The Minister of Health was required by the 1946 Act to establish a comprehensive, free health care to replace voluntary insurance and out-of-pocket charges.

Nonresidents possessing a European Health Insurance Card, as well as those who are "ordinarily resident" in England, are automatically entitled to NHS care, which is still generally free at the point of use. Only emergency room treatment and treatment for some infectious diseases are free for others, such as non-European travelers or undocumented immigrants. The NHS Constitution summarizes the rights of persons eligible for NHS treatment, which include the right to receive care without discrimination and within particular time restrictions for certain categories, such as emergency and planned hospital care.

Governmental role: In England, Parliament, the Secretary of State for Health, and the Department of Health are responsible for health legislation and policy. NHS England, an arm's-length, government-funded entity separate from the Department of Health, is in charge of the NHS on a day-to-day basis. Its responsibilities include the following:

• managing the NHS budget
• overseeing 191 local Clinical Commissioning Groups (CCGs), which are groups of local general practitioners (GPs) who plan, commission, and pay for most of the hospital and community care service in their areas
• directly commissioning certain types of care, including primary care in some areas, dental care, treatments for rare conditions, and some public health services (such as immunizations)6
• working toward objectives in the annual mandate from the Secretary of State for Health, which include both efficiency and health goals
• setting the strategic direction of health information technology, including the development of online services to book appointments and the setting of quality standards for electronic medical record-keeping and prescribing.

Hospitals and suppliers of NHS care, such as ambulance services, mental health services, district nursing, and other community services, are all owned by the government. NHS trusts are the organizations that deliver these services.

Other important public agencies involved in health care governance include:

• NHS Improvement, which licenses all providers of NHS-funded care and may investigate potential breaches of NHS cooperation and competition rules, as well as mergers involving NHS foundation trusts
• the Care Quality Commission, which ensures basic standards of safety and quality by registering providers and monitoring the achievement of care standards
• the National Institute for Health and Care Excellence, which sets guidelines for clinically effective treatments and appraises new health technologies for their efficacy and cost-effectiveness
• Health Education England, which plans the NHS workforce.

What is being done to close the gap?

Although the applicable legislation does not define what activities must be taken, the Secretary of State, Public Health England, NHS England, and CCGs have a legal duty to "have respect" for the need to minimize health disparities. NHS England issues an annual report detailing the steps taken and progress made in eliminating gaps in access and outcomes based on gender, disability, age, socioeconomic position, and ethnicity.?

NHS strategies include:

• ensuring that local CCG areas receive adequate resources to tackle inequalities
• measuring progress toward reducing disparities
• financially incentivizing reductions in inequalities in certain areas, such as early cancer diagnosis and mental health
• sharing best practices for achieving targeted goals, such as care for homeless people
• using risk stratification tools to identify people at risk of ill health.

Public Health England has also been entrusted with addressing health disparities and has issued detailed guidelines to local governments. In a health equity "dashboard," the agency also shares data on progress.??Local government authorities are in charge of public health budgets, and they are mandated to host health and well-being boards in order to promote local service coordination and eliminate health disparities. Local governments support social services for children and adults, with the latter subject to means testing, using local taxes and grants from the federal government.

China

Through the provision of publicly sponsored basic medical insurance, China achieves near-universal coverage. Employed people in cities are required to enroll in an employment-based program, which is funded primarily through payroll taxes paid by both employers and employees. Other residents can freely enroll in Urban-Rural Resident Basic Medical Insurance, which is primarily funded by individual premium subsidies from the federal and state governments..

Local health commissioners coordinate the delivery of services by public and commercial health care organizations. Primary, specialist, hospital, and mental health care are all covered under the basic medical insurance plans, as well as prescription medications and traditional Chinese medicine. There are deductibles, copayments, and reimbursement ceilings that must be met. Out-of-pocket spending has no annual limit. Private health insurance can help with cost-sharing and coverage gaps.

In China, how does Universal Health Coverage work?

In 2011, China attained nearly universal insurance coverage thanks to three national insurance programs:

• Urban Employee Basic Medical Insurance, mandatory for urban residents with formal jobs, was launched in 1998.
• The voluntary Newly Cooperative Medical Scheme was offered to rural residents in 2003.
• The voluntary Urban Resident Basic Medical Insurance was launched in 2007 to cover urban residents without formal jobs, including children, the elderly, and the self-employed.

The State Council of China declared in 2016 that the Newly Cooperative Medical Scheme and Urban Resident Basic Medical Insurance would be merged to enlarge the risk pool and minimize administrative costs. This process of consolidation is still ongoing. Urban-Rural Resident Basic Medical Insurance is the new name for the integrated public insurance program.

Because of China's large population, insurance coverage has been gradually increased. Around 95 percent of the Chinese population was covered by one of the three medical insurances in 2011. In China, insurance coverage is not required.

Governmental role: China's central government is in charge of the country's health legislation, policy, and administration. It is based on the concept that every citizen has the right to access basic health care. These services are organized and provided by local governments, which include provinces, prefectures, cities, counties, and towns..

Health quality and safety, cost control, provider fee schedules, health information technology, clinical recommendations, and health equity are all duties of both national and local health institutions and authorities.

In March 2018, the State Council reorganized the central government’s health care structure. The responsibilities of various agencies include the following:

• The National Health Commission is the main national health agency. The commission formulates national health policies; coordinates and advances medical and health care reform; and supervises and administers public health, medical care, health emergency response, and family planning services. The State Administration of Traditional Chinese Medicine is affiliated with the agency.
• The State Medical Insurance Administration oversees the basic medical insurance programs, catastrophic medical insurance, a maternity insurance program, the pricing of pharmaceutical products and health services, and a medical financial assistance program.
• The National People’s Congress is responsible for health legislation. However, major health policies and reforms may be initiated by the State Council and the Central Committee of the Communist Party, and these are also regarded as law.
• The National Development and Reform Commission oversees health infrastructure plans and competition among health care providers.
• The Ministry of Finance provides funding for government health subsidies, health insurance contributions, and health system infrastructure.
• The newly created State Market Regulatory Administration includes the China Drug Administration, which is responsible for drug approvals and licenses.
• The China Center for Disease Control and Prevention, although not a government agency, is administrated by the National Health Commission.
• The Chinese Academy of Medical Science, under the National Health Commission, is the national center for health research.

Local governments (prefectures, counties, and towns) may have commissions, bureaus, or health departments of their own. Local commissions, bureaus, or health departments also manage centers for disease control and prevention in their communities. The China Center for Disease Control and Prevention only provides technical assistance to local centers at the national level.

?What steps are being taken to narrow the gap?

Although China has achieved tremendous progress in this area over the last decade, there are still major gaps in access and quality of health care. Prior to the reform of the health insurance system more than ten years ago, income-related inequities in health care access were exceptionally severe, as most people did not have any coverage at all. Health insurance provided by the government is now practically universal, and there are safety nets in place for the poor (see above). As a result, gaps in income have narrowed significantly. There is, however, no monitoring organization to monitor or report on health inequalities, and no targeted programs to address disparities for specific groups.

The remaining inequalities in access are primarily due to differences in locally established insurance benefit packages, urban and rural variables, and income disparity. The cost-sharing for urban employee basic medical insurance is cheaper than for urban-rural resident basic medical insurance. In recent years, federal and state government subsidies to urban-rural residents' basic medical insurance have increased.

The majority of good hospitals (especially tertiary institutions) with more qualified health personnel are located in cities. Doctors in rural areas are frequently undertrained. The federal government and local governments fund training for rural doctors in urban hospitals, and new medical graduates are required to work as residents in rural health institutions to help bridge the gap between urban and rural health care. Despite this, the China Health Statistical Yearbook demonstrates that significant disparities still exist.

There are five adjustments that must be made in order to enhance health care systems.

1.?????For starters, increasing investment in population health would make people, especially vulnerable populations, more robust to health hazards. Any viral or bacteria attack has a greater impact on the health and socioeconomic well-being of disadvantaged groups, stretching a social fabric already strained by high levels of inequity. Despite much discourse about the need of health promotion, only about 3% of total health spending in the richer OECD countries is spent on prevention. To address underlying structural inequities and poverty, building population resilience also necessitates a greater focus on solidarity and redistribution in social safety systems.

?2.?????The importance of primary and elder care must be emphasized. COVID-19 posed?a double threat to persons who suffer from chronic illnesses. Not only are they at higher risk of severe complications and death as a result of COVID-19, but they also risk unexpected health consequences if they forego routine care owing to service disruptions, infection fears, or concerns about burdening the health system. For these groups, good primary health care ensures continuity of care. COVID-19 is responsible for 94 percent of deaths among people over 60 in high-income countries, making the elder care sector particularly vulnerable, necessitating increased infection control, support and protection for caregivers, and better coordination of medical and social care for the frail elderly.

3.?????A crisis emphasizes the significance of health-care systems having both reserve capacity and agility. With an estimated global deficit of 18 million health professionals, especially in low- and middle-income countries, there has been a historic underinvestment in the health workforce. Creating a "reserve army" of health professionals that can be quickly mobilized is one strategy to address this. Some countries have given medical students in their last year of study the opportunity to start working right away, have expedited licensure, and provided extraordinary training. Others have enlisted the help of pharmacists and health-care aides. It's also crucial to keep a reserve supply of supplies like personal protection equipment on hand, as well as care beds that can be quickly turned into critical care beds.

4.?????There is a need for more robust health data systems. The problem has encouraged the development of novel digital solutions and data-driven applications, such as smartphone apps to track quarantine, robotic equipment, and artificial intelligence to track a virus and predict where it will arise next. Telemedicine has become more accessible. There's still more that can be done to extract routine data from standardised national electronic health records for real-time illness surveillance, clinical trials, and health system management. Barriers to complete telemedicine adoption, such as a lack of real-time data, interoperable clinical record data, data connection capacity, and data exchange within and between sectors, must be overcome.

5. The only genuine exit plan will be a viable vaccine and successful vaccination of populations all across the world. Success isn't certain, and there are still a lot of policy concerns to work out. It is critical to collaborate internationally. Multilateral agreements to pay for successful candidates who?would provide producers with assurance, allowing them to scale production and have vaccine doses ready as soon as possible after marketing authorization, while also ensuring that vaccines reach the most vulnerable areas first. Multilateral access arrangements that include license commitments to ensure?

In conclusion. The COVID-19 pandemic provides a wealth of insights for health-care system preparedness and resilience. A better future normal will include a greater focus on predicting responses, solidarity within and between countries, agility in managing responses, and increased attempts for collaborative initiatives.

References; Commonwealth Fund; Ruth Thorlby,?Assistant Director, Policy,?The Health Foundation; Hai Fang, Peking University; World Economic Forum