General Commentary ARTICLE
Commentary: Implementing Pro-Poor Universal Health Coverage
- 1The Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- 2Hosei University Tokyo, Tokyo, Japan
A commentary on
Implementing Pro-Poor Universal Health Coverage
by Bump J, Cashin C, Chalkidou K, Evans D, González-Pier E, Guo Y, et al. Lancet Glob Health (2015) 4:e14–6. doi: 10.1016/S2214-109X(15)00274-0
Recently published extraordinary article entitled: “implementing pro-poor universal health coverage” depicts an issue of truly global outreach (1). Modern day health system establishments had their historical roots back in the early industrial era of late nineteenth century Europe (2). Risk sharing through introducing the first health insurance funds was initially targeted to protect industrial laborers as an important segment of the society of the time (3). Health coverage of citizens beneath poverty line therefore began to slowly expand to the other vulnerable groups. During the first half of twentieth century, such practice spreads to North America (4) and Japan (5). It is less known that the first nationwide success in achieving universal health coverage (UHC) is attributable to the early Soviet Union back in 1930s and its famous Semashko system (6). Disintegration of colonial system worldwide after the end of WWII and rise of the non-aligned movement gave significant impetus to the health system developments among the Third World nations (7). After the end of Cold War Era, accelerated pace of globalization saw the uneven growth of welfare in these countries (8). Although attractive as a policy goal, health coverage for massive rural populations remained a distant dream for many world regions (9).
The aforementioned paper by Bump et al. pointed out to the core global UHC developments in a comprehensive manner. Their call to national governments to commit to the established milestones of UHC evolution is clear and might indeed serve the purpose. Nevertheless, few crucial facts were omitted, which might significantly narrow the horizon of perception on global evolution of UHC with regard to the role of BRICS nations (10).
Due to overall increase in welfare, UHC for the poor rapidly expanded around the world (11). Therefore, it seems that we might be deceived by perception that all of these world regions contributed evenly or at least to the comparable extent (12). The reality is rather different: there is a very narrow circle of top emerging economies to which we own most of this progress. Lion share of the growth in UHC, the world owns to the BRICS nations (13). Accounting for roughly two-fifths of world’s population, over the past two decades these national governments lifted from poverty hundreds of millions of the world’s poorest citizens (14). Quite efficient government policies dedicated to reducing poverty took place in these economies since late 1990s with few notable examples led by Chinese overachievement (15–17). Such an increase in social welfare of poorest citizens was attributable to industrial enterprise and direct foreign investment (18, 19). Their health reforms were bold and successful to the large extent leading to the notable gains toward achieving UHC (20). Distinctive role of these economies in global health arena led WHO Bulletin to establish a specialty issue committed to BRICS back in 2014 (21). Some of the exposed weaknesses alongside this ambitious process were India’s inability to expand health expenditure in terms of GDP percentage (22). Socioeconomic inequalities in health care expanded in some members of the group driven by exploding prevalence of prosperity diseases (23). Despite the fact of these obstacles accelerated expansion of UHC remains clearly visible in Russia, Brazil, India, and China (24). One of the surprising developments is the strong and continuing upward trend of their national abilities to increase investment in health care and expand insurance coverage of the population below poverty line (25). Long-term commitment of BRICS governments ultimately resulted in significantly improved health outcomes, including nationwide longevity (26). A global landscape of UHC evolution implies that orchestrated international efforts should regard these nations as one of the pillars of any responsible policy aimed to protect the world’s poor from health-related risks.
MJ has designed drafted and finalized the manuscript.
Conflict of Interest Statement
The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
4. Getzen TE. Health care is an individual necessity and a national luxury: applying multilevel decision models to the analysis of health care expenditures. J Health Econ (2000) 19(2):259–70. doi:10.1016/S0167-6296(99)00032-6
12. McIntyre D, Thiede M, Dahlgren G, Whitehead M. What are the economic consequences for households of illness and of paying for health care in low-and middle-income country contexts? Soc Sci Med (2006) 62(4):858–65. doi:10.1016/j.socscimed.2005.07.001
13. Marten R, McIntyre D, Travassos C, Shishkin S, Longde W, Reddy S, et al. An assessment of progress towards universal health coverage in Brazil, Russia, India, China, and South Africa (BRICS). Lancet (2014) 384(9960):2164–71. doi:10.1016/S0140-6736(14)60075-1
19. United Nations Industrial Development Organization. Structural Change, Poverty Reduction and Industrial Policy in the BRICS. Vienna: United Nations University (2012). Available from: http://www19.iadb.org/intal/intalcdi/PE/2013/10846.pdf
20. Rao KD, Petrosyan V, Araujo EC, McIntyre D. Progress towards universal health coverage in BRICS: translating economic growth into better health. Bull World Health Organ (2014) 92(6):429–35. doi:10.2471/BLT.13.127951
21. McKee M, Marten R, Balabanova D, Watt N, Huang Y, Finch AP, et al. BRICS? Role in global health and the promotion of universal health coverage: the debate continues. Bull World Health Organ (2014) 92(6):452–3. doi:10.2471/BLT.13.132563
23. Jakovljevic M, Milovanovic O. Growing burden of non-communicable diseases in the emerging health markets: the case of BRICS; Research topic: health care financing and affordability in the emerging global markets. Front Public Health (2015) 3:65. doi:10.3389/fpubh.2015.00065
Keywords: universal health coverage, low middle income countries, risk sharing, financial, BRICS, global health
Citation: Jakovljevic M (2016) Commentary: Implementing Pro-Poor Universal Health Coverage. Front. Public Health 4:186. doi: 10.3389/fpubh.2016.00186
Received: 16 July 2016; Accepted: 17 August 2016;
Published: 29 August 2016
Edited by:Sandra C. Buttigieg, University of Malta, Malta
Reviewed by:Krzysztof Kaczmarek, Medical University of Silesia, Poland
Kyriakos Souliotis, University of Peloponnese, Greece
Copyright: © 2016 Jakovljevic. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.