Significance
and Challenges of implementing
Universal
Healthcare
In 2010, a revolutionary act was passed in congress and was signed by President Obama. It was the Patient Protection and Affordable Care Act, a set of health insurance and industry reforms. It was definitely desperate for the nation since nearly 50 million Americans without insurance and FamiliesUSA, a health care advocacy group that supports Obamacare, it was estimated that in 2012 that an American would decease every 20 minutes for deficiency of insurance. During Trump administration, this effort was erased because of political reasons. However, the current president Joe Biden is trying to revive it because we learned the importance of government-led healthcare due to COVID-19.
What
is Universal Healthcare? According to the World Health Organization (WHO),
Universal Health Care (also called Universal Health Coverage or UHC) means that
all individuals and communities receive the health services they need without
suffering financial hardships. It includes the full gamut of indispensable,
quality health services, from health promotion to prevention, treatment,
rehabilitation, and palliative care.
There
are basically two ways of Health Coverage, which are NHI (National Health
Insurance) and NHS (National Health Services). NHI is largely funded by
contributions by employers and employees and is run by non-profit organizations,
which are usually related to the government. It is adopted in countries like
Germany, Japan, and Korea. In this system, the public sector pays part of the medical
expenses. NHS is funded by tax and is run directly by the government. It is
adopted in countries like the UK and Canada. All medical expenses are covered
by the government except for some treatments like plastic surgery.
At
least half of the world’s population still does not have full coverage of
essential health services and about 100 million people are still being pushed
into “extreme poverty” because they have to pay for healthcare. According to
the World Health Organization (WHO), around 400 million people, which are
approximately one out of every seventeen people in the world, do not have
access to necessary health services. Furthermore, according to the latest
statistics published by the International Labor Organization (ILO), 55% of the
world’s population, which is about 4 billion people, have no basic social
welfare such as public and universal education, healthcare or pension,
unemployment benefit, or support for dependent individuals. Moreover, two out
of every three children in the world, which is around 1.3 billion, mostly
living in Africa and Asia, cannot access any kind of social protection. While
in Europe and Central Asia 84% of the population can reach at least one social
service, in Africa this percentage drops to 18%.
(Countries with UHC)Universal
healthcare (UHC) was encompassed as the main health-related target of the
Sustainable Development Goals (SDGs) number 3 for all countries. In order to disseminate
UHC, operative and funding mechanisms must be formed to back health services
that can guarantee that all entities have access to the rudimentary health
services without monetary destitution. Such mechanisms are desirable to
exterminate the vicious cycle of being in poverty after being hospitalized
without UHC.
Middle
and low-income countries, such as Argentina and Indonesia, are accepting various
policies to execute universal healthcare but are still struggling to adopt it.
Among the world’s high-income countries, only the United States of America does
not have UHC and 10.4% of the country’s population (33 million people) is not protected
by any kind of health insurance. Why are some of the countries still battling
to adopt Universal Healthcare or have no will to adopt it?
Healthcare
and politics are in an inseparable relationship. The implementation of
Universal Healthcare has always been the issue among politics and a major
conflict among politicians in every country. The political will of a leader or
leading party determined the country’s UHC implementation. Many countries
without UHC are still facing timidity of politicians within the countries. The
best example would be the United States of America, the only developed country
without Universal Health Care. The history of healthcare in the U.S. is deeply
related to American Medical Association(AMA)’s opposition and lack of political
will. After experiencing several wars, the U.S. government made public
insurance for veterans and their dependents. In the time of great depression,
the necessity of UHC increased and several presidents insisted upon the
implementation of UHC. However, some members of Congress called the plan
“socialist” and suggested that it came straight out of the Soviet Union, with
the AMA taking a hard stance against the bill. The AMA and pro-free market
presidents thought that encouraging private insurance in the free market would
reduce the price of insurance, which was not true. In 1960’s, Social Security
Act of 1965 laid the groundwork for what we now know as Medicare and Medicaid
which is for those who cannot pay private insurance. When Obama administration
appeared, the Affordable Care Act was signed but could not effectively cover
most of uninsured people due to severe lobbying from insurance company and
strong opposition from the conservatives. The United States still face a lot of
oppositions and health care reform is a long way to go.
Moreover,
lack of social and political demand is hindering the application of Universal
Healthcare. The best example could be India. While subjects such as economic
development, administrative reforms, gender equality, and environment safety
are filling up public discourse, health care seems to have taken a back seat.
Although health-care demands from communities exist, “health care” has not yet
progressed as political demand for the Indian citizens. This might be
attributable to the ignorance of citizens among their politics which was shown
in the survey done by Ipsos Mori. India ranked lowest among 40 countries
regarding the citizen’s ignorance to their country. In addition, traditional
medicine systems such as Ayurveda or Unani hinders them from going to the
regular hospital. The problem is that India is a major global burden of
disease, with health indicators compared negatively with other middle-income
countries and India's regional neighbors. Large health inequalities exist among
states, rural and urban populations, and social classes. A large amount of the
population is penniless because of high out-of-pocket healthcare expenditures
and suffer the adverse consequences of poor quality of care.
The
countries without proper medical systems are also facing major challenges
adopting the Universal Healthcare. The availability of medical services to near
inhabitants is crucial to adopt UHC. Not having a hospital nearby makes UHC
meaningless and inapplicable. The case of Indonesia indicates the importance of
geographical availability. In the case of diabetes, for instance, in a quarter
of provinces, less than a fifth of health centers could carry out basic urine
and blood tests. Urban-rural variances also exist with almost all health
centers in the city of Yogyakarta able to perform these tests, but only a fifth
of provinces in Eastern Indonesia were capable to do so. For non-communicable
diseases (NCDs) which are a growing share of the disease burden, there is a
predominantly wide disparity in service readiness. A compound index for NCD
service readiness generated and mapped for each province, shows that those in
the east score below 65 percent, while those towards the west perform better.
Mostly, better-off provinces have improved service readiness than poorer ones.
This deters the Indonesian government from adopting UHC since it cannot be
truly “universal”.
The
last problem is the informal sectors which is hard to embrace into Universal
Healthcare. Relatively inclusive coverage of civil servants and the formal
sector are effortlessly achieved through payroll deductions (whether in the
form of reserved contributions to health insurance systems or income tax) and
complemented by the inclusion of the poor through government subsidies.
However, it has resulted in a “missing middle”, consisting of informal workers
and their families. To include this group is puzzling. In the case of
Indonesia, in 2018, 74 percent of Indonesia’s population was covered by UHC.
However, informal workers in particular are yet to be sufficiently covered.
They are in the low-productivity sector which contains activities of the
working poor, usually without any recognition, protection, and regulation by
the public authorities. Indonesia’s UHC commitment for informal workers is thwarted
by the difficulty to identify those qualified to access government’s coverage
due to the deficiency of trustworthy data at the national and provincial level
since informal workers are mostly unregistered as employees. Many are dearth
with fixed contracts and usually seasonal and temporary workers are paid on a daily
or weekly basis, often with an immobile amount of salary. Consequently, it is
problematic to expect contribution from this group. Although the government
might be able to assist them in the registration stage, their long-term
membership remains indeterminate.
In
conclusion, Universal Healthcare is still having a difficult time being
implemented in many middle and low income countries due to several factors
mentioned above. The
right to health is one of the internationally agreed human rights and is
inseparable or ‘indivisible’ from other human rights. UHC is not an option but
a duty for a country to protect this right and should not be hindered to be
implemented.
Reference
Kliff, Sarah. "What Is Obamacare?"
Vox. March 26, 2014. https://www.vox.com/cards/obamacare/what-is-obamacare.
"Universal Health Coverage (UHC)."
World Health Organization. December 31, 2017. http://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc).
Griffin, Jeff. "The History of Healthcare
in America." Employee Benefits Consultants - JP Griffin Group. March 07,
2017. https://www.griffinbenefits.com/employeebenefitsblog/history_of_healthcare.
Chapman, Alister. "Why Doesn't the US Have
Universal Health Care?" The Rest of the Iceberg. February 12, 1970. https://restoftheiceberg.org/posts/2017/11/14/why-doesnt-the-us-have-universal-health-care.
Kumar, Raman, and Pritam Roy. "India in
Search of Right Universal Health Coverage (UHC) Model: The Risks of
Implementing UHC in the Absence of Political Demand by the Citizen." Journal of Family Medicine and Primary Care5, no. 3 (July 2016): 515.
doi:10.4103/2249-4863.197252.
"India Most Ignorant Country in World:
Survey - World - Dunya News." Dunya News. March 18, 2017. http://dunyanews.tv/en/World/379611-India-most-ignorant-country-in-world-survey.
Miranda, Randi Julian. "Health Coverage
Challenge: Reaching Informal Workers." The Jakarta Post. May 21, 2018.http://www.thejakartapost.com/academia/2018/05/21/health-coverage-challenge-reaching-informal-workers.html.
Bredenkamp, Caryn, Timothy Evans, Leizel
Lagrada, John Langenbrunner, Stefan Nachuk, and Toomas Palu. "Emerging
Challenges in Implementing Universal Health Coverage in Asia." Social Science & Medicine145 (July 26, 2015): 243-48.
doi:10.1016/j.socscimed.2015.07.025.
Comments
Post a Comment